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How Health Reform Impacts You

You Buy Your Own Health Insurance

Many things have changed for people who buy their health insurance directly from an insurance company. Here are some important points for how some of the Affordable Care Act’s (ACA’s) changes could affect you.

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Health Care Reform Key Mandates

Health Care Reform ensures the following key mandates.

  • The ACA’s Individual Mandate requires nearly everyone to buy insurance. Since you already buy insurance and continue to do so, this shouldn’t affect you at all. If you have healthcare coverage going into 2014, you will not be impacted by the penalties people will have to pay for not having insurance after January 1, 2014.
  • With a few exceptions (such as temporary medical), if you bought your current plan before March 23, 2010, your plan is considered ‘grandfathered’ and you don’t need to buy a new ACA plan. As long as you keep that plan paid up and unchanged, you can keep it for as long as you like.
  • The ACA also guarantees that no one can be denied coverage or be charged more because they’re sick or because they have a pre-existing medical condition. That’s good news if you’ve been charged more in the past.
Essential Health Benefits & Preventive Services

The law requires that each state’s plans cover these same core Essential Health Benefits:

  • Ambulatory patient services
  • Maternity & newborn care
  • Prescription drugs
  • Laboratory services
  • Preventive/wellness care
  • Pediatric dental & vision care
  • Emergency services
  • Hospitalization
  • Mental health/substance abuse services
  • Rehabilitative/habilitative services & devices

All plans also must offer preventive services at no charge. You won’t pay a copay or co-insurance for these services, and you won’t have to meet your deductible before you use these no-charge services including:

  • Adult physicals and blood pressure/cholesterol screenings
  • Well-child care visits and immunizations
  • OB/GYN visits
  • X-rays and diagnostic/lab tests
  • Cancer screenings such as mammograms, pap tests, prostate and colorectal screenings
  • Routine pre-natal maternity visits
Metal Levels & Exchanges

ACA tries to make it easier for you to compare plans by requiring that all plans (except high-deductible Catastrophic plans) fit into one of four Metal Levels. Bronze, Silver, Gold and Platinum plans all cover the same core benefits, but as you can see in this table, each differs in how much of your care you'll pay.

Metal Level
What the Health Plan Pays
What You Pay
Platinum 90% 10%
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%
Your monthly premium rate is a separate cost and is not included in these calculations.

Different plans have different monthly premiums and varying out of pocket cost for you. The ACA also created public websites (most often called Exchanges or Marketplaces) that will make comparing and buying health insurance easier. CareFirst has 15 plans on the public Exchange, but you can also buy virtually the same plans for the same rates on CareFirst’s private Exchange (URL).

If you qualify for financial help from the federal government, you’ll have to buy the plans on that state’s public Exchange to qualify and receive the financial help for the plan.

Subsidies

For people who qualify, there are two types of financial assistance, called Subsidies. Remember, to qualify for a subsidy you must buy your health plan on your public State Exchange.

  • The Premium Subsidy may help lower your monthly premiums if your total household income in 2012 was:
    • less than $45,960 for an Individual
    • less than $62,040 for a Family of 2
    • less than $78,120 for a Family of 3
    • less than $94,200 for a Family of 4
    • less than $110,280 for a Family of 5
  • The Cost-Share Subsidy can help limit how much you’ll have to pay out of pocket for your health care. This Subsidy only applies to Silver Level plans. You may be eligible if your total household income in 2012 was:
    • Less than $28,725 for an Individual
    • Less than $38,775 for a Family of 2
    • Less than $48,825 for a Family of 3
    • Less than $58,875 for a Family of 4
    • Less than $68,925 for a Family of 5
Impacts of ACA if You're under 30

Depending on your specific age, the ACA affects how you can be covered. If you’re under 26, you can get coverage on your parents’ plan. If you’re 26 or older, but won’t be 30 by January 1, 2014, you may be eligible to buy a health insurance plan by buying:

  • A high-deductible Catastrophic plan.
    • These plans usually offer lower premiums, and provide no-cost wellness and other preventive services.
    • Just as important, these plans also protect you from having to pay the “catastrophic” health care costs that a serious illness or injury could amount to if you didn’t have insurance. With CareFirst’s Catastrophic plan, you would be responsible for the first $6,350 of your health care costs, after which the plan would pay 100% of the remainder.
    • These plans are not eligible for either federal Subsidy.

Regardless of your age, you may buy an ACA plan from a Metal Level that has a better balance between premium cost and how much you would have to pay for the care and services you receive.

A lower-deductible plan would start helping you pay for health care costs sooner than a Catastrophic plan. To offset the higher premiums associated with these kinds of plans, you should see if you qualify for one or both kinds of federal Subsidies that are available. If your total individual income last year was less than $45,960, and you meet the other subsidy criteria, you may qualify.

Help with paying for your monthly premiums is based on a sliding scale according to your income; the less you make, the more financial help you may get. You can learn more about this and other Subsidies by using the online calculator to get an estimation.

Note: you must apply for Subsidies on the public Exchange; any award can only be applied to a plan you purchase on that Exchange.

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