What is the Affordable Care Act ("Obamacare") and How Will It Affect Your Cancer Care Expenses?
The Patient Protection and Affordable Care Act, commonly called the Affordable Care Act (ACA) or “Obamacare,” is a federal statute. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.
It’s no wonder that such a large, complex program has patients across the country wondering how it will affect their finances.
To help you better understand your situation, we asked our Patient Account Services team to clarify some key questions regarding the ACA. Here’s our interview with OHC PAS Director Dave Hammond, PAS Financial Services Manager Jessica Spinks, and PAS Clinical Manager Gail Dammert.
Q: Can you summarize the Affordable Care Act in layman’s terms?
OHC: The Affordable Care Act is a health care reform bill signed into law in 2010 by President Barack Obama with intentions to increase the quality and affordability of health insurance. It also aims to lower the uninsured rate by expanding public and private insurance coverage and reducing the cost of healthcare for individuals and the government.
Q: What will change in 2014?
OHC: Our patient’s should be aware of these eight key points:
• Patients who do not have access to affordable health coverage or qualify for Medicaid will now have the opportunity to purchase insurance on the health insurance exchange. We ask that they visit www.healthcare.gov or call 800-318-2596 to find out more information and apply.
• There will no longer be pre-existing conditions denials.
• Patients have the right to appeal coverage denials.
• There will not be annual or lifetime dollar limits on insurance plans.
• Medicaid coverage will expand to 138 percent of the Federal Poverty Level in Ohio and Kentucky.
• Young adults can stay on their parent plans until the age of 27.
• There will be reduced prescription drug cost in Medicare’s “donut” hole.
• Insurance companies can no longer drop your coverage based on your illness.
Q: What should OHC patients do to prepare for the change?
OHC: If a patient does not have any insurance, the first thing they should do is visit healthcare.gov and research what their options are. For patients who do have insurance, it’s important that they contact their insurance and ask if there will be any changes to their coverage going in to 2014. If they’re signing up for an exchange plan, they should double check to make sure their doctors are in-network. Here’s what to do:
• Visit www.healthcare.gov or call 800-318-2596 if you are in need of health insurance.
• Call your current insurance company to see if anything on your 2014 plan will change.
• Stay informed on the various options and understand what your current insurance plan offers, and what you are responsible to pay.
Q: Will any patients have to switch doctors due to the ACA?
OHC: Our patients need to check with their insurance company to insure that all of their doctors are still in-network in 2014.
Q: How will the ACA affect patients who are currently receiving some form of treatment?
OHC: Patients should contact their current insurance plan, or any plan they are considering purchasing, to ask specifically if it will provide coverage of their treatment.
Please notify OHC right away at 800-710-4674 if you will be making any change to your insurance. By supplying us with your new insurance information, we can review your coverage and benefits, begin authorizing your treatments, and investigate any assistance you might qualify for.
Q: How can OHC’s Financial Navigators help guide you?
OHC: We can help our patients understand what their current insurance plan out-of-pocket costs will be. We can also direct you to the correct website and answer any questions you might have. We’re here to help answer your questions and give you direction on the various new websites. Contact us anytime at 800-710-4674.
Q: What personal information will I need to apply in the marketplace or on state-expanded Medicaid?
OHC: Here’s the list of what you need:
• Your Social Security numbers (or document number for legal immigrants).
• Your employer and income information for every member of your household who needs coverage (for example: pay stubs or W-2 forms – Wage and Tax statement).
• And your policy number for any current health insurance plans covering members of your household.
Q: If I have Cobra continuation health care, can I still shop on the marketplace?
OHC: Yes. OHC patients who have COBRA coverage typically pay the entire premium themselves. There may be better options in the marketplace, allowing you to have a lower coverage cost.
Q: If I was denied Medicaid in years past, could I possibly be covered under the expanded Medicaid?
OHC: Yes. Ohio and Kentucky expanded the Federal Poverty Level requirement to 138 percent. To apply in Ohio, visit www.benefits.ohio.gov.com or call 800-324-8680. In Kentucky, visit www.kyenroll.ky.gov.com or call 855-459-6328.
Q: If patients have really specific questions, what can they do?
OHC: They can contact the Financial Navigator from their OHC office location. We have Financial Navigators at almost every office, so patients have a local resource convenient to them. You can find a complete list of OHC Financial Navigators on our website.