Affordable Care Act
Impact of the Affordable Care Act
The Affordable Care Act (ACA) brings the country one step closer to ensuring that people living with disabilities have access to high quality, comprehensive and affordable care that meets their individual needs and enables them to live as independently as possible.
The Affordable Care Act (ACA) includes important changes that impact the disability community. Among others, these include:
Prior to the passage of the ACA, many people living with disabilities were often denied coverage, charged higher premiums, or had their coverage rescinded following an injury. Under the ACA, most insurance plans won't be allowed to deny or exclude coverage to any American based on a preexisting condition, including a disability.
Lifetime and annual benefit caps
One of Christopher Reeve's greatest fears was that he would exceed the lifetime or annual cap on his insurance coverage. No population is more affected by these caps than those dealing with catastrophic injury. Under the ACA, lifetime and annual caps on benefits are prohibited.
The Medicaid program provides health coverage to some of the country's most vulnerable populations, including people with disabilities. While the ACA mandated expansion of state Medicaid programs for all Americans under 65 with incomes up to approximately $15,000, the Supreme Court decision in 2012 made state expansion optional. For information on Medicaid eligibility in your state, please visit www.medicaid.gov.
Health Insurance Marketplace
The Marketplace enable individuals to shop for health insurance – much in the same way they currently shop online for airline tickets or hotel rooms. It provides information on insurance options, including eligibility for public coverage programs, as well as tax credits and premium assistance to help make insurance more affordable.
Home and community-based services
The ACA expands home and community-based services offered through state Medicaid programs, making it easier for people with disabilities to live at home, rather than being forced to receive services in an institutional setting.
Among others, improvements include programs such as the “Community First Choice Option”, which provides home and community-based attendant services and supports for people who are eligible for an institutional level of care.
Understanding the Marketplace
2013 marked a major milestone in the implementation of the Affordable Care Act, as open enrollment for the legislation's "Health Insurance Marketplaces" began.
According to healthcare.gov, a Health Insurance Marketplace is "a new way to find quality health coverage. It can help if you don't have coverage now or if you have it but want to look at other options. With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll."
The health reform law requires that all American citizens have the opportunity to shop online (or by phone) for the best available insurance to fit their individual needs and budget.
Depending on a person's income, the coverage options provided through the Marketplaces may be a better choice than the plans currently offered through an individual's employer, but they may not be. Of course, the Marketplace will also offer the uninsured choices they may not have been privy to in the past.
Based on where you live, the Marketplace in your state will be accessible through a website operated by either the federal or state governments.
Where can I access the Marketplace?
HealthCare.gov will direct you to the Marketplace in your state. It's the best place to get started.
Here's how the Marketplace basically works:
- Individuals interested in learning more about buying private insurance can go online and compare health insurance options.
- From there, you can select a plan that meets your needs and budget, and enroll in coverage.
- The plans are required to be presented through a "metal tier" system – "platinum" plans are the most expensive but offer the most comprehensive coverage, while " bronze" plans are the least expensive but require the highest out of pocket costs.
The Marketplace sites will ask you basic questions about your income, your family, where you live, etc. and will provide an overview of the insurance options (both private and public) for which you qualify.
Ultimately, you will have to make decisions based on your own needs, the needs of your family, and your budget.
Tips to consider prior to enrollment
Have basic information handy when you first log on:
You'll need to have some basic information to get started with the enrollment process – whether you choose to enroll online, or by phone. Of course, you'll need information like your social security number and where you live. But you'll also need income information for all of the members of your family who need coverage (i.e., from pay stubs, W-2 forms, tax statements, etc.).
This information will help you determine if you're eligible for private insurance through the Marketplace, a public health coverage program (such as Medicaid), and/or for financial assistance from the government to help pay for coverage.
Budget, budget, budget:
When you log on to the Marketplace, you'll be presented with plans from a number of different insurers. These plans will be organized by price, benefits, and other features.
Plans will be presented in four categories – bronze, silver, gold, and platinum – to make comparing them easier. Platinum plans will pay the highest percentage of your medical costs, but will also have the highest premiums. On the other hand, bronze plans will cost you less each month, but will require you to pay a higher percentage of your medical costs out-of-pocket when you receive care.
Be smart about how much money you can put aside per month to cover your medical costs, and those of the rest of your family. Knowing what you can afford to pay – both for monthly premiums, as well as out-of-pocket costs – will help you make the best decisions.
Research available plans and ask questions:
While all plans in the Marketplace are required to offer a set of "Essential Health Benefits," it's important to keep in mind that specific plan benefits may be different in each state. And even within the same state, there can be small differences between plans.
This can make choosing a plan extremely intimidating – especially for people living with a spinal cord injury who often require a significant amount of rehabilitative services, medications, therapies and equipment. It's important that you know which services you will have access to under each plan, and this may not be obvious online.
The good news is Health Insurance Marketplaces are staffed with individuals who should be able to answer very specific questions about what a certain plan does, and doesn't, cover.
Also, ACA plans should provide for increased coverage for rehabilitative and "habilitative" services and devices. Ask a professional about which plans are best for you – especially if rehabilitation represents a critical portion of your care.
You can reach out to these staffers in real time via online chat, or by phone. HealthCare.gov offers a hotline, as well as an online chat option, to help you answer any questions you might have.
Marketplace plans aren't right for everyone:
Remember, you aren't required to purchase insurance through a Marketplace. It certainly can't hurt to do your research, but if you're happy with your current insurance plan, you can keep it. It's possible that this plan is still the best for your family’s needs.
Medicare and the Marketplace
What do these new Marketplaces mean for those who already have Medicare? In short, the answer is nothing.
If you're covered under Medicare, the following are some important things to remember:
- Medicare isn't part of the Health Insurance Marketplace so, if you are already covered by Medicare, no action is needed.
- The good news is, if you're on Medicare now, the ACA won't affect your choices, and your benefits won't be changing.
- According to the Centers for Medicare & Medicaid Services (CMS), "No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you'll still have the same benefits and security you have now, and you won't have to make any changes."
Note: The Marketplace does not offer Medicare supplement (Medigap) insurance or Part D prescription drug plans.
If you are looking for more information on the Affordable Care Act or have a specific question, our information specialists are available business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm ET.
Additionally, the Reeve Foundation maintains fact sheets on the ACA with additional resources from trusted Reeve Foundation sources. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.
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