Get the tools and information you need to understand health care reform. FirstCare has gathered the best calculators, articles, and links from the most trusted sources in the industry to keep you informed on the latest developments.
Learn how health care reform will impact your community. We’ve asked local employers, insurance professionals, and health care providers to list their top concerns with providing affordable, quality health care to West Texans in 2014.
Find the answers you’re looking for in our FAQ section. We’ll be updating this list based on the conversations we have with our clients and partners, so check back often.
Can’t find what you’re looking for? We’re here to help.
Changes to Health Insurance
What is health care reform versus the Affordable Care Act?
The Affordable Care Act (ACA), commonly referred to as health care reform, is a United States federal statute that was signed into law in 2010. The ACA is designed to improve the quality of health care, increase access to care, and reduce costs. The ACA mandates began in 2010, but the most significant changes to health care and insurance will occur in 2014.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace will be a new way for individuals, families, and small businesses to buy health insurance beginning in 2014. The Marketplace will list and compare health insurance companies that have applied with the Federal Government to be listed as a Qualified Health Plans (QHPs). As a QHP, an insurance company has agreed to offer comprehensive coverage from doctors to medications to hospital visits.
Do I have to buy health insurance from the Health Insurance Marketplace?
No. In addition to buying coverage through the Marketplace, individuals can continue to purchase health coverage through agents and directly through insurance carriers.
Coverage in 2014
When will I be able to purchase health insurance for 2014?
Beginning October 2013, individuals and families will be able to access information about all the plans available through the Marketplace. Individuals and families can enroll in health insurance plans for 2014 during the open enrollment period from October 1, 2013, to March 31, 2014. At that time, the Small Business Health Options Exchange, or SHOP Exchange, will be available to small businesses.
There is also a special enrollment period for individuals who experience a life-changing event (such as the loss of a job, death of a spouse, or birth of a child). They may enroll in a new plan within 60 days of the event.
Are health insurance plans changing in 2014?
In the individual and small business markets, health plans will have four different coverage levels. These new plans are often referred to as the "metal plans" since they are each named after a different type of metal (platinum, gold, silver, and bronze), similar to the Olympics. Each metal level has a different cost sharing.
In the individual market, there is also a catastrophic plan that will cover the essential health benefits, plus three primary care visits per year. The catastrophic plan is only available to consumers under age 30 and consumers who are exempt from the individual mandate as a result of low income or hardship.
I’ve heard about penalties related to health care reform. How do they work?
Beginning in 2014, most people will be required to have health insurance through their jobs, coverage they buy themselves, or insurance from the government like Medicare, Medicaid, or the Children’s Health Insurance Program (or CHIP). Individuals who do not have insurance may have to pay a penalty.
What are the Essential Health Benefits (EHB) and when will they be effective?
The ACA requires that all health plans include the following essential health benefits:
The EHB requirements become effective for each plan on the first day of the first plan year beginning on or after January 1, 2014. They apply only in the fully insured individual and small group market. Grandfathered plans and self-funded plans are excluded from the EHB requirements.
Do EHB requirements apply to self-funded plans?
No, self-funded plans are exempt from the EHB requirements. So, if your employer health plan is a self-funded plan, your coverage may not include all the essential health benefits.
What are preventive services and when will the requirement to provide them be effective?
Beginning in 2014, most health plans will provide coverage for preventive care without any member cost sharing (such as coinsurance, deductible, or copayment) as long as the services are provided in-network.
There are specific additional preventive services for children, women, and men. For a complete list,
Will I be able to get health insurance even if I have a pre-existing condition?
Yes. As of January 1, 2014, health insurance companies will accept consumers who apply for coverage regardless of pre-existing conditions.
What if I have a dependent who previously became ineligible for coverage because of age, marital status, or student status?
That dependent may be added back on to your plan at your group's next renewal date and remain covered until age 26.
Are there health care reform taxes I need to be aware of?
Yes. There are several taxes associated with health care reform, but most taxes will be paid by the health insurer. Two taxes that may impact you directly are:
The Health Insurer Tax will be assessed on fully insured large group, small group, and individual and family health plans. Self-funded (ASO) plans are not subject to this tax beginning January 1, 2014 (there is no end date specified). The Health Insurer Tax will be added to premiums for fully insured health plans.
Transitional Reinsurance Tax will be assessed on fully insured and self-funded large group and small group plans, as well as individual and family health plans beginning January 1, 2014, and ending December 31, 2016. Health insurance issuers and self-funded health plans (directly or via third party administrators) will pay the Transitional Reinsurance Tax to the Federal Government to fund state non-profit reinsurance entities.
Am I eligible for a subsidy?
You could be. Individuals and families who enroll in a plan through the Health Insurance Marketplace may be eligible for a subsidy based on income and family size. The subsidy would help lower your out-of-pocket expenses.
To determine if you qualify, use this
Health Reform Subsidy Calculator.
Health care reform will affect each unique community in different ways.
That’s why we’ve been talking with employers in our community and the surrounding area, and with our agents, providers, and members to get their perspectives about the opportunities and challenges related to health care reform changes.
Coming Soon! We’re developing an answer line that will allow you to chat online with our health care reform specialists.