Affordable Care Act–Health Insurance Updates

Starting in January 2014, most Americans are required to have health insurance or pay a penalty. Health insurance helps you pay for medical care and can protect you from high health care costs, like emergency room visits or hospital stays. Health care bills can add up quickly and often cause people to go into debt or even bankruptcy. There are important things to look at when buying health insurance: the health services the plan covers; how much you’ll pay for the plan = monthly premiums; how much you’ll pay for things like doctor visits or prescription medicine = cost sharing.

There are new health insurance rules, for 2014 that may improve the quality of the health insurance you already have or that you buy this year. These include:

> New protections: can no longer set annual limits, and lifetime limits are not allowed on any health insurance plans; cannot deny coverage for pre-existing conditions.

> New options: In the Missouri Health Insurance Marketplace, people can compare and buy health insurance plan that best meets your needs. Find out if you can get financial help – some people may qualify for some financial assistance; see if you qualify for Medicaid, a public health insurance program. You can get help finding the right plan for you and your family through the Marketplace website, in person, and by phone.

> New benefits: New health insurance plans must cover recommended preventive care with no cost-sharing. New health insurance plans for individuals and small businesses must cover essential health benefits. These are 10 categories of health services, usually included in the coverage provided by large employers.

The Missouri Health Insurance Marketplace is a website where you can compare and buy the health insurance plan that’s right for you. The Marketplace enrollment opens October 1, 2013; enroll by December 15, 2013 for health insurance coverage to start on January 1, 2014. The date your coverage starts depends on when you buy your health plan. Enroll by March 31, 2014 to avoid penalties. Plans purchased in the Health Insurance Marketplaces as well as job-based coverage, Medicare, Medicaid, state Children’s Health Insurance Programs (CHIP), TRICARE and the Veterans health care program, and certain other coverage meet the requirement to avoid a penalty. The Internal Revenue Service (IRS) will decide if you have to pay a penalty based on your tax return, where you’ll be asked to show proof of health insurance. If you owe a penalty, the amount may be subtracted from any tax refund you’re due. In 2014, the penalty is the larger amount of: 1% of income or a flat dollar amount – $95 per adult and $47.50 per child, not to exceed $285 for a family. In 2016, the percentage increases to 2.5%. There are some exceptions to the requirement to have insurance. Several educational materials about the Missouri plans can be found at www.covermissouri.gov.

You only need to fill out one application to get coverage and financial help. You can apply online, by phone, or in person. If you need help figuring out if you can get financial help or qualify for Medicaid, you can:

• Call the toll-free call center open 24 hours a day, seven days a week. Call 1-800-318-2596 (TTY 1-855-889-4325) or visit http://www.healthcare.gov.

• Talk to someone in person: Navigators and Certified Application Counselors are trained people who can answer questions and help you fill out your Marketplace application in person. Find help near you at http://www.covermissouri.org.

• Talk to an agent or broker: Insurance agents and brokers can also help you find, choose, and buy coverage. They must be appropriately registered to conduct business in Missouri. It is important to note that agents and brokers can receive money from a health insurance company for enrolling people into their plans.

The American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA) also have fact sheets on the new Marketplaces available, including www.diabetes.org/HealthInsuranceMarketplaces.

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