ACA Exchanges: Here is a Basic Resource Guide

[Zorra]

that I created and am using to help folks sign up for the Health Insurance Marketplace exchanges.

Please feel free to use it to help yourself or others sign up.


Affordable Care Act Basic Resource Guide

This is a compilation of links to websites that I have gathered, designed to give you fast, easy access to basic resources providing information that you may find helpful for understanding your health insurance options in the new Health Insurance Marketplace Exchanges.

Please keep in mind, because this is a new program, it may change as they work the bugs out.

Marketplace open enrollment is a 6 month period, from October 1 to March 31.

Health Insurance Marketplace: You can create your Marketplace Account beginning on Oct. 1.

https://www.healthcare.gov/

https://www.healthcare.gov/quick-answers/#step-1

https://www.healthcare.gov/creating-an-account-and-logging-in/

Kaiser Foundation Subsidy Calculator. There is important information for you at this link, and you can get an estimate of the insurance subsidy you may be eligible for here:

http://kff.org/interactive/subsidy-calculator/

There are four types of plans:

• Bronze: Your plan pays 60%. You pay 40%.
• Silver: Your plan pays 70%. You pay 30%.
• Gold: Your plan pays 80%. You pay 20%
• Platinum: Your plan pays 90%. You pay 10%.

How to find the Health Insurance Plan that is right for you:

https://www.healthcare.gov/blog/how-to-find-the-health-insurance-plan-that-s-right-for-you/?utm_medium=email&utm_source=govdelivery&utm_campaign=hcgov_25dayslearn&utm_content=09_06_13

Prices will be available for Marketplace Insurance Plans on Oct. 1:

https://www.healthcare.gov/how-much-will-marketplace-insurance-cost/

10 Essential Benefits you receive from the Affordable Care Act – What is covered under Marketplace Insurance Plans:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management, and
10. Pediatric services, including oral and vision care

http://www.healthinsurance.org/learn/health-reforms-10-essential-benefits/

The ACA and Women:

http://www.hhs.gov/healthcare/facts/factsheets/2012/03/women03202012a.html

Premium Tax Credit

https://www.healthcare.gov/glossary/premium-tax-credit/

Qualifications For Lower Premiums:

https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/

Some FAQ

http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/

Medicaid Eligibility

http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

Who is required to obtain insurance under the ACA:
http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision

The main ACA IRS homepage is:
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

What is the Affordable Care Act?

The Patient Protection and Affordable Care Act (PPACA),[1] commonly called Obamacare[2][3] or the Affordable Care Act (ACA), is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the country's healthcare system since the passage of Medicare and Medicaid in 1965.[4]
The ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government. It provides a number of mechanisms—including mandates, subsidies, and insurance exchanges—to increase coverage and affordability.[5][6] The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex.[7][8] Additional reforms aim to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of health care. The Congressional Budget Office projected that the ACA will lower both future deficits[9] and Medicare spending.[10]
http://en.wikipedia.org/wiki/Affordable_Care_Act

Full Text of the Affordable Care Act (this is a pdf file):

http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

[area51]

1. Kind of an odd place to post this.

ACA is most definitely not single-payer.

[blue14u]

2. I am very uninformed

about what all the fuss is about when people say they

want single payer ins. I think that means that a family of 4

might want to only pay for a (example) child, maybe with

pre-existing conditions. Is that the outrage? I want to understand

so I can communicate the difference in what we got, (I am very happy we have the ACA), and what it means when they say I want single payer health care.
Thank you if you can answer this for me . I really need to know, and appreciate any info you may have to help me..

[enlightenment]

3. There are many resources in this group that can help you understand

but in general, proponents (like myself) of "single payer" systems of health care delivery reject the "free market" approach.

There are a variety of "single payer" systems - some are nationalized, like the NHS in the UK - and receive at least a percentage of their funding through contributions made by workers and employers (a "tax", if you will, like FICA or Medicare, but not exactly the same). Some are a combination of nationalized service and health insurance - the big difference being that the insurance is strictly regulated and required to be not-for-profit at the base level.

All of these systems allow for the purchase of additional insurance to cover things that are not covered by the system (cosmetic surgery, for example, or private hospital rooms - bells and whistles, basically). If someone has enough money, they can opt out of some of these systems and use private insurance . . . but honestly, even most very wealthy people don't see the point of doing that.

