September 29, 2013

Questions and answers about the Affordable Care Act's impact

(Continued from page 3)

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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NEW ESSENTIAL BENEFITS

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

Hospitalizations

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.

SOURCE: obamacarefacts.com

Anthem has requested permission from the Maine Bureau of Insurance to transfer some existing customers to new plans. That transfer would affect only 9,000 people in the state, Anthem said. Anthem customers who bought their plans before March 23, 2010, would be allowed to keep their coverage.

It will be illegal for insurance companies to cancel your coverage if you make simple mistakes on forms, but you still can be canceled for intentionally making false claims. If you have COBRA continuation health coverage, you can maintain it or decide to buy a new insurance plan. If you select a plan by Dec. 15, you can have coverage starting Jan. 1.

I KEEP HEARING ABOUT BRONZE, SILVER, GOLD AND PLATINUM. WHAT DOES THAT MEAN?

A: Bronze, silver, gold and platinum refer to the types of insurance policies available to businesses and individuals under the exchanges created by the health care law. The categories reflect how much premiums will cost each month and the amount you will pay for such things as hospital visits and prescription medications. The percentage covered by the plan increases from bronze to platinum.

The lowest-cost plan is bronze, in which the insurance company covers 60 percent of the expenses and the individual will pay 40 percent. The highest-cost tier is platinum, in which the insurer covers 90 percent of the expenses and the individual pays 10 percent.

The annual out-of-pocket costs for co-payments and deductibles top out at $6,350 for individuals and $12,700 for families.

IS "OBAMACARE" AVAILABLE FOR IMMIGRANTS?

A: It depends on whether they are in the country legally. Legal immigrants will be required to buy health insurance or pay a tax penalty if they don't. They can buy insurance through the marketplace and are eligible for the subsidies.

Immigrants who are in the country illegally will not be eligible to buy insurance through a marketplace. They also are ineligible for Medicaid, although they remain eligible for emergency care under the law. Young immigrants who have been granted "deferred action" status by the Obama administration to avoid deportation by obtaining temporary work permits also will not be eligible for the new marketplace or Medicaid.

-- The Associated Press and Staff Writer Jessica Hall contributed to this story.

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