Frequently Asked Questions about Health Care Reform

Updated:Dec 31,2015













If you have questions about health care reform, you are not alone. As a non-partisan, patient advocacy organization, the American Heart Association/American Stroke Association has sought to provide our volunteers with the facts they need to stay informed about the new law and what it means to them.

For further detail on the topics discussed below, please visit www.healthcare.gov.

Frequently Asked Questions

Q. How can I find out what options for health care coverage are available in my state?

A. Health Insurance Marketplaces are now open in every state that make it easier to shop for, apply and enroll in insurance coverage. Through your state’s Marketplace, you can see all of your choices in one place, know upfront what your premium, deductibles, and out-of-pocket costs will be and make apples-to-apples comparisons of the different private health insurance plans available to you before you decide to enroll. The Marketplace also determines whether you qualify for financial assistance to help make health insurance premiums more affordable. You can access your state’s Marketplace online at www.healthcare.gov or by phone, toll-free, at 1-800-318-2596.

A. Health Insurance Marketplaces are now open in every state that make it easier to shop for, apply and enroll in insurance coverage. Through your state’s Marketplace, you can see all of your choices in one place, know upfront what your premium, deductibles, and out-of-pocket costs will be and make apples-to-apples comparisons of the different private health insurance plans available to you before you decide to enroll. The Marketplace also determines whether you qualify for financial assistance to help make health insurance premiums more affordable. You can access your state’s Marketplace online at www.healthcare.gov or by phone, toll-free, at 1-800-318-2596.

A. The next open enrollment period begins November 1 and ends January 31. However, in special circumstances, such as if you lose your health insurance coverage, get married, or move, you may also be eligible to enroll at that time, even if it’s not during an open enrollment period. Likewise, if you have or adopt a child, that child is immediately eligible to be signed up for coverage. To find out whether you may be eligible to purchase coverage immediately through a Special Enrollment period, check out this tool, https://www.healthcare.gov/screener. Finally, individuals who qualify for Medicaid or the Children’s Health Insurance Program can apply and be enrolled at any time throughout the year.

A. There are several different ways to apply for coverage: Applying online through the website www.healthcare.gov is the quickest, easiest way for many people to apply. You can also apply by phone (1-800-318-2596), in person, or by mail in every state. You can find local in-person assistance by visiting localhelp.healthcare.gov or by visiting your state’s Marketplace website.

A. Every health insurance plan sold through the Marketplaces is required to cover a core set of benefits called Essential Health Benefits. The 10 categories of essential benefits include the range of services important to heart disease and stroke patients, including hospital care, doctors office visits, emergency services, prescription drugs, lab tests, rehabilitative and habilitative care, and preventive screenings and services. The services covered are intended to be similar to the benefits provided by a typical employer plan.

A. No, consumers can’t take benefits out of a plan. At a minimum, every health plan sold to individuals and small businesses must provide coverage for all 10 categories of essential health benefits. Even though a person may not need every benefit in a plan, plans must cover all of the essential benefits to share risk across a broad pool of consumers and be sure all benefits are available for everyone. This also helps to protect people from risks they can’t always predict across their lifetimes.

A: For the vast majority of Americans, if you currently have health insurance coverage and you like that coverage, you’ll be able to keep it. Most Americans who are currently insured receive their coverage through their employer or through a government program like Medicare or Tricare and two-thirds of them are satisfied with that coverage.

A relatively small percentage of Americans who currently buy coverage on their own have been notified by their insurer that their policy is not being renewed because it does not include all of the consumer protections required by the health care law. Consumers who were covered by these policies as of October 1, 2013 may be able to keep this coverage through 2016, provided their insurance company and their state permits it. Consumers should check with their insurance company to see whether they have such a policy and if so, whether they have the option to renew it.

Consumers should make sure they understand all of their coverage options before deciding to remain on a plan that doesn’t provide all of the protections required by the health care law. Many of these people may find that they qualify for better, more affordable coverage by shopping through the Health Insurance Marketplace.

A: Most importantly, health reform will provide American families with peace of mind that they will always have access to quality, affordable coverage, even if they lose their job, switch jobs, or move. Reform will also ensure that insurance companies can no longer cancel your insurance if you get sick or put annual or lifetime limits on the coverage for which you’ve been paying. And reform will help to get a handle on rising health care costs so that insurance is affordable in the future. For example, about 13 million Americans are expected to get rebates from their insurance company in 2012 as a result of the new requirement that insurers spend at least 80 percent of premium dollars on paying medical claims or improving quality, not on administrative expenses.

A: The reform law is already improving coverage for Medicare beneficiaries and improving the quality of care they receive. For example, approximately 6.3 million Medicare beneficiaries whose prescription drug costs reached Medicare’s coverage gap (or “doughnut hole”) have saved $6.1 billion on their prescription drugs, and the gap will be eliminated completely by 2020. The law also eliminates cost-sharing for preventive services in Medicare and added a new annual wellness exam to Medicare. About 34 million Medicare beneficiaries have received at least one free preventive service as a result of this provision. While steps are being taken to reduce waste, fraud and abuse in Medicare, the new law has not cut Medicare benefits or increased seniors’ out-of-pocket Medicare costs nor does it deny seniors end-of-life care.

A. Yes, a Marketplace is available to consumers in each of the 50 States plus D.C. If you live in a state that has opted not to establish its own Marketplace, then the U.S. Department of Health and Human Services is operating the Marketplace in your state. So regardless of where you live, residents will have the new insurance options provided by the Marketplace, as well as the benefit of the new insurance protections.

