On Tuesday October 1st the health insurance exchange, a key part of the Affordable Care Act, opens for enrollment. While the various insurance plans and stipulations can be confusing, there are many resources available to offer assistance.
On Thursday September 26th, representatives from various health access groups came together at the Community Broadcast Center to talk about how the new healthcare & insurance plans will affect individuals and businesses. Listen to an edited broadcast of the forum on Tuesday October 1 at noon and 8pm on 90.5 WESA.
Dr. Titus North, executive director of the consumer advocacy group, Citizen Power says when the health exchanges take effect, Pennsylvanians will go to the website Healthcare.gov and can choose from plans labeled at the gold, silver and bronze levels. Those who need to purchase insurance from the exchange will be able to see if they qualify for Medicaid, or a subsidized insurance plan.
“The government would send a check directly to the insurance company to lower your premiums, and this would lower your monthly premium that you pay directly,” says North.
As Pennsylvania Director of Doctors for America, Dr. Christopher Hughes has fielded many patient questions about the affordable care act and the health exchange.
He says “In general, just like the health insurance you have now, there are going to be restrictions. And often times the less expensive your policy is, the less choice you’re going to have in doctors and hospitals.”
For those who currently have health policies that don’t include the preventive services required by the affordable care act, a new plan will have to be acquired. Hughes says theoretically, everyone should be covered by some level of insurance. But people have fallen through the cracks because they didn’t know they qualified for Medicaid until they got to a hospital or doctor for an emergency.
For healthcare professionals, Hughes is optimistic about the efficiency measures that will be introduced through the ACA over time for preventative services.
“We’re going to have more studies and more research telling us whether A works better than B, works better than C. Right now we’re flying by the seat of our pants in many cases.”
Women's Healthcare and the ACA
The ACA’s effect on women’s health care coverage will be more expansive and preventative. Rachel Dingfelder, development coordinator for the Midwife Center for Birth and Women’s Health says preventative services such as mammograms, birth control and prenatal care will have no co-pay.
The Midwife Center is part of a coalition helping patients navigate the affordable care act plans.
“We know that preventative care is covered,” says Dingfelder “But what we don’t know is if a woman goes in for her annual exam and she’s diagnosed with an issue, if she needs follow up testing, we don’t know if that’s covered.”
Senior Healthcare and the ACA
Seniors in particular have been targeted with misinformation when it comes to how the Affordable Care Act will affect their health care, especially when it comes to Medicare.
Erin Gill-Ninehouser, education and outreach director of the PA Health Access Network says Medicare has been the foundation of middle class security since it was signed into law in 1965, because the program covers seniors and people with disabilities regardless of income or health status.
“Over half of all Medicare patients have 3 or more chronic conditions. And about half get by on incomes of about $23,000 a year,” says Ninehouser.
Those who qualify for Medicare will have the opportunity to make changes to their coverage during the upcoming open enrollment period from October 15 to December 7. New discounts on medications have already been applied for Medicare recipients. Some aspects of Medicare will cover preventative services such as flu shots and colonoscopies with no co-pay.
For seniors looking for clarity about Medicare enrollment and how the ACA will work for them, APPRISE is a free health insurance counseling program through the Allegheny Department of Human Services.
To better determine your options within the exchange visit https://localhelp.healthcare.gov/
To estimate your potential premium visit http://kff.org/interactive/subsidy-calculator/