Healthcare Q&A

Q. What is the Marketplace?
 
A. In the Marketplace, also called the exchange, you can purchase health care coverage. See our document that gives you links to and telephone numbers for those individual states that have chosen to offer their own options.
 
Q. If I have health insurance, how does the health care law protect me?
 
A. Whether you need health coverage or have it already, the health care law offers new rights and protections that make coverage fairer and easier to understand.
 
Q. How does the Affordable Care Act help people like me?
 
A. If you need coverage, you can use the Marketplace. If you have coverage, you gain new protections. If you don’t have coverage, you may have to pay a fee.
 
Q. Can children stay on a parent’s plan until age 26?
 
A. If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old.
 
Q. What if I currently have COBRA coverage?
 
A. If you have COBRA continuation health coverage, you keep it or decide to buy a Marketplace insurance plan instead at any time starting January 1, 2014.
 
Q. What if I want to change individual insurance plans?
 
A. If you have an individual insurance plan and want to change it, you can use the Marketplace to explore your options and enroll in a new plan.
 
Q. What if I have job-based insurance?
 
A. If you have job-based health insurance you like, you can keep it. You're considered covered. You may be able to change to Marketplace coverage if you want to.
 
Q. What if I have a grandfathered health insurance plan?
 
A. If you are covered by a plan that existed March 23, 2010, your plan may be "grandfathered." You may not get some rights and protections that other plans offer. Grandfathered plans are those that have stayed basically the same, but they can enroll people after that date and still maintain their grandfathered status. In other words, even if you joined a grandfathered plan after March 23, 2010, the plan may still be grandfathered. The status depends on when the plan was created, not when you joined it. How to find out if your plan is grandfathered?

  • Check your plan’s materials: Health plans must disclose if they are grandfathered in all materials describing plan benefits. They must offer contact information.
  • Check with your employer or your health plan's benefits administrator.

What grandfathered plans do and don't have to cover. Here's a quick look at the consumer protections that do and don't apply to grandfathered plans. All health plans must:

  • End lifetime limits on coverage
  • End arbitrary cancellations of health coverage
  • Cover adult children up to age 26
  • Provide a Summary of Benefits and Coverage (SBC), a short, easy-to-understand summary of what a plan covers and costs
  • Hold insurance companies accountable to spend your premiums on health care, not administrative costs and bonuses

Grandfathered plans DON'T have to:

  • Cover preventive care for free
  • Guarantee your right to appeal
  • Protect your choice of doctors and access to emergency care
  • Be held accountable through Rate Review for excessive premium increases

In addition to the above, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) don't have to:

  • End yearly limits on coverage
  • Cover you if you have a pre-existing health condition

Note: Some grandfathered plans offer protections they're not required to. Check with your insurance company or benefits administrator to learn if your grandfathered plan offers the rights and protections listed above.
 
Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:

  • coverage only for vision care or dental care
  • workers' compensation
  • coverage only for a specific disease or condition
  • plans that offer only discounts on medical services

Q. What if I'm losing job-based insurance?
 
A. If you lose your job-based health insurance, you have two primary options for health insurance coverage: a Marketplace plan or COBRA continuation coverage.
 
Q. How do I appeal a health plan decision?
 
A. If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party
 
Q. How can I get consumer help if I have insurance?
 
A. Many states offer direct help with problems or questions about health insurance through Consumer Assistance Programs. Other help resources are available too.
 
Q. Can I use a Flexible Spending Account (FSA) to pay some medical expenses?
 
A. You can use a Flexible Spending Account (FSA) to pay for co-payments, deductibles, some drugs, and other health care costs. FSAs are limited to $2,500 per year.
 
If you have further questions, call 800-318-2596, 24 hours a day, 7 days a week.