OBAMACARE SET TO TAKE EFFECT

The Patient Protection and Affordable Care Act, better known as Obamacare, takes effect January 1, 2014. Open enrollment begins October 1, 2013. Plans and prices will be available then. Open enrollment closes March 31, 2014.

A visit to www.healthcare.gov/ will give you information regarding the Healthcare Marketplaces available in your state. Providers fall into 1 of 5 categories. There are Health Maintenance Organizations (HMO), Exclusive Provider Organizations (EPO), Preferred Provider Organizations (PPO), Point of Service plans (POS), and High Deductible Health Plans (HDHP).

If you employer provides health insurance your options will be limited by the plan your employer chooses to provide. If your employer does not provide health insurance, the Marketplace is the place to go. Some states will run their own healthcare exchanges. Some will use a federal exchange. And some states will have a partnership between the state and the federal government. Michigan falls into the last group. Plans will vary by state but 4 levels of coverage will be offered: bronze, silver, gold and platinum.

By visiting the above site you can get information regarding these various options and sign up to receive information about the providers in each category in your state.

A health center locator can be found at findahealthcenter.hrsa.gov/SearchHCC.aspx. Simply type in your location (zip code works well) and free and low costs healthcare sites will be displayed.

Most plans must provide certain preventive services, such as shots and screening tests, at no cost to you and most health plans cannot charge you more or refuse to cover you because of a pre-existing health condition. And beginning in 2014 you may not be turned down or be charged a higher premium because you are pregnant.

Information regarding the Children’s Health Insurance Program (CHIP) can also be accessed. Each state has a CHIP program but the benefits provided vary from state to state.

If you meet your state’s criteria for Medicaid you will be eligible for a free or low-cost health plan and will not need to buy a Marketplace plan. Beginning October 1, 2013 when you fill out an application for the Marketplace on line you will be informed if it looks like you qualify for Medicaid.

Similarly, if you have Medicare you need not buy a plan through the Marketplace, whether you have original Medicare or a Medicare Advantage Plan.

If you have job-based insurance coverage which qualifies as minimum essential coverage under the law you need do nothing. But if your employer currently covers all or a portion of your health insurance you may find yourself thrust into the Marketplace, if your employer chooses to discontinue that contribution.

There are other protections built into the Affordable Care Act. For example, frivolous cancellations are barred. For example, if you make a minor error on your application currently the insurance company can cancel your coverage. This will no longer be permitted. You may use an out of network emergency room without penalty. Persons under 26 years of age may stay on their parent’s coverage. A right to appeal coverage decisions is guaranteed. And there will no longer be yearly or lifetime limits to coverage.

It is also important to realize that if you do not have insurance and do nothing you may have to pay a fee.

So it is important to fill out the Marketplace application on line, shortly after October 1st to learn your options and get ready for the future of healthcare.