Navigating your insurance options
Details of health plan benefits and prices that will be offered through the Health Insurance Marketplace aren’t yet available online. But consumers can still begin to explore their options in advance of the Oct. 1 launch.
Here’s how it works:
- Go to HealthCare.gov and select "start now." (For Spanish, go to CuidadoDeSalud.gov.)
- You'll be asked to answer some basic questions about yourself including your age, what state you live in and whether your income falls above or below a certain threshold.
- Read about options that might apply to you, including preventive care benefits, federal tax credits, government health care programs and other information.
Alternatively, you can call a customer service representative for help at 800-318-2596. Hearing-impaired customers using TTY/TDD technology can dial 855-889-4325.
Obamacare — the derisive title coined by opponents of the Patient Protection and Affordable Care Act of 2010. The president said during his 2012 re-election campaign that he likes the name "Obamacare" because it suggests that he cares. It has since devolved into a shorthand reference used by opponents and supporters alike.
Health Insurance Marketplace — a website where people whose employers don't provide affordable health insurance may shop for policies and prices. The federal government will help pay for coverage for people whose incomes fall between 100 percent and 400 percent of the federal poverty level. Each state has an exchange. Some states decided to create their own — Covered California, Connect for Health Colorado, New York State of Health, HealthSourceRI, Kynect, etc. Other states, like Georgia, decided to let the federal government build their exchanges.
Affordable care — According to the law, insurance that's "affordable" costs no more than 9.5 percent of your annual income. If the cost of your employer's insurance exceeds that threshold, you are free to go to the insurance exchange and shop for a better deal. Note: in this case, "your cost" refers only to your coverage — the additional costs of your spouse or kids don't count in this calculation. Second note: If you do find a better deal on the exchange AND you qualify for a subsidy, your employer will be subject to fines.
Uninsured — Well, yeah, what you thought. But it's a severe problem in Georgia, where one in five people has no insurance. Obamacare envisioned a massive expansion of Medicaid to provide coverage to most of these folks. But the Supreme Court ruled that the federal government can't compel the states to expand Medicaid. Given the choice, Georgia and about half of the other states opted out. See "coverage gap" below.
Coverage gap — If you earn less than 100 percent of the federal poverty level, and your state is not expanding Medicaid, you can't get a piece of the Affordable Care Act. People who earn more than you do can shop on the exchange and might qualify for a federal subsidy. You can't.
Fee for service — Hospitals and doctors generally receive a separate fee for each and every service they offer. That means, of course, that doctors and hospitals get paid more for doing more stuff. Some people believe that, next to the vast numbers of uninsured people, fee for service is the biggest problem with our system. Obamacare seeks to neutralize fee for service by emphasizing preventive care and keeping people healthy. It also dings hospitals if too many discharged patients end up back through their doors within 30 days.
Penalty — Starting Jan. 1, most of us will have to have health insurance or else be ready to pay a penalty. A single adult who doesn't have coverage next year will face a fine of $95 or 1 percent of his income, whichever is greater. That sum jumps to $695 or 2.5 percent of income by 2016.
In network, out of network — Insurance companies make deals with certain hospitals and doctors to offer services at a set price. This is called a network. As a patient, you will almost always pay more if you "go out of network," sometimes a lot more. On the new Health Insurance Marketplace, you may find that plans with lower prices also give you fewer choices when it comes to the doctors and hospitals that will treat you — that is, smaller networks.
Essential health benefits — The minimum level of coverage that must be offered by all plans on the exchanges starting Jan. 1. This includes emergency services; hospitalization; maternity and newborn care; mental health services; prescription drugs; lab services; preventive and wellness care and more.
Grandfathered health plan — Applies to plans in place before March 23, 2010 (the date the law was signed). Grandfathered plans are exempt from many of the provisions of Affordable Care Act. For example, these plans don't have to offer free preventive screenings, such as colonoscopy and mammography, which the law requires of other plans. Plans may lose their grandfathered status if they make big changes, reduce benefits or increase costs.
Self-insured — If you work for a big company, chances are that your employer collects your premiums and pays your medical claims. This is called self-insuring. Companies often hire an insurance company to handle the whole thing, but your company is still paying your bills (and typically covering most of the cost).
Uncompensated care — Industry term for when it treats somebody and that person can't pay. See "uninsured," above.
All glossed out or ready for some more? Go to HealthCare.gov/glossary.
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Helpful websites
myajc.com/healthcare is The Atlanta Journal-Constitution's guide to the Affordable Care Act in Georgia. It has a subsidy calculator for people who will shop on the exchange, an aggregation of the AJC's most important health care coverage and more.
kff.org is the Kaiser Family Foundation's website and is probably the most comprehensive source of independent (and reliable) information on the Affordable Care Act. See also kaiserhealthnews.org.
HealthCare.gov is the federal government's clearinghouse for information on Obamacare. It's also where you'll go to shop on the exchange in Georgia starting Oct. 1.
rwjf.org is the Robert Wood Johnson Foundation, which offers two-page issue briefs on a variety of ACA-related topics. Go to rwjf.org/en/topics/rwjf-topic-areas/health-policy.html
consumerreports.org offers "Health Reform: Seven Things You Need to Know Now." consumerreports.org/health/resources/pdf/ncqa/The_Affordable_Care_Act-You_and_Your_Family.pdf
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