Make the Affordable Care Act pay off for you

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Three years ago, the Affordable Care Act was passed by Congress and signed into law by President Barack Obama. This historical law is structured to transform health care in America. To start, it will grant health care to people who could not otherwise afford it.

According to the 2010 Census, 20 percent of African-Americans do not have health insurance. Additionally, 28 percent of African-Americans rely on Medicaid for health insurance.

Some experts say that the slow economic recovery and high unemployment rates contribute to the high levels of uninsured Americans.  There are also many Americans who are working full time but cannot get health insurance through their employer. This presents an estimated $73 billion dilemma for the country.

Now that the Affordable Care Act is law, consumers can start exploring health insurance plans that will suit their needs and budgets, protect their rights, and lower the cost to tax payers.

It begins with the Marketplace.

Part of the health care act includes providing an exchange that puts the consumer in control of their health insurance. Consumers have the power to determine which plan will work best for them and they are protected from discriminatory practices that, in the past, would have locked them out of coverage.

How it Works

Beginning in October 2013, consumers will shop for health insurance the same way they shop for travel deals: comparatively. They will log on to their state’s health department website and compare the plans, the costs, and the benefits side-by-side. Insurers can no longer refuse to sell consumers a policy and must comply with the new consumer protections. If a customer prefers to purchase insurance on their own through a private broker, they are free to do so as well.

Open enrollment will begin on October 1,2013 and end on March 31, 2014.  Within that time frame, consumers must apply for the insurance of their choice.  By the end of 2014, everyone who files taxes must provide proof of health insurance.  If they fail to do so, they may incur a penalty from the IRS.

The Essentials

All health insurance plans will offer a basic essentials package. Anton Gunn, director of external affairs in the Office of Intergovernmental and External Affairs (IEA) at the U.S. Department of Health and Human Services, describes the essentials as everything you need to remain healthy.

“Beginning in October, all health insurance plans will have something called essential health benefits,” he explains. “It will cover ambulatory care, patient care, and hospital care. “

He adds that the package covers services that were not always offered in the past or were more costly, such as maternity and newborn care, mental health and substance abuse. Prescription drugs and preventative services like mammograms and flu shots are included.

“All the preventative care services you need to stay healthy,” Gunn says. “So beginning in October, there are going to be a lot of benefits for a lot of people that they didn’t have before the Affordable Care Act.”

The ‘Look Fors’

When shopping for health insurance, it is important that the consumer closely examines their own needs so that they can find the options that best fit their situation. According to Healthcare.gov, there are several “Look Fors” that should be considered when exploring the marketplace. Some notable suggestions are:

• Determine what you will have to pay out of your own pocket for covered services (deductible, co-insurance, copayments, and out-of-pocket limit)
• Check whether the plan’s health care providers include your current providers.
• Inquire about whether or not the provider’s location is convenient for you.
• Check whether the plan covers the health care services and medications you require.
• Beware of insurance-like products that don’t offer comprehensive coverage.

Gunn explains that there are several programs that sound like insurance coverage but fail to provide coverage for what a patient really needs.

“I used to have a type of coverage that gave me a card for my pocket, but when I went to use it there were so many important services that weren’t covered like lab work,” he recalls. “It only covered things like accidents. It didn’t cover many of the things that I needed. So beware of that kind of coverage.”

Giving consumers the power of choice is just one of the features of the Affordable Care Act. Over the next few articles, theGrio.com will explore what else the public can expect from this law and how it will change health care in America.

For more information about the marketplace, visit www.healthcare.gov.

Candace Y.A. Montague is a health advocate and freelance writer in Washington, D.C.  She is the DC HIV/AIDS Examiner for Examiner.com.  Candace is also a contributor to The Body.com, The Black AIDS Weekly, and East of the River Magazine, a publication of Capital Community News.  Writing is her activism.