Time to Sign Up for Mandatory Healthcare Coverage

DoctorInformation to help you with enrollment in the Affordable Healthcare Act – known as ‘Obamacare.’

Mandatory enrollment will open October 1 for Obamacare, the Affordable Healthcare Act of 2009. As of that date, people without health insurance can sign up for standardized coverage through new health-insurance marketplaces; in NC, because the McCrory administration refused to set up a state marketplace, it is being set up by the federal government. Those with insurance through an employer or who have coverage through a government program such as Medicare or Medicaid will not be affected.

The NC Health Insurance Marketplace “will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets,” said Health and Human Services Secretary Kathleen Sebelius.

The state received $39,000,000 in grants from the Prevention and Public Health Fund created by the health care law; across the state, 32 health centers operate 183 sites, providing preventive and primary health care services to 411,015 people.

Health Center grantees in North Carolina have received $96,236,414 under the health care law to support ongoing health center operations and to establish new sites, expand services, and/or support major capital improvement projects.

Those seeking to enroll must have the following information: the Social Security numbers of the people you’re looking to insure; employment and income information, such as pay stubs, tax return or W-2 form; and policy numbers if you currently have any health insurance. Eligibility for tax credits and subsidies is based on modified adjusted gross income.

The most important aspect of Obamacare is that every individual is expected to have coverage—that is known as “the mandate.” Coverage can be from a policy provided by an employer, or through a government program such as Medicare or Medicaid, or as private insurance, which can now be purchased on the NC Health Insurance Marketplace (the “exchange”).

But the law also includes many other provisions, some of which have already begun, and others which will begin in 2014 or 2015. Already in place are the following provisions.

Better Value

Under Obamacare, health insurance companies must spend at least 80 cents of every premium dollar on health care or improvements to care, or provide a refund. 192,757 North Carolina residents with private insurance coverage will benefit from $9,847,666 in refunds from insurance companies this year, for an average refund of $87 per family covered by a policy.

New coverage options for young adults

Under the health care law, if any plan covers children, whether job-related coverage, a private plan, or insurance bought through the new exchange, children can be covered until they turn 26 years old. This provision has provided coverage to more than 3 million young people nationwide, including 95,000 in NC.

Ending discrimination for pre-existing conditions

Another provision of Obamacare ended exclusions for pre-existing health conditions, affecting more than 4 million non-elderly North Carolinians including half a million children. Under the health care law insurers may not deny coverage to those with a pre-existing illness or health condition, and beginning in 2014, they will not be able to charge more, either.

Provisions beginning in 2014

Beginning this year and in 2014, the rest of the Act’s provisions will kick in. The most important is the “exchange” whereby everyone must have or buy coverage. The NC exchange will offer five different plan levels: Bronze, Silver, Gold, and Platinum, and, for those under 30 or suffering financial hardship, a “Catastrophic” plan.

•     Bronze plans offer the lowest premium in exchange for the highest out-of-pocket costs

•     Silver level offers some financial help with out-of-pocket costs such as copayments and deductibles

•     Gold and Platinum plans require higher premiums but lower copayments

•    Catastrophic plans are available for people younger than 30 and those suffering a financial hardship

Removing lifetime limits on health benefits

The Affordable Care Act also bans insurance companies from imposing lifetime dollar limits on health benefits—freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits.

Covering preventive services with no deductible or co-pay

The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.

Scrutinizing unreasonable premium increases

While NC has long had strong regulation of insurance rates, for the first time Federal law will required insurers to publicly justify their actions if they want to raise rates by 10 percent or more.

North Carolina has received $4,984,080 under the new law to help fight unreasonable premium increases. Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent nationally. To date, the rate review program has helped save Americans an estimated $1 billion.

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