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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Insurance Costs: FAQ

I buy my own insurance and I've been shocked by big jumps in the cost of my premiums. Do I have to keep worrying about this?

Under health reform, you may be less likely to see major jumps in your premiums. If your insurance company wants to raise premiums by 10% or more, the rates will be reviewed by experts to make sure increases are based on reasonable information. This is expected to help keep premium hikes in check. However, not all states have the power to stop rate increases if insurers refuse to reconsider.

I smoke. Can a company charge me more for health insurance?

Yes. Starting in 2014, insurance companies can charge you up to 50% more for premiums than someone who doesn't use tobacco.

On the other hand, smoking-cessation programs are one of the benefits that all health plans sold on a state's Marketplace must offer. If you participate, you may be able to avoid a penalty.

I've heard that I might get a rebate from my health plan if it doesn't spend enough on health care. Is that true?

Yes. Health plans must now spend at least 80% of the premiums they charge customers on:    

  • Medical care
  • Steps to improve the quality of care

If they spend less than this percentage, health insurance companies have to send out rebates to customers.

However, employers who are self-insured don't have to follow this rule. A self-insured employer is a company that pays the workers' medical claims itself.

I take good care of my health. Can I start getting preventive services free of charge?

You may now be able to get a number of preventive treatments and services without extra out-of-pocket costs.

Out-of-pocket payments are medical costs that you have to pay on your own, often through a copay, coinsurance, or a deductible . A copay is a set amount you have to pay for a health service that's covered by your insurance plan. For instance, each time you see a doctor you may pay $15, and your health plan pays the rest of the charges. Coinsurance is a percentage of the cost of health care services. For instance, you might pay 20% of the cost when you see a doctor and your health plan pays the rest.

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