The Affordable Care Act â also known as health reform or âObamacareâ â was ... In the Marketplace, you can shop
The Affordable Care Act and Autism The Affordable Care Act – also known as health reform or “Obamacare” – was signed into law on March 23, 2010. The health reform law is expected to affect millions of Americans, including the autism community. Autism Speaks knows that health insurance is complicated but we want to help you make sense of these changes so you can make the best choice for your family. We have developed this series of fact sheets to provide factual information about some of the law’s most significant reforms and how they might affect you.
What Does the Affordable Care Act Mean for Me? What if I already have health insurance? If you already have insurance through your job, Medicare, Medicaid, TRICARE, or veteran’s coverage, you can keep it. And, since you’re already covered, you won’t have to pay the fee that uninsured people will have to pay in 2014. You’ll also notice a few new benefits too – for example, insurers can no longer put a dollar cap on how much they will pay for your care or deny your coverage because of a preexisting condition. If you’re unhappy with your existing coverage, the Affordable Care Act provides an opportunity to explore your new coverage options. For example, you might currently get health insurance through your employer but the employer’s insurance doesn’t include coverage for applied behavior analysis (ABA). If you’d like, you can check whether the plans offered through the new Health Insurance Marketplaces in every state will cover ABA services. If so, you can explore whether this coverage (including a child-only policy) is an affordable option for you and your family. Based on Autism Speaks’ analysis, ABA coverage will be available through the Marketplaces in at least 26 states and the District of Columbia. Keep in mind that there are important considerations in switching from job-based coverage to an individual policy in the Marketplace. First, most employers pay a portion of your premiums – if you choose a Marketplace plan, the employer will no longer contribute to your premiums and you’ll pay the full cost. Second, the law includes ways to reduce monthly premiums and out-of-pocket costs for low-income Americans. If you turn down your job-based coverage, you may not qualify for this financial assistance, even if your income would qualify you otherwise.
What if I’m uninsured? If you’re uninsured, you will have to get health insurance. In fact, most Americans will have to have health insurance by 2014 or else pay a fine. You can explore your new coverage options under the Affordable Care Act using the new Health Insurance Marketplaces that are available in every state. In the Marketplace, you can shop online, over the phone, or in-person for a plan that fits your budget and your needs. You can also learn whether you are eligible for financial assistance or coverage through Medicaid or the Children’s Health Insurance Plan. Financial assistance will be available based on your annual income. If you need help understanding your options, there will be trained individuals and organizations that you can turn to. You can use this tool to find help in your area or you can call 1-800-318-2596 (available 24/7). Will I have to have health insurance? Yes. The health reform law requires most Americans – with some exceptions – to have health insurance beginning in January 2014. If you don’t have insurance, you will have to pay a penalty. In 2014, the penalty is 1 percent of your yearly income or $95 for the year, whichever is greater. The penalty increases each year. Want to know more about what the requirement to buy health insurance means for you? This quick infographic may help. When should I buy health insurance? Beginning in 2014, insurers will have to offer coverage to anyone that applies. However, you can only apply for coverage during certain times, known as “open enrollment periods.” This year, if you are uninsured, buy your own health insurance, or want to check out your new options, you can apply for coverage inside and outside of the new Marketplaces between October 1, 2013 and March 31, 2014. In the future, this time period will be shorter – from October 15 to December 7 of each year. If you’re signing up this year, you may want to do so by December 15, 2013 so that your benefits begin on January 1, 2014. (You can still sign up after December 15, 2013, but your coverage won’t begin right away.) Although most people will sign up for coverage during the open enrollment period, you can also consider your coverage options if there is a certain change in your life, known as a “qualifying life event.” Qualifying life events include having a baby, getting married or divorced, becoming eligible for financial assistance, or losing your existing coverage. If you have one of these events, you are entitled to a “special enrollment period” where you can change your coverage by, for example, adding a new dependent.
Do I have to buy health insurance through the Marketplace? No, you do not have to buy health insurance through the Marketplace. Although most people can shop through the Marketplace if they choose to, the Marketplace is primarily an option if you are uninsured or buy your own health insurance. This is because you may qualify for financial assistance that makes coverage more affordable – and this assistance is only available through the Marketplace.
