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.
Managing Heart Disease
If you buy health insurance through your state's Marketplace, on the individual market, or through an employer with 50 or fewer employees, your plan must cover certain Essential Health Benefits. You may need some of these services as a heart patient, such as:
- Outpatient services, such as visits to your primary care physician, heart specialists, and lab tests
- Counseling for diet, smoking cessation, 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.
Medicare includes the essential health benefits. So does Medicaid in some states. Medicare and Medicaid also offer 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. Large employers are not required to offer the essential health benefits, but nearly all do.
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.
- Health plans cannot impose annual or lifetime dollar limits on your benefits.
- Your out-of-pocket costs will be limited. Health plans will have what is called an out-of-pocket maximum. Once you reach that amount through your deductibles and other cost-sharing, your insurance company covers the rest of your costs. That includes what you would spend on copays and deductibles for medical services and prescriptions. The out-of-pocket maximum does not include your monthly premiums.
- 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. You can find your state’s Marketplace by going to HealthCare.gov.
- 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. You can find out whether you qualify for Medicaid by going to your state’s Marketplace.
Savings on Drug Costs for Seniors
If you're on Medicare and take medicine for a heart condition, you may be pleased to know the doughnut hole -- the gap in Medicare coverage for prescription drugs -- is gone. Now you pay just 25% of the cost of your brand-name and generic medications once you reach a certain amount of out-of-pocket costs. See What Medicare Costs, Part D to get the details.
Buying and Keeping Insurance Will Be Easier
With a chronic heart problem, you will have many protections under the Affordable Care Act:
- You cannot be dropped by your health plan because you have a heart problem or a condition that can lead to heart disease, such as high blood pressure or high cholesterol.
- You cannot be turned down for health insurance coverage because of a heart problem.
- You cannot be charged more for health insurance because you have a heart condition.
* Short-termhealth plans, thosethat offer coverage for less than 12 months, do not have to offer the essential health benefits and can still deny coverage for pre-existing conditions.