Your Guide to the New Healthcare Laws
Healthcare is changing –and so are your choices.
Nothing is more important than your health.
We believe you deserve to keep up with the
changes that will make a difference in your life.
After all, you have a right to understand the new
healthcare updates and how they impact you.
Stay informed. Stay in charge. Stay healthy.™
1
What will you learn in this guide?
The biggest, most important change to healthcare
in decades, the Affordable Care Act (ACA)
makes sure that more Americans can get health
insurance and stay healthy. This guide helps you
understand everything you need to know.
Learn About the New Affordable Care Act 2
Discover the Benefits of the ACA 4
Section Page
Navigate the Health Insurance Marketplace 8
Review Health Insurance Basics and Words to Know 14
2
What is the Affordable Care Act?
2010 2013 2014 2015 2016
MARCH: ACA bill passed
OCTOBER: Open enrollment begins
Health Insurance Marketplaces open in every state
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3
Before, you did not need to have
health insurance. Now that this
law has passed, almost every
American will have to have
health insurance.* This will begin
in January of 2014.
The ACA makes it easy to
choose the right plan. It does
this through a Health Insurance
Marketplace.
So let’s go over some of the
most important parts of the ACA.
You need to stay in charge
of your health.
Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.
Penalty Tax: If you don’t have health insurance, you will pay additional taxes on your tax return. These taxes will increase over time.
Open Enrollment: A period of time during the year when people can buy or make changes to a health insurance plan.
2010 2013 2014 2015 2016
WORDS TO KNOW
MARCH: Open enrollment ends
Everyone must have health insurance*
*except some religious groups and some financial situations
Penalty tax begins Bigger penalty taxes begin
OPEN ENROLLMENT
JANUARY: If you have enrolled, your health insurance starts
4
The ACA brings a lot of new changes to
the way that our healthcare system works.
Here are some of the main benefits that
you might notice.
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5
How does the ACA make healthcare better?
Coverage for those with pre-existing conditions.
If you have a pre-existing condition, you are able
to obtain coverage. Some examples of pre-existing
conditions are diabetes, pregnancy or a history
of heart problems.
No lifetime limits.
Your health insurance company will keep paying
your healthcare needs no matter how much you
need. It won’t run out.
Increased coverage for children.
Kids can stay on a parent’s healthcare plan until
they are 26 years old. Some states may increase
this age limit.
6
How does the ACA make healthcare better? (Continued)
Covered preventive care for women.
Some of these services are:
• Breastfeeding support and supplies
• Well-woman visits
• FDA-approved birth control methods
• Gestational diabetes screenings
Better benefits and more preventive care.
Yearly checkups are covered. And, a lot of preventive
services are also covered — such as blood pressure tests,
shots and some cancer screenings.
Continued care for Medicaid.
In most cases, there are no changes to how Medicaid will
operate in your state. And some states may expand their
Medicaid coverage to include even more people.
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7
Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.
Premium: The amount of money you pay each month in order to have health insurance. Premiums depend on:
• Your age
• Whether or not you smoke
• Where you live
If you are on Medicaid, you do not have to pay a monthly premium.
Subsidy: The amount of money the government pays to your insurer to help pay your premium.
Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.
Fair coverage at a fair cost.
Insurance companies can only look at your age,
where you live and whether or not you smoke to
figure out how much your health plan will cost.
More opportunities for subsidies.
One of the ACA’s main goals is to make sure
everyone can afford health insurance. In some
cases, the government helps pay for your
premium. This is called a subsidy.
Health Insurance Marketplaces.
By October 2013, each state will have its own
Health Insurance Marketplace.
WORDS TO KNOW
8
What is a Health Insurance Marketplace?
With the new healthcare law, you might have to shop for health insurance for the
first time. A Health Insurance Marketplace, an online shopping mall of healthcare
plans, makes it easier. Healthcare plans on Insurance Marketplaces come from
different insurance companies. The government approves these plans.
On the Insurance Marketplace, you will be able to see all the plans
at one time. This will let you compare your choices. You will be able to:
• Find out how much of a subsidy you can get
• Shop for a plan
• Sign up for a plan
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9
Subsidy: The amount of money the government pays to your insurer to help pay your premium.
Federal Poverty Level: The set minimum income a family needs for food, clothing, transportation and shelter. The government decides this level. It depends on your income and the size of your family. For more information on the Federal Poverty Level, visit http://aspe.hhs.gov/poverty/13poverty.cfm.
Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.
How do subsidies work?
You may qualify for a subsidy on a Health Insurance Marketplace.
In order to qualify for a subsidy, you must make between 100% and
400% of the Federal Poverty Level.* People who can get health
insurance through their employer or through public coverage, like
Medicaid, cannot, in most cases, qualify for a subsidy.
If you qualify, your subsidy is based on your income and family size.
*The Federal Poverty Level range, as it pertains to subsidy eligibility, may change based on the state you live in.
100% Federal Poverty Level 400%
Max
imum
Sub
sid
y
Subsidy
Income
WORDS TO KNOW
10
How will you use a Health Insurance Marketplace?
