Frequently Asked Questions About the Affordable Care Act and New HealthInsurance Options in New York
What does Health Care Reform and the Affordable Care Act mean for me?
The Affordable Care Act (ACA), sometimes called Obamacare, is Federal legislation that substantially expands insurance coverage and protections for many Americans. Although some provisions are already in place, many more changes are coming in 2014. Here are some examples of how these changes may benefit you or your family:
- Exclusions from coverage for pre-existing medical conditions (i.e. a condition you already had before you obtained the insurance) are no longer allowed. That means that a person with a bleeding disorder can no longer be denied coverage because of the bleeding disorder.
- Plans will no longer be able to have lifetime or annual dollar limits on coverage for anything considered an “essential health benefit” (EHB) under Federal law. The 10 general essential health benefit categories required by law include: emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; pediatric services, including oral and vision care. We interpret these benefits to include all drugs and therapies for approved and generally used for the treatment of specific conditions, including bleeding disorders.
- Young adults up to age 26 will be able to stay on their parent’s private insurance plan, even if they are married or don’t live with their parents. After they turn 26, New York State law will allow some young adults to continue coverage through their parent’s plan up to age 30. These young adult coverage changes apply now to newly purchased plans. For existing plans, the changes will apply when the health plan policy is renewed.
A new range of coverage options are now available through an Exchange or Marketplace in each state. In New York State this marketplace is called New York State of Health. Enrollment in these plans began on October 1.1st, 2013, with coverage taking effect on January 1st, 2014.
Tell me about this Exchange?
New York State of Health is now the official name for the Health Plan Marketplace or Exchange in the State of New York. These exchanges are designed to help people shop for and enroll in health insurance coverage. Individuals, families and small businesses will be able to use the Exchange to help them compare commercial insurance options, calculate costs and select coverage online, in person, over the phone or by mail.
The Exchange will also help people to check their eligibility for health care programs like Medicaid and sign up for these programs if they are eligible. The Exchange will also be able to tell what type of financial assistance is available to applicants to help them afford health insurance purchased through the Exchange. Insurance coverage is now available through the Health Benefit Exchange 1st,2013 and will be effective January 1 1st, 2014.
SPECIAL NOTE ABOUT CHILD HEALTH PLUS:
Child Health Plus is a state program that covers children in lower income families who do not qualify for Medicaid. However, right now, the program does NOT cover outpatient clotting factor. We have worked with a statewide coalition of bleeding disorders organizations to fix this problem and legislation directing the Department of Health to adjust the program has now been passed and signed into law. However, the change may not take effect until April. Please check with with NYCHC or your treatment center before opting for this coverage.
Is this coverage applicable to me and my family?
Anyone who currently has adequate health insurance at an affordable cost (i.e. through an employer or government program) will probably want to continue on the coverage they already have.
Folks who either do not have health insurance or are paying exorbitant premiums may want to explore enrolling in health coverage through New York State of Health starting on October 1st.
Please note that under the provisions of the Affordable Care Act, all families and individuals must have health insurance starting in 2014, and those who do not may be subject to penalties.
What plans will be available through the Exchange in my area?
Twenty-one providers have been approved to offer Qualified Health Plans (QHPs) in New York State, but only about half of these will be offering plans in the Greater New York City area. To see which plans will be offered in your area, click on your county or borough below.
Bronx Brooklyn Manhattan Queens Staten Island Nassau Suffolk Westchester Rockland
If you live in a part of New York State that is not listed, CLICK HERE for a map of the entire state and click on your county.
If you live in a state other than New York, please visit https://www.healthcare.gov/.
Each of these providers will offer Platinum, Gold, Silver, and Bronze plans as well as catastrophic plans with varying premiums, deductibles and levels of coverage. Plans will be available for individuals and families, and some providers will also offer plans for small businesses.
What will the premiums for this coverage cost?
A preliminary list of what the monthly premiums will be for all Exchange plans in New York State can be viewed by CLICKING HERE. Remember that not all of the listed plans will be available in your area, so use the borough/county links above to determine which ones will be available in your area.
The premium you pay for health plans purchased through the Marketplace may be further reduced through Federal (and sometimes State) subsidies if your household income is below 400 percent of the federal poverty level ($45,960 for individuals and $94,200 for a family of four). You can check your eligibility for the Federal subsidy and see how much of a discount you may be eligible to receive using NYSOH’s Tax Credit and Premium Estimator. CLICK HERE to access the estimator.
How do I know which plan is best for me or my family?
Selecting the right coverage is not always easy. The plan with the lowest premium is often not the best choice, especially when dealing with a high-cost condition like hemophilia and other bleeding disorders. It is more important to determine which plan will cover all of the things you and your family need for the lowest out-of-pocket cost.
The National Hemophilia Foundation (NHF) has a Personal Health Insurance Toolkit which can help you figure this out. You can download a copy of the Toolkit by CLICKING HERE. The New York City Hemophilia Chapter (NYCHC) also has printed booklet versions of these toolkits available to Chapter members at no charge. To request one, send an email to [email protected].
The Hemophilia Federation of America (HFA) also has a variety of resources to help you choose. You can find them by CLICKING HERE.
The City of New York has an excellent website to help residents identify and evaluate coverage options. It’s called the NYC Health Insurance Link and you can find it by CLICKING HERE.
The State of New York will be establishing Navigators who will assist individuals seeking to evaluate their options and enroll in a plan. A variety of community health organizations around the state will be designated as navigators. Assistance will be available on line, by telephone, and in person, depending on the organization and locale. More information about the navigator program and all aspects of the exchange are available on the New York State of Health website at www.nystateofhealth.ny.gov.
New York City Hemophilia Chapter is also working to develop more resources to assist you and your family with this process. Information will be available on our website at www.nyhemophilia.org. We will also be offering a major session on this topic at our Education Day (formerly Annual Meeting) on November 24th, so please plan to attend. You can also email your questions to us at [email protected].