With respect to Medicaid, it currently appears that approximately half of the states will not expand their Medicaid programs for 2014. That is truly unfortunate and does mean that some of the poorest people in these states may not be able to access coverage that they can afford. However, some of these poor uninsured will still have the option of getting coverage through their state Marketplace. They also will qualify for financial assistance to help make both their premiums and their cost-sharing affordable. In addition, some of them may already be eligible for Medicaid under your state’s existing eligibility rules. Individuals who don’t have insurance coverage should check with their state’s Marketplace to find out what assistance they qualify for.

A. Starting January 1, 2014, all individuals and their children are required to have some type of health insurance coverage, unless there is no affordable insurance available to them. The vast majority of Americans already have coverage and are already meeting this requirement. Those people who can afford coverage but choose not to obtain it will be subject to a tax penalty. For those who don’t have health insurance in 2016 or beyond, this penalty will be 2.5 percent of their annual household income or $695 per person, whichever is greater.

A. Yes, a new type of tax credit, called the Health Insurance Premium Tax Credit, is available to individuals and families buying their health insurance coverage through the Marketplace. This is to help make the premiums affordable. The amount of the tax credit that an individual can receive depends on their income and family size. Those with the lowest incomes may be eligible for a health plan with no premium. An individual who qualifies for a tax credit can choose how they want to take their credit. They can take the credit right away and pay a lower health insurance premium each month. Or they can decide to take the credit later and either subtract the amount of their credit from the taxes they owe at the end of the year or get a bigger refund. People with income up to 400 percent of the federal poverty level – that is more than 90 percent of the people who are currently uninsured –are eligible for this tax credit.

A: The American Heart Association supports the principle of individual responsibility, provided that the coverage is made affordable. Under health care reform, insurance plans will no longer be able to deny coverage to those with preexisting conditions or charge them higher premiums because of their medical needs, which will help tremendously in making coverage available and affordable for heart disease and stroke patients. In return, however, individuals can’t be allowed to wait until they have an accident or develop a chronic condition to sign-up for insurance. This would make insurance unaffordable for everyone. If we require insurers to cover everyone – regardless of their health status – we need to be sure that there are healthy individuals in the insurance pool to balance the high costs of sicker patients.

A: The health reform law is already making care more available and affordable for millions of people with heart disease and stroke who are uninsured or who have inadequate coverage. While the law certainly isn’t perfect, we believe it makes a number of important improvements to the current health care system that we can build on in the years to come. The AHA has long recognized that the current healthcare crisis in the United States threatens our central mission of building healthier lives, free of cardiovascular disease and stroke. The reform law preserves what works in our current health care system; includes an important and long overdue emphasis on preventing illness; and will help to improve the quality of care that everyone receives. The law also includes important new consumer protections to ensure that health plans meet their obligations to pay for needed care. Read more about how the law is already benefitting people with heart disease and stroke.

A: No. This concern is based on provisions in the law that authorize “comparative effectiveness research.” This research will evaluate which drugs or other treatments work best for different medical conditions and different patients. The American Heart Association supports this research because it will provide doctors and their patients with more and better information to help them decide the best course of treatment. Ultimately, however, doctors and patients − not insurance companies or the government − will decide what treatment is best.

A: This is false. The law requires that Members of Congress get their health insurance coverage through the new Health Insurance Marketplaces that are being established in every state by October 1, 2013. In other words, Members of Congress will have the same choices of private coverage that other Americans are being given under the reform law.

A: The goal of health care reform is to make health care more affordable for individuals and families as well as for our nation. Americans pay more for our health care than any other country, in part because we are covering the uninsured in a very inefficient way after they get sick and seek care at an emergency room. Some estimate that individuals with insurance pay up to $1,100 more per year through higher premiums and taxes because of uncompensated care received in public hospitals and emergency rooms. The exact impact of reform on the cost of your insurance premiums will depend on what type of coverage you have and on your particular circumstances. However, the non-partisan Congressional Budget Office has estimated that for most Americans (who get their coverage from large employers), premiums will be up to 3 percent lower in 2016, relative to current law.

A: The final health reform law does not extend coverage to illegal immigrants. The American Heart Association remains committed to improving the cardiovascular health of all U.S. residents, including undocumented individuals. As a society we are already paying a high cost for ignoring the health care needs of these individuals (through higher emergency department utilization, preventable and avoidable hospitalizations and the associated costs of untreated cardiovascular disease).

A: Most of the provisions of the health care law have now taken effect. Some important protections and changes took effect in 2010: For example, private health plans are no longer allowed to deny coverage to children with pre-existing conditions, to drop people from their coverage when they get sick, or impose lifetime caps on care. Also, the smallest employers are now eligible for tax credits to help make it affordable to offer coverage to their employees, more than 130,000 Americans who were uninsured due to a pre-existing condition gained access to insurance through Pre-existing Condition Insurance Plans, and Medicare beneficiaries impacted by the prescription drug “doughnut hole” are getting discounts on their medications. Beginning October 1, 2013, state-based Health Insurance Marketplaces opened in every state to provide affordable coverage to those who are currently uninsured. And on January 1, 2014, the remaining insurance reforms, such as the ban on private insurance companies denying coverage or charging higher premiums to people with pre-existing conditions, took effect.