On October 1, 2013, patients without insurance can start applying for coverage through the Health Care Marketplace. Their coverage will begin January 1, 2014. Your patients have likely already started asking you questions about how the new health care laws will affect them. Confidently answer their questions when you review these eight frequently asked questions about health care reform.
1. What is health care reform?
The term “health care reform” refers to the Affordable Care Act—the federal law that was passed in March 2010—as well as any state laws passed to put it in place. These laws are intended to help more patients get affordable health care coverage and receive better medical care.
2. What needs to be done now to prepare?
Pharmacies and patients are encouraged to learn about health care reform and how it might affect their health coverage. Patients will need to begin shopping for coverage when the Health Care Marketplaces open October 1, 2013.
3. What are the Health Insurance Marketplaces?
A marketplace, sometimes called an exchange, will be a state or federal-run website where people can buy health care coverage. It will be available to people who are uninsured or who buy insurance on their own. They will be able to compare and choose health plans offered by private companies, get answers to questions, and find out if they are eligible for financial assistance or special programs. The marketplaces will be open in October 2013, and coverage purchased there will be effective January 1, 2014, or later.
4. Do patients have to buy from the Marketplace?
No, not necessarily. The marketplace is just one of the ways patients can shop for health coverage. Patients will have to buy coverage through the marketplace to apply for subsidized coverage, however.
5. Who has to buy health insurance?
The Affordable Care Act requires most U.S. citizens and legal immigrants to have a basic level of health coverage starting January 1, 2014. Some people won’t have to buy insurance. This includes people with certain religious beliefs, members of Native American tribes, undocumented immigrants, and people who are in prison. People whose income is below a certain level are also not required to buy insurance.
6. What if patients don’t buy health care coverage?
The government will charage a tax penalty to patients who don’t buy coverage and go without it for three months or longer. Patients lacking coverage for a period of fewer than three months will not be charged a penalty for that period of time.
7. Can anyone get health care coverage?
Yes, anyone can get coverage. Insurance companies can no longer deny coverage to anyone who has a medical condition, and you don’t have to pass a medical exam to qualify for coverage.
8. What services will be covered?
In general, most medically necessary services will be covered. This includes preventive care visits, immunizations, and screenings (such as mammograms and other cancer screenings). Maternity, newborn and pediatric care will be covered, as well as emergency and hospital care. Laboratory services, prescriptions, and mental health/substance abuse services will also be covered.
Source: Kaiser Permanente
