Glossary

Health Care Reform

Health care is constantly changing. In the midst of all that change, it’s nice to have some clarity on what’s happening. We’re here to tell you the basics of health care reform, what’s changing, and how it may affect you.

The Affordable Care Act (ACA) itself is nearly 11,000 pages long! No one expects you to read that much legal jargon, but the law is important and affects us all. We’ve put together an overview of the law so you can understand how it affects your health and wallet.

Read on to learn some important facts about the ACA.

What is the Affordable Care Act?

The Affordable Care Act is a federal law that changes how many people get health insurance, particularly people who work at small businesses or buy coverage on their own.

Why was it created?

Health care reform was created to:

  • Help more people get health care.
  • Slow the growth of health care costs.
  • Improve people’s health.

Will it affect me?

Chances are, yes, it’ll affect you. Health care reform affects almost everyone.

Insured: With health care reform, people with health insurance get more coverage for free than ever before.

Uninsured: Nearly 50 million Americans who don’t have health insurance will be able to get it.

What’s changed?

No one can be turned down for health care coverage even if they have existing health problems, such as asthma, diabetes, cancer, or heart disease.

Young adults up to age 26 can be covered under their parent’s health plan.

Adults can receive more preventive screenings and immunizations at no charge, including:

  • Blood pressure screenings.
  • Cholesterol screenings.
  • Colonoscopies.
  • HIV screening and counseling.

Women can receive certain health care services at no charge, including:

  • Breast-feeding support and counseling.
  • Mammograms.
  • Well-woman exams.

Men who smoke can be tested for an aneurysm at no charge.

Read “Health Care Reform Coverage for Preventive Health Benefits” for a complete list of screenings and immunizations that are usually covered. Some exceptions may apply. Check with your health plan for details.

What’s changing in 2014?

  • Almost all Americans must have health insurance by March 31 or risk paying a fine.
  • Insurers will offer new ACA health plans to small businesses and individuals.
  • Rates for new ACA health plans will be based on age.
  • ACA health plans starting in 2014 will cover these 10 essential health benefits:
    • Ambulance service.
    • Emergency care.
    • Hospitalization.
    • Maternity and newborn care.
    • Mental health and substance use services.
    • Pediatric oral and vision services.
    • Prescription drugs.
    • Rehabilitation.
    • Laboratory services.
    • Services for preventive care, wellness, and chronic disease management

How can I get health insurance?

I have a health plan through work.

If you work for a large business with more than 50 employees, your health plan won’t change much. The state will decide whether large companies can use state health insurance marketplaces starting in 2017. In the meantime, you can continue getting your health care coverage through your employer.

If you work for a small business with up to 50 employees, your employer will decide whether to continue offering existing plans or switch to new ACA plans that meet health care reform requirements. Your employer will also decide whether to allow you to buy a health plan on the state health insurance marketplace.

I get health care coverage on my own.

If you have an individual health plan, you can either extend your current plan for another year or switch to a new ACA plan that starts in 2014. You can either buy insurance directly from a health insurance company or on your state’s health insurance marketplace.

I don’t have health care coverage.

Health care reform requires most people to have health insurance in 2014, or risk paying a fine to the Internal Revenue Service. You can either buy insurance directly from a health insurance company or on your state’s health insurance marketplace.

I don’t have insurance, and I can’t get coverage through an employer.

Your best bet is an individual health plan, and you have several options to buy health insurance. You can contact a health insurance company directly or online, or shop on your state’s health insurance marketplace. Depending on your income, you could get financial help when you buy coverage on the state health insurance marketplace.

I’m still confused!

If you’ve got questions, call HMSA’s health care reform helpline at 948-6387 on Oahu or 1 (800) 465-4672 toll-free on the Neighbor Islands, Monday through Friday, 8 a.m. to 5 p.m.

For in-person help, visit one of your local HMSA Centers; go to hmsa.com/contact to find locations and hours of operation.

For businesses, contact your HMSA representative or call 948-5555, option 3, on Oahu or 1 (800) 620-4672 toll-free on the Neighbor Islands.

For more information, visit HMSA’s website at hmsa.com/reform.

This information is based on HMSA’s review of the Affordable Care Act (ACA), also known as health care reform. This overview is intended for educational purposes only and should not be used as tax, legal, or compliance advice.

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