Health Reform and Your Insurance Options
The familiar world of health insurance is going through a lot of changes. If you're trying to get your bearings, take a look at what's different since the health reform bill became law.
- No one can be denied coverage because of health problems they had in the past. This is known as a "preexisting condition." In addition, health insurance companies cannot charge you more if you have a preexisting condition.
- If you have children who are 19 to 26, they can stay on your insurance plan.
- Insurance plans, with some exceptions, now cover some preventive medical services. You won't need to pay a co-payment or reach the deductible first. These preventive services include certain vaccinations and screenings.
Health insurance Marketplaces are set up in each state. Marketplaces, also known as Exchanges, are websites where you can shop for coverage, enroll in a health plan, and find out if you qualify for a government subsidy to help pay your premium.
What You'll Find in the Health Insurance Marketplace
What is it? The health insurance Marketplace is a new way to find health coverage. It lets you compare the costs and benefits of different plans.
Each state has a Marketplace. The federal government oversees the Marketplaces in some states, while other states run their own.
All plans sold on the Marketplace must include 10 essential health benefits:
- Outpatient care
- Emergency care
- Pregnancy, maternity, and newborn care
- Mental health and substance use treatment
- Prescription drugs
- Rehabilitative and habilitative care
- Laboratory services
- Preventive and wellness services
- Pediatric care, including vision and dental
In addition to offering standardized benefits, Marketplace plans must fit into one of four “tiers” based on how much of your medical expenses are covered:
- Platinum - on average covers 90% of your medical expenses
- Gold - on average covers 80%
- Silver - on average covers 70%
- Bronze - on average covers 60%
Plans can't turn you down because you have a health problem or you've had one in the past.
Who can use it? To get health insurance from an exchange, you must:
- Be a U.S. citizen or legal immigrant
- Not be in prison
- Lack access to affordable coverage through an employer