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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Care Reform Affects Your Heart Care

You will find it easier to manage heart problems with the Affordable Care Act. Helping you manage chronic diseases is an important part of health care reform. This includes helping you lower your risk for heart attack or stroke.

You will see these benefits once the health reform law takes full effect in January 2014.

Managing Heart Disease

If you buy health insurance through your state's Marketplace, your plan must cover certain essential health benefits. You may need some of these services as a heart patient, such as:

  • Counseling for diet, smoking, alcohol abuse, or depression to learn how to lower your chance of complications from heart disease
  • Prescription drug coverage
  • Emergency room and hospital coverage
  • Rehabilitation services

Be aware that each state determines the details of exactly what must be covered under these categories. Individual health plans may add to those minimum requirements. So before you enroll, read the plan's summary of benefits to see what specific services you’ll have access to and what your costs will be.

If you're on Medicare, it includes the essential health benefits. So does Medicaid if you are new to the program. Medicare and Medicaid are also offering special programs for home monitoring of blood pressure and other heart risks.

If you get insurance through your job, check your health plan to confirm the details of your coverage.

Reduced Costs to Treat Heart Disease

The Affordable Care Act has rules about the most you have to pay out-of-pocket for your medical care. These start in 2014:

Health plans cannot limit how much they will spend on covered expenses for your health care. Annual and lifetime limits go away.

Your out-of-pocket costs will be limited. Health plans will have what is called a cap. Once you reach that amount, your insurance company covers the rest of your costs. That includes what you would spend on copays and deductibles for medical services and prescriptions.

You might be able to get financial help to pay for some costs if you're buying insurance through your state's Marketplace. You may be able to get a tax credit to lower your insurance premiums. And you may qualify for a cost-sharing subsidy, which reduces out-of-pocket expenses, like paying for heart medicines.

You might qualify for Medicaid coverage, even if you haven't in the past. This will depend on how much you earn and the state you live in. See Medicaid Expansion: At-a-Glance to learn more.

Savings on Drug Costs for Seniors

If you're on Medicare and take medicine for a heart condition, you may be pleased to knowthe doughnut hole -- the gap in Medicare coverage for prescription drugs -- is slowly going away. It will be gone by 2020, leaving you to pay just 25% of the cost of your brand-name and generic medications. See What Medicare Costs, Part D to get the details, including what discounts are available until the doughnut hole closes.

Finding Insurance Will Be Easier

With a chronic heart problem, you will have many protections under the Affordable Care Act. By 2014:

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