The Affordable Care Act Part 7 – The Marketplace

With key parts of the ACA becoming effective in 2014, the Health Insurance Marketplace will allow individuals and small businesses to compare private health insurance plans, get answers to questions, find out if they are eligible for tax credits to purchase private insurance or for health programs like Medicaid or the Children’s Health Insurance Program (CHIP) and, finally, to enroll in a health plan that meets their needs.

Each state will have its own Health Insurance Marketplace through which insurance companies compete for your business. States can create and operate their own Marketplace, use a Marketplace operated by the Department of Health and Human Services (HHS), or choose to partner with HHS to run some functions of their Marketplace.

State Health Insurance Marketplaces are currently scheduled to be available for open enrollment beginning in October 2013, with private health plan coverage purchased through the Marketplace becoming effective on January 1, 2014. You can also purchase a health plan outside your State Marketplace on the “open market” or through a private insurance exchange. 

New Benefits and Protections

If your health plan is subject to ACA requirements, you and your family may be eligible for some important preventive services at no additional cost to you, services such as:

  • Blood pressure, diabetes, and cholesterol tests
  • Many cancer screenings, including mammograms and colonoscopies
  • Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use
  • Regular well-baby and well-child visits, from birth to age 21
  • Routine vaccinations against diseases such as measles, polio, or meningitis
  • Counseling, screening, and vaccines to ensure healthy pregnancies
  • Flu and pneumonia shots

Beginning in 2014, a “Patients’ Bill of Rights” takes full effect, providing you with certain protections, including:

  • You cannot be denied health insurance because of a pre-existing condition.
  • Your coverage cannot be cancelled or rescinded if you get sick.
  • Lifetime limits on essential health benefits are banned for all new health insurance plans.
  • Annual limits on essential health benefits are phased out.
  • Premium rating variations can be based only on age, premium rating are, family composition and tobacco use and insurers must justify annual premium increases of 10% or more.
  • You can seek emergency care at a hospital outside your health plan’s network.

 

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