THE AFFORDABLE CARE ACT: What every patient needs to know.
Under federal law, everyone is required to have health insurance coverage. However, you can’t just buy it any time you want. There’s a limited open enrollment period during which you can sign up for a new plan or change your current plan. For 2018 coverage, the open enrollment period is November 1, 2017 to December 15, 2017. The only exception to that is if you experience certain life-changing events, such as marriage, divorce, birth of a child, the loss of employer-provided coverage, or a qualified hardship.
If you choose to go without coverage, you may be subject to a fine. For 2018, the penalty can be as high as $13,100.
For more information and to review the plans available to you, go to www.healthcare.gov. But, first, please consider a few tips.
The #1 “Must-do”: Compare Plans
You will want to comparison shop for your health insurance coverage. Due to recent actions by the federal administrators of the Affordable Care Act and by state regulators as well, consumers in most states will see significant changes in their plan options and prices for 2018. For instance, in several states, some “Gold” tier plans are now less expensive than typically-cheaper “Silver” tier plans. These changes make it more important than ever to compare the options to see what plan will best meet your needs.
If you qualify for premium tax credits and/or cost-sharing reduction assistance, be sure to compare your options on www.healthcare.gov. You can also conduct a search on www.healthcare.gov to see if there is a certified “assister” in your community who can help you enroll. If you do not qualify for these premium or cost-sharing subsidies based on your income, review the plan options available to you through www.healthcare.gov and also contact a local insurance agent or broker to help you compare the “off-exchange” plan options available outside the marketplace website. In either case, as you start shopping, many cancer patients have found the Cancer Insurance Checklist to be a helpful resource for helping to compare plan options.
Consider Out-of-Pocket Costs
When reviewing the plans available to you, it will be important to remember that what you pay in premiums is just one portion of the total costs you will be required to pay during the course of the year. In addition to premiums, you may be required to cover different types of cost-sharing, such as deductibles, copays, and coinsurance.
Cost-sharing requirements vary from one plan to the next, which is why it’s so important to pay close attention to those details when determining which plan will best suit your needs. For example, some plans may include very high deductibles, and plans differ regarding whether or not medications are subject to a deductible. Another key feature to look at is whether the prescription medications you take are specifically listed among the drugs covered by a particular plan, and you should be sure to review the cost-sharing assigned to those drugs. If that cost-share involves a coinsurance, know that you’ll be required to pay a percentage of the actual cost of that drug, which for some cancer medications can translate to hundreds or even thousands of dollars for one month’s supply.
The Affordable Care Act set a limit on the total amount that plans are permitted to require you to pay in out-of-pocket costs over the course of the year. In 2018, that limit is $7,350 for an individual and $14,700 across all family members who share a plan. While this offers some protection against catastrophic debt, this limit does not apply to certain costs, including premiums, most out-of-network medical care, and services and medications that aren’t already covered or approved by your plan.
To get a sense for how different plans may or may not suit your needs, you may want to check out the National Health Council’s Putting Patients First Cost-Estimator.
LLS Wants Your Feedback
LLS is committed to removing access barriers for blood cancer patients. If you are covered by a marketplace plan and experience high treatment costs, a lack of access to your provider or hospital, or a delay in getting timely care, please share your story with us at firstname.lastname@example.org. If you have a positive experience, we would like to hear that too. Making your voice heard can really make a difference!
If you have questions or want more information, please contact LLS's Information Resource Center (IRC) at 1-800-955-4572, Monday to Friday, 9 a.m. to 9 p.m. ET.