Traverse City Record-Eagle

September 21, 2013

New health care law: Answers to 10 questions

BY MARTA HEPLER DRAHOS
mdrahos@record-eagle.com

---- — TRAVERSE CITY — Just 10 days remain until the uninsured and underinsured can buy affordable health care coverage, and questions about the Patient Protection and Affordable Care Act — also known as the Affordable Care Act, “Obamacare,” Health Care Reform and “the new health care law” — still loom large. Here are some questions posed to experts at a Thursday night forum and the answers they gave.

Q. What changes have already occurred as a result of the law?

A. Changes that applied to most health coverage starting on or after Sept. 23, 2010 include an end to lifetime limits on care, addition of no-cost preventive care and protection from being dropped by insurance companies because of making a mistake on an application. Changes also include extended coverage for young adults (to age 26) on their parents’ plan and an end to coverage denial because of pre-existing conditions for those younger than 19.

Seniors who are in the Medicare prescription drug coverage gap known as the “donut hole” will receive discounts of up to 50 percent on covered prescription drugs. Seniors also will be entitled to a “Welcome to Medicare” preventive visit and yearly wellness visits (not annual physicals) thereafter. Medicare recipients will continue to get coverage through Medicare, with no reduction in benefits.

In addition, small business owners will be eligible for tax credits if they buy coverage for their employees.

Consumers can file a complaint or appeal with their health carrier if it refuses to provide health care coverage, reduces benefits or denies health benefit claims. Once they exhaust the health carrrier’s internal grievance process, consumers can request an external review with the Michigan Department of Insurance and Financial Services.

Q. What can consumers expect in 2014?

A. Consumers who are uninsured, purchase individual coverage or believe their employer-provided coverage is inadequate or unaffordable, will be able to shop for coverage directly in the federal Health Insurance Marketplace, accessed through HealthCare.gov, a new insurance marketplace for individuals and small businesses to shop for health coverage.

Little will change for consumers who are on government assistance like Medicaid or Medicare. However, under likely Medicaid expansion, eligibility would be based solely on income and would include individuals with an income of $15,000 or less a year or $30,00 or less for a family of four.

Q. When is open enrollment on the new Health Insurance Marketplace?

A. Open enrollment begins Oct. 1 and goes through March 31, 2014. Consumers will need to create an account, apply, pick a plan and enroll.

Q. When does coverage begin?

A. Consumers must enroll by Dec. 15 for coverage to start Jan 1, 2014.

Q. What does coverage include?

A. There are four tiers of coverage, from Bronze to Platinum, plus a Catastrophic Plan for those younger than 30 or those who obtain a hardship waiver from the Marketplace. Each tier will include several plans to choose from and consumers will have the ability to compare plans head to head for their

Upcoming health care reform presentations • The League of Women Voters Grand Traverse Area sponsors a free seminar on the changes healthcare reform will bring to consumers and their families from 5:30-7 p.m. Wednesday at the Traverse City Area District Library. Brett Williams, Central Michigan Coordinator at Michigan Consumers for Healthcare, will present information about the history of health care, the new Health Insurance Marketplace, consumer tax credits and how the law will impact the way consumers gain healthcare coverage. • TV 7&4 and UpNorthLive.com host a televised community forum called "Understanding Health Care Reform" from 7-8 p.m. Sept. 30 at Northwestern Michigan College. News anchor Kristen Lowe will host the live program in front of a studio audience at the college's Milliken Auditorium, while co-anchor Marc Schollett will staff an expert panel featuring Jeff Rubleski from Blue Cross/Blue Shield of Michigan and Marti Lolli of Priority Health at the 7&4 studio. The panel will answer questions about the new health care regulations from the audience, by call-in to the television station, and online and via Twitter. After the broadcast, a question-and-answer session will continue in a live chat on the UpNorthLive.com web site. Studio audience members also can meet with local health professionals who can answer questions on how to access the health care marketplace under the new regulations. Attendance is free but pre-registration is encouraged. Audience members should arrive by 6:45 p.m. for introductions and seating arrangements before the 7 p.m. air time.