September 29, 2013

Questions and answers about the Affordable Care Act's impact

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Pat Quinn, Kathleen Sebelius
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Health and Human Services Secretary Kathleen Sebelius has played a key role in refining provisions of the Affordable Care Act, including oversight of states’ insurance marketplaces.

The Associated Press

Mitch McConnell
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The clock is running out for Senate Minority Leader Mitch McConnell and other Republicans who are trying to delay the implementation of “Obamacare.”

The Associated Press

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Starting Jan. 1, the following "essential benefits" must be included under all insurance plans that are considered "qualifying health plans" sold on and off the marketplace:

Emergency services


Laboratory services

Maternity care

Mental health and substance abuse treatment

Outpatient or ambulatory care

Pediatric care

Prescription drugs

Preventive care

Rehabilitative and habilitative (helping maintain daily functioning) services

Vision and dental care for children

Essential benefits are provided with no "cost sharing" on every insurance plan sold on Obamacare's Online Health Insurance Marketplace.


Many participants will qualify for federal subsidies in the form of tax credits to help ease the cost. The amount is based on income and is available to individuals making up to $45,960, or $94,200 for a family of four.

The Maine Bureau of Insurance expects 5 percent to 8 percent of state residents, or 65,000 to 104,000 people, to purchase insurance in the marketplace. The federal government aims to sign up 7 million people in the U.S. in the first year.

Helpers, or navigators, will be available in Maine and elsewhere to help people figure out what policy may be right for them. To find a navigator in Maine, consumers can call 2-1-1. The website will provide state-specific information about health plan options and offers a ZIP code locator that will help people find navigators and "certified assisters" in their communities. The site also will provide a link to, the federal Health Insurance Marketplace website, to purchase coverage.

The federal government has set up call centers to help people with open enrollment. Call 1-800-318-2596 (TTY: 1-855-889-4325). The number is staffed 24 hours a day. Information is available in more than 150 languages.


A: Coverage in the marketplace will be more comprehensive than what is typically available to individuals in the current health insurance market, which is dominated by bare-bones plans. The plans will have to cover a standard set of benefits, but will vary in price based on deductibles and co-payments. All plans in the exchange, and most outside it, will have to cover care such as prescriptions, emergency room treatment, and maternal and newborn care.

Under the law, insurers can't turn away people or charge them more because of health problems or chronic illnesses. Insurers also are banned from setting different rates based on gender. Middle-aged and older adults can't be charged more than three times what young people pay, but insurers can impose penalties on smokers.

Most health insurance plans have to cover certain preventive services. Those include routine vaccinations, vision and hearing tests for children, and screenings for diabetes, high cholesterol, colon cancer and high blood pressure.


A: Maybe. For many people who have health insurance through their employer, the Kaiser Family Foundation says not a lot is expected to happen right away.

Some workers may receive a financial break from the new cap on out-of-pocket expenses and free preventive care. But some larger companies, those with 50 or more employees, already are looking for ways to cut costs and avoid getting hit with a new tax set to take effect in 2018 on so-called "Cadillac" insurance plans. Those are defined as plans valued at $10,200 or more for individual coverage and $27,500 for family policies.

Some companies have taken steps to save money on health insurance coverage. United Parcel Service, for example, informed its white collar employees that it will no longer cover spouses if they can get coverage through their own employers. Delta Air Lines, meanwhile, recently predicted its workers may have to help shoulder the cost of various new mandates under the Affordable Care Act, such as coverage for employees' children until they are 26 years old, and coverage for workers who previously opted out but will now be required to have health insurance.

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