Major Parts of Health Care Law to Go into Effect
Article date: September 30, 2013
By Stacy Simon
Editor's note November 25, 2013: The deadline to sign up for health insurance coverage that takes effect on January 1 under the new health care law has been extended from December 15 to December 23.
Editor's note November 7, 2013: Technical problems with HealthCare.gov have made it difficult for people from states where the federal government is operating the marketplace to enroll in a plan. In addition, independent websites have appeared in at least some states that resemble official marketplace sites in name and/or appearance. Both cases are likely to cause consumers to be confused and frustrated. It is important to remember that there are 4 ways to sign up for coverage through the marketplaces:
- Visit HealthCare.gov.
- Call 1-800-318-2596 to enroll over the phone. (TTY: 1-855-889-4325).
- Apply in person with the help of a trained counselor in your community. Find help in your area at LocalHelp.HealthCare.gov.
- Complete a paper application and mail it in. Download the paper application form and instructions from HealthCare.gov.
A major piece of the health care law, known as the Affordable Care Act, got under way October 1. That’s when health insurance “marketplaces” opened in every state and Washington, DC, that enabled uninsured Americans and some others to go online to compare health insurance plans and select the best one for them and their families.
John R. Seffrin, PhD, chief executive officer of the American Cancer Society and its advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN) discusses the law with Consumer Reports president and chief executive Jim Guest in this USA Today op-ed.
People who do not have health insurance through their job and are not currently receiving health coverage through Medicare can shop for a health plan on their state’s marketplace through March 31, 2014. For those who select a plan by December 15, coverage will begin January 1, 2014.
Health plans sold in these marketplaces must cover essential benefits and provide the patient protections required under the health care law. Some of these patient protections are described below.
The marketplaces group health plans into 4 coverage levels – platinum, gold, silver, and bronze. The highest category is platinum; these plans charge higher monthly premiums but tend to offer more coverage before a patient must start helping to pay deductibles, co-payments, co-insurance, and other costs. The lowest category is bronze; these plans tend to charge lower monthly premiums but require the patient to pay more out-of-pocket costs later on.
Low- and middle-income people shopping for coverage in the marketplaces may qualify for help paying for their plan. Most individuals earning up to $45,960 per year and families of 4 with a combined income of up to $94,200 per year could be able to get financial help to pay a health plan’s monthly premiums and/or out-of-pocket costs for medical services.
Visit the health care law’s official website, HealthCare.gov, to find your state’s marketplace and to see if you may qualify for financial help to pay for a health plan.
About the health care law
The health care law was passed in 2010. Several parts have already taken effect that:
- Provide screening mammograms, colonoscopies, and other proven prevention and early detection services at no cost to patients
- Enable children to stay on their parents' health plan until age 26
- Require insurers to provide consumers with short, simple summaries of their plans
- Prohibit patients from having their coverage suddenly revoked when they get sick
- Ban limits on the value of coverage a policyholder may receive over his or her lifetime, and restrict annual limits on coverage
- Ensure that children are not denied coverage because they have a pre-existing condition such as cancer
Several significant provisions in the law will take effect in 2014 that ensure that:
- No one is denied coverage because of a pre-existing condition such as cancer
- People are not charged more than others for health insurance because they have a history of cancer or another health condition
- Health plans no longer include annual or lifetime limits on the value of care a health plan will cover
- The amount of out-of-pocket costs that a patient must pay for care is limited
- Low-income, uninsured people have access to health coverage through Medicaid in states that have opted to use available federal funds for that purpose
Also in 2014, most Americans will be required to have health insurance or pay a penalty, a policy designed to balance the high health insurance costs of people with chronic diseases such as cancer, who need lots of care, with the lower costs of healthy people who require less care. In 2015, companies with 50 or more full-time employees will have to offer insurance or pay a penalty. Smaller employers will not be required to offer employees insurance, but may receive incentives such as tax breaks to do so.
The American Cancer Society can help
Scientific studies by the American Cancer Society have shown that people with health insurance are less likely than the uninsured to be diagnosed with late-stage cancer and are more likely to survive the disease. Getting health insurance is an important matter, and deciding on a particular health plan can be complicated.
The American Cancer Society has information and resources about private health insurance plans, government programs such as Medicare and Medicaid, and other possible sources of coverage and financial help:
- Managing Insurance Issues
- Health Insurance and Financial Assistance for the Cancer Patient
- The Health Care Law: How It Can Help People with Cancer and their Families
- How Health Insurance Works
- The Health Insurance Marketplace
- Medicaid and the Health Care Law
Reviewed by: Members of the ACS Medical Content Staff
Thank you for your feedback.