The Patient Protection and Affordable Care Act (PPACA, or ACA) is a federal law intended to give more people access to affordable health care coverage and medical care. The ACA requires that beginning in 2014, if you do not get health insurance through your employer you must purchase an individual health plan or pay a penalty. This is often referred to as the individual mandate.
If you already have coverage that you purchased on your own, you can keep your current plan if it is a “grandfathered” plan, or a plan that was purchased on or before March 23, 2010. These grandfathered plans are exempt from many changes required under the ACA. However, Anthem BlueCross Blue Shield—New Hampshire’s only health insurance exchange participant—has announced that even renewals of grandfathered plans effective on or after January 1, 2014 will be impacted by some of the ACA’s requirements (eliminating lifetime limits, coverage for students up to age 26).
If you have made changes to your individual health plan since March 1, 2010, your plan will not be grandfathered and it will be subject to other changes required by the ACA beginning on January 1, 2014. Your RW Insurance agent can help you determine if your existing individual health plan is a grandfathered plan.
If you do not have health insurance now, you will need to purchase a plan that is effective in 2014.
What Are Health Insurance Marketplaces?
The Health Insurance Marketplace—or the Health Insurance Exchange—is where individuals and small businesses can go to purchase health insurance. Most people will purchase through their state’s exchange website, but you can also compare plans and purchase by phone or by mail. Your RW Insurance agent can also help you navigate the exchange and work with you to find you a plan (on or off the exchange) that fits your needs, at no additional cost.
The exchanges are for people who are currently uninsured or who currently buy insurance for themselves or their family on their own. They will allow consumers to compare and choose health plans offered by private companies that have agreed to sell their plans on the exchange. Insurance companies and the plans they offer will vary by state, but all plans will have to comply with a certain level of federally mandated coverage.
Consumers will also be able to use the exchanges to find answers to questions and to find out if they are eligible for federal subsidies or other special programs. The ACA and all of its requirements are new to everyone and very complex. Remember that you are not alone; we can help you work through the system and find answers to all of your questions.
What Types of Plans Will Be Offered?
The marketplaces will include plans with several different levels of coverage offered by one or more insurance companies. You can choose among the plans according to your personal situation and needs. Every plan is required to offer the same essential benefits, such as doctor visits, hospital care, prescriptions, and maternity care, as well as certain preventive services at no cost.
Plans in the marketplaces will be grouped by coverage level into Bronze, Silver, Gold and Platinum categories. The categories are designed to make it easier for people to compare plans. Bronze plans, for example, will offer lower premiums with higher out-of-pocket costs (deductibles, copays, coinsurance). Platinum plans, on the other hand, will generally have higher premiums and lower out-of-pocket-costs.
If you need to purchase individual or family health coverage because of the ACA’s individual mandate, RW Insurance can help you determine if you qualify for a tax credit or cost-sharing assistance. If you qualify for federal financial assistance, we can help you sign up for a plan through the exchange, which is the only way to receive any tax credits that you may have coming. If you do not qualify for a tax credit, we can help you find a plan off of the exchange as well.
Plans outside of New Hampshire’s health insurance exchange will be offering more comprehensive provider networks, and may be more appropriate for those who do not qualify for federal financial assistance for health insurance.
When Can I Begin Using My State Marketplace to Purchase Coverage?
The health insurance marketplaces will open on October 1, 2013. Coverage purchased from an exchange will be effective on or after January 1, 2014.
Where Can I Go to Find Out More?
Some state insurance exchanges will be run by the state, while the federal government will run others. New Hampshire will have a federally operated exchange. The state will control plan management and consumer assistance, while the federal government maintains control over every other aspect of the exchange.
Despite the goal of encouraging competition among insurers in the individual market, only Anthem BlueCross BlueShield will be authorized to “compete” on the New Hampshire exchange when it opens on October 1. Other insurers may elect to participate in future years.
Individuals who wish to purchase insurance from the New Hampshire health insurance marketplace don’t have to go at it alone. Contact RW Insurance today to discuss your rights and responsibilities under the new health care law. We can help answer your questions, navigate the system, and find the best plan to fit your needs.