Shopping for health insurance on
a Health Insurance Marketplace
is simple. To find a plan on an
Insurance Marketplace, you can
go online or call a toll-free number.
An impartial person will be there to
help you over the phone.
There are four steps to buying a
plan on an Insurance Marketplace: • Enter your information (for example: family size, income) online to see your eligibility for Medicaid and/or an Insurance Marketplace healthcare plan. You can also submit your application by mail.
• You will see how much of a subsidy you may get, based on your status. This will show you how much you will pay for healthcare coverage.
• If you are eligible for an Insurance Marketplace product, you will get a list of plan options.
Filing a tax return
by the deadline every
year (April 15) will make this step
easier.
11 22Enter Your Information
Online
Compare Plans
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11
• Choose and buy a healthcare plan.
• After you enroll, you will receive a welcome packet and an ID card from your new health plan.
• Your coverage may begin as soon as January 2014.
• You can relax now.
Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.
Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.
Subsidy: The amount of money the government pays to your insurer to help pay your premium.
3 4Choose Your Plan
Start Coverage
WORDS TO KNOW
12
Every health plan on the Insurance Marketplace
will include these Essential Health Benefits:
Essential Health Benefits:
Emergency services
Prescription drugs
Laboratory services
Preventive and wellness services
Outpatient or ambulatory
services
Mental health and substance abuse services
Various therapy services (such as physical therapy)
and devices
Maternity and newborn care
Pediatric services
Hospitalization
What benefits will your new plan include?
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13
All Insurance Marketplaces will offer plans with four different levels of
costs. The Essential Health Benefits are covered and will be equal
across all plans.
Every insurance plan on the Marketplace is a primary health
insurance plan. It is not secondary or supplementary insurance.
No matter which plan you
choose, you may still be able to get a subsidy.
+
-+
-
Cost to You Based on Plan Choice
Monthly Premium Payment
Plans
Bronze
Silver
Gold
Platinum
Out-of-Pocket Expenses
(coinsurance and deductible)
Plan Options
What types of plans will be offered on the Insurance Marketplace?
14
How much you pay depends
on the plan you purchase.
Now that you know more about the
ACA, it’s important to understand how
paying for insurance works.
The next page shows what type of healthcare payments you’ll have
over a year. How much you pay depends on the plan you purchase
and how much medical care you need over a year.
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What type of healthcare payments might you make over a year?
PremiumWhat you pay every month, all year, for your health insurance.
Co-PayThe set amount of money you pay at the time of certain medical services.
DeductibleHow much you pay for certain services, in total, before your insurance starts to pay.
Depending on how much healthcare you need, you might meet your deductible or you might not.
Out-Of-Pocket MaximumThe total amount you’ll spend for healthcare, after which the insurance company pays for all your medical care until the year ends.
Depending on how much healthcare you need, you might meet your out-of-pocket maximum or you might not.
CoinsuranceThe portion of your medical bill you pay, for certain services, after you meet your deductible.
JANUARY
16
Coinsurance: This is the percentage you pay, for certain services, while your insurance company pays the rest (after deductible is met).
Example: You meet your deductible. You have 20% coinsurance, and your insurance company pays 80% for a $100 service. You will pay $20 and the insurance company will pay $80. The percent you pay remains the same until you reach your maximum out-of-pocket limit. Your plan will then pay 100% of the costs.
Co-pay: The set amount of money you pay at the time of a certain medical service. You also might pay this when you pick up a medication. Your co-pay depends on the type of covered service.
Deductible: The fixed amount of money you have to pay for certain services each year before your insurance company begins to pay. After you meet your deductible, your health insurance will begin to pay for these services. Plans with high deductibles usually have lower monthly premiums, and vice versa.
Federal Poverty Level: The set minimum income a family needs for food, clothing, transportation and shelter. The government decides this level. It depends on the size of your family. For more information on the Federal Poverty Level, visit http://aspe.hhs.gov/poverty/13poverty.cfm.
Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.
Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.
Open Enrollment: A period of time during the year when people can buy or make changes to a health insurance plan.
Out-of-Pocket Maximum: This amount is the most you pay during a plan period (usually a year) before your health insurance plan starts to pay 100% of your medical services. This does not include your monthly premiums. It includes co-pays, deductibles and coinsurance that you pay.
Premium: The amount of money you pay each month in order to have health insurance. Premiums depend on:• Your age • Whether or not you smoke• Where you live If you are on Medicaid, you do not have to pay a monthly premium.
Subsidy: The amount of money the government pays to your insurer to help pay your premium.
Words to Know
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Want to learn more?
Stay informed. Stay in charge. Stay healthy.™
© 2013 Magnolia Health Plan. All rights reserved.
Knowledge is healthy. If you have more questions
about the ACA or Health Insurance Marketplaces,
call 1-877-687-1187 (TDD/TTY: 1-877-941-9235).
Some information contained in this brochure was
gathered from these helpful resources:
www.healthcare.gov and http://healthreform.kff.org
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