As of March 2018, The Affordable Care Act (ACA) is still law in the United States and the Health Insurance Marketplaces are still operational. The ACA’s eligibility requirements and provisions remain the same. For up-to-date information about healthcare reform, you can visit www.triagecancer.org/blog.
The ACA is intended to give people access to affordable, quality healthcare. The ACA provides assistance in two ways. It creates
- New protections for healthcare consumers.
- New options for accessing health insurance coverage
Healthcare Consumer Protections Under the ACA
The following list provides the protections for people under the ACA.
Insurance cancellations (rescissions): Insurance companies can no longer cancel nor can they “rescind” your policy unless you commit fraud, intentionally lied on your application, or you stop paying your premiums. In the past, insurance companies could cancel coverage for an error or technical mistake in a person’s insurance application. This practice is now illegal.
Pre-existing condition protection: Insurance companies are no longer allowed to deny a health insurance policy to children or adults who have a pre-existing medical condition, such as cancer. Insurance companies also can no longer impose preexisting condition exclusion periods on their policies.
Premium rating: Insurance companies are no longer allowed to consider an individual’s pre-existing condition, health history, or gender when determining the cost of a policy’s monthly premium. Insurance companies can only look at age, geographic location, and (in some states) tobacco use, to determine the cost of a policy’s monthly premium.
Annual or lifetime limits: Private health plans are not allowed to place annual or lifetime limits (sometimes known as “caps”) on the dollar amount of a person’s coverage. This means that insurance companies cannot refuse to pay for care after a person has reached a specific total dollar amount for that year for all benefits covered under the plan. An individual still may be responsible for paying for benefits that are not covered.
Health Insurance Marketplace Plans
Through the ACA, individuals and small businesses (with fewer than 50 employees) are able to buy health insurance coverage through state-based Health Insurance Marketplaces.
In order for insurance companies to sell policies through the Marketplaces they must
- Provide a minimum level of essential health benefits
- Place a cap on annual out-of-pocket costs (in 2018, $7,350 for an individual and $14,700 for a family).
- Amounts may increase in future years.
- Provide five levels of standardized plans (Bronze, Silver, Gold, Platinum and Catastrophic), each with a different cost.
Note that individuals with incomes up to 250 percent of the federal poverty level and who have purchased a Silver plan are eligible to receive help paying for their health insurance coverage through cost-sharing subsidies.
For information about the Health Insurance Marketplaces, visit www.healthcare.gov and select your state.
2019 open enrollment runs from November 1, 2018 through December 15, 2018. You will want to comparison shop for your health insurance coverage. When reviewing plans available to you, it is 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.
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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 an LLS Information Specialist.