Essentially, "single payer" systems are "free at the point of service" - in other words, if you go to the doctor you do not pay a deductible/co-pay. You ARE paying, of course - but your payment was made through your contribution to the general fund through your "tax".

So, if you wind up in the ER with a broken leg, you're not going to have to fill out paperwork proving your insurance coverage or receive a bill for the percentage the insurance didn't cover.

Is it perfect? No. Every variety of "single payer" has drawbacks - but in comparison to the cobbled together mess of out-of-control costs that make up (and will continue to make up, because the ACA doesn't address costs) that we have, "single payer" looks like paradise.

And we still just have our noses pressed to the glass, looking in at what we cannot have.

[blue14u]

4. enlightenment, thank you so

much. Now I understand the reactions of why so many people are

angry with this issue. I have to agree then. My x hubby is

French, and we lived in Europe for a while. This sounds like what the French

have, and they LOVE, LOVE, LOVE their healthcare.. I was even able to see Dr's while living there at no cost b/c I had duel citizenship being married to him. He moved back last January for the insurance and other benefits...

So now I can start my campaign to help move us in that direction by helping

beat that drum... Again, thank you for the easy to understand

explanation. Have a beautiful day..

[enlightenment]

5. You're welcome, blue14u.

It sounds like you have a good understanding of at least one type of single-payer - the French system is (from what I've read) a very good one.

I think it is very helpful to clarify the confusion people have about "single payer" systems and I hope that you're able to share your experiences with others who want to know more.

[blue14u]

6. Yes, I have many

people on my FB that want to know. Most are republicans I went to HS with. Its not by choice I assure you..

I live in the deep red State of MS.. so I'm not the usual form of human life around here...lol

That's ok, I enjoy spreading news from our side and watching them squirm...

[EastHarlemGayDude]

7. My Experience on the New York State Health Exchange (NYSHE)

I was laid off in June of 2013. I was paying for COBRA to the tune of $535 per month. I had United Healthcare/Oxford. In November, I received word that the plan would go up to $615 in December of 2013. The $535 was hard enough, but the $615 just wasn't doable. I figured I would try the New York State Health Exchange. In mid December I searched for plans where my doctor was part of the network. A slew of plans came up. I chose the coop, Health Republic of New York. The premium was $438 and change per month. A doctor visit carried a $30 copay not subject to deductible and I didn't have to have a referral to see a specialist. I bought a dental plan for $11.00 per month. A great deal I thought. Then it started. I couldn't log into the insurance company website (which is where I would make payments, get the plan documents, etc.). I couldn't get the plan documents. When I called, after waiting on line for 20 minutes, people didn't know what I meant when I said plan documents. They offered to send me a summary of benefits. They offered to have me speak with a "counselor." I just wanted the plan documents because I wanted to know what my coverage was. I explained to them that the summary of benefits was not a binding document. They told me they emailed the plan documents to me. They told me they sent them to me. No dice. I asked the company to send them again. They emailed me the plan documents, in the form of a link to a their website. I could simply log in to my account and down load them from there. The only problem was I still couldn't log in. I called again. I had the same conversation. I asked that they send me the plan documents in an attachment to an email. The representative agreed but said it would take 48-72 hours. "To send an email?," I thought. Oh, well, either way I would have them. (All this time, they kept asking me to pay the premium. Funny, but I got letters in the mail with the premium. I received reminders by both mail and email (once I received four emails about 2 minutes apart). Still no plan documents. When I explained that I was not going to pay a premium when I couldn't even see what I was getting, silence.

Fast forward to December 31, 2013. I tried to call again to get my plan documents. No dice. Finally, I got them later. Pretty good. It was a gold plan. Decent coverage It had just a $250 deductible. I had had a physical scheduled with my doctor under my old insurance. I finally got it canceled (that's another story). So, on 1/2, I called to reschedule. I knew I had to have blood work done, so I called the doctor's office to find out which lab to go to. When they asked me my insurance, they told me they didn't take the insurance I chose. I called the insurance company. The woman assured me that, no, they did take the insurance they were just mistaken. She told me she would call them to ask what the deal was and that she would call me back with whatever the answer was. I did a search on the insurance company website for my doctor. According to their website, my doctor was in network. So, at this point, both the exchange and the insurance company said my doctor was an "in network" doctor. I called the doctor's office again. They gave me the number of the billing person. I called her and spoke to her. I told her the situation. I said I had Health Republic, but that, since they were a new company, they were using the network of another insurance provider called Magnacare. The billing person said that they had canceled with Magnacare....in 2011.

