Some states will require insurers to specifically pay for bariatric surgery, but that will vary across the country. You'll need to check the plans you're considering buying very carefully to see if the services you need are specifically covered. Beyond that, it's important to keep in mind that whether surgeries and other treatments are covered are determined by their medical necessity. With regard to limitations, again, you cannot be turned away because you're obese and you cannot be charged more for your health plan either.
Yes, Michael, your daughter should absolutely check the marketplace starting October 1, 2013. She can shop for and purchase a plan this fall that will take effect January 1, 2014. She cannot any longer be denied coverage, and depending on her income, she may get a price break on her health plan.
A tax credit under the law translates to your health plan cost being reduced. People do have the option of paying the full price of insurance throughout the year and then taking the credit at tax time. But most people will choose to have the credit applied to their health plan so they pay less for it each month. If you don't make enough money to file taxes, you will no doubt qualify for Medicaid, and hopefully you live in a state that has decided to expand its program. If you do, you'll gain coverage at no cost to you. Also, if you don't make enough money to file taxes, you won't be held responsible for getting coverage. So if you don't have insurance, you won't be on the hook for the penalty.
A question we get a lot is, "What happens if you purchase a plan and then in the middle of next year your needs change?" Would you please explain the circumstances under which you can change policies?
There will be open enrollment periods during which you can select and purchase a health plan. The first year the ACA takes effect, it will run from October 1, 2013 through March 31, 2014. Unless you experience what’s called a “qualifying event” – you get married, have a baby, divorce or otherwise lose existing health insurance coverage – you will only be able to switch plans during the open enrollment periods.
The income that counts are things like your salary, unemployment income, pensions, and social security income. Your assets do not count. You'll need to estimate what your income is likely to be for 2014 when applying for coverage.
Miss Red, insurance companies need to build their provider networks in advance of plans being released on the marketplaces, so many doctors have already been approached by insurers and asked to join. Many healthcare providers are now considering whether or not they'll choose to participate in those plans, just as they would any insurance company network.
Another question we receive is whether or not anything will change with the high risk insurance pools because of the ACA.
Yes, the high risk pools made available under the Affordable Care Act were intended to function only as a bridge to coverage until the ACA took full effect. So the plan is to transition people now covered by these plans onto plans sold through the state marketplaces and for the high risk insurance pools to eventually shut down.
Beginning in this fall, people will receive information about open enrollment and their health insurance options via the new online markets. The same is true for people enrolled in state high-risk pools, which is existed prior to those set up under the ACA.
Starting October 1, 2013, open enrollment will begin on the exchanges and people will be able to shop for a health plan. Those enrolled in a new plan before December 15, 2013 will have coverage that takes effect January, 1, 2014.