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Health Care Reform:

Health Insurance & Affordable Care Act

What You Need to Know About Health Care Reform

Financial Help to Buy Insurance continued...

In general, you'll be eligible if you're single and make about $46,000 or less a year, or if you have a family of four and make about $94,000 or less a year.

You can find out if you qualify for a tax credit when you apply to buy health insurance through your state's Marketplace.

If you still cannot afford insurance, there is a way to avoid paying a fine. The law says you must have health insurance in 2014. If you do not, you have to pay a tax. But if you cannot find insurance that fits your budget, you can apply for an exemption. If you qualify, you would not have to pay the tax.   

Expansion of Medicaid

You might be able to use Medicaid for the first time. In some states, Medicaid is changing because of health reform. More people will qualify for it.

Under the new rules, you may be able to get Medicaid in 2014 if your yearly gross income is no more than about $15,856 for one person and $32,500 for a family of four. You may hear this amount called 138% of the federal poverty level.

What's Already in Effect

These benefits have been in place for a while. Check with your health plan about any you're interested in and haven't used yet.

Your children have guaranteed coverage regardless of their health status. Children age 18 and younger must be covered by insurance even if they already have a health problem, called a pre-existing condition.  If your child develops a chronic condition, such as diabetes or asthma, your insurance still must cover your child.

You can keep your children on your health insurance longer. Your children can stay on your policy until they are 26 years old.

You can get some types of care for free.  Certain tests and checkups, called preventive services, are now completely paid for by your insurance. These include a well-child visit each year, blood pressure and cancer screenings, and flu shots. This means:

  • You do not have to make a copay. That’s the amount you usually have to pay each time you see a doctor.
  • You do not have to pay anything toward your insurance deductible if your health plan has one. The deductible is an amount you must pay before your insurance pays for any of your care.

You’re better protected by insurance. If you or someone in your family gets sick, your insurance company can no longer cancel your coverage. You can get certain types of health care, called essential health benefits, that must be covered by all qualified health insurance plans.

Essential benefits include emergency services, hospitalization, maternity and newborn care, prescriptions, and more. You can choose who will be your primary care provider, often referred to as PCP. Your PCP is your lead health care professional -- the one you see for screenings and when you're sick. A PCP can refer you to specialists if you need them.

You now have a way to complain about insurance problems. Each plan must have an appeals process, which are the steps you must go through to ask a health plan to pay for something they said wasn't covered. Every health plan must tell their members what their appeals process is.

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