I called the insurance company back again to speak about this. I told her that their database indicated that my doctor was affiliated with St. Vincent's hospital in lower Manhattan, a hospital that has been out of business for about 2 years. The woman then explained to me that doctors could be affiliated with more than one hospital. I explained that that was not the point. The point was that their database was at least 2 years out of date. Then I got the response of all responses: "Just because he's listed on the exchange doesn't mean he takes the insurance." Not much literally makes me speechless...that did.

So, then I chatted with the exchange again regarding this (there is an option in New York to chat with someone rather than wait 60 minutes on the phone). I asked the woman if I couldn't rely on the exchange website to be correct, how was I supposed to know if I was choosing the best insurance for me. She then gave me the links to all of the insurance plans on the site. So, I checked all of them. My doctor was listed as a provider in two of the websites' databases. The kicker was that he was listed as taking 5 or 6 of the exchange plans, when he only takes one. In fact, Blue Cross Blue Shield listed my doctor as an "in network" doctor. However, when I contacted them, they said he was an existing BCBS doctor, but they didn't know if he would take the exchange BCBS. I later found out he doesn't.

My doctor called me today to speak about this. He told me the two exchange insurances he accepted. One is United Healthcare/Oxford. The lowest premium was $577. If I wanted the equivalent insurance I had when I was paying COBRA, it was $630. The lowest Oxford plan had a $3,000 deductible. Office visits were subject to the deductible, and after that they only paid 50%. Now, preventive visits are $0, but I'm not sure what that covers. The other one he takes is $477. Again, office visits are subject to the copay of $600 after which the copay is $30.

What I thought was a great plan at first has quickly become a complete disaster. The exchange was almost 100% wrong about what my doctor took. I signed up for a plan that the exchange said my doctor took to being coverage on 1/1. Thank God I didn't pay the premium because it would have been for naught. The reason it is very important to me to keep my doctor is because I have had this doctor for 10-15 years. He knows my history, which includes two surgeries; he knows the drugs I have to take, and he knows crotchety me. We have developed a relationship. I understand changing doctors sometime. Sometimes it helps to have another person (although I disagree in this case). However, THIS is not the scenario under which a person should have to change doctors, particularly when two of the big selling points of this (sorry, but I have to call it what I think it is) debacle was that I could keep my doctor and my insurance would go down.

People are going to lambaste me when I say this. However, I think this was nothing more than window dressing so that a president who possesses no leadership skills, no moral core and no core beliefs could "brag" about something he knew would be a farce and would not, COULD NOT, deliver on what he was saying. The man has no fight. The man is incapable of fighting. As much as I hate to say it (after voting enthusiastically for him once and reluctantly for him the second time), Hillary was right. There just isn't any there there. He is soulless. He should have known that the private, for-profit insurance companies would never do right by the American people. There may be no preexisting conditions, but the hoops one has to jump through just to find the information to sign up for bad insurance is just too coincidental. I have the wherewithal to fight through this. I can completely understand why a father or mother would see something like this and throw their hands up in complete despair.

There is a solution, and it is single payer. No deductibles. No "networks". No "what if I have insurance in New York but get sick in Ohio" mess to deal with.

[Scott6113]

8. Isn't it nice?

Obamacare is already saving over ten thousand lives a year. Here's how I arrived at this figure. Persons who lack insurance die needlessly according to a Harvard Medical School study at the rate of 44,789 a year. Obamacare, according to a Rand.org study, has reduced the rate of uninsurance, net, from 20.5% to 15.8%. This reduces the 44k figure by about a quarter: 10,269 to be exact.
Isn't it nice to have a President who saves lives instead of ending them in needless wars or neglect of his duties? 9/11: 2,977 dead, Katrina 1,836 dead, Iraq war, 4,489 American soldiers dead.
http://www.rand.org/blog/2014/04/survey-estimates-net-gain-of-9-3-million-american-adults.html
9.3 million net increase in healthcare coverage.
http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/

[nomorenomore08]

9. Even as someone who's personally benefited from the ACA, I'm well aware of its shortcomings.

So allow me to say it again - single payer now!

(My own health plan is "only" $300 or so a month, but I realize not everyone can afford that.)