Your Guide to the New Healthcare Laws

Healthcare is changing –and so are your choices.

Nothing is more important than your health.

We believe you deserve to keep up with the

changes that will make a difference in your life.

After all, you have a right to understand the new

healthcare updates and how they impact you.

Stay informed. Stay in charge. Stay healthy.™

1

What will you learn in this guide?

The biggest, most important change to healthcare

in decades, the Affordable Care Act (ACA)

makes sure that more Americans can get health

insurance and stay healthy. This guide helps you

understand everything you need to know.

Learn About the New Affordable Care Act 2

Discover the Benefits of the ACA 4

Section Page

Navigate the Health Insurance Marketplace 8

Review Health Insurance Basics and Words to Know 14

2

What is the Affordable Care Act?

2010 2013 2014 2015 2016

MARCH: ACA bill passed

OCTOBER: Open enrollment begins

Health Insurance Marketplaces open in every state

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3

Before, you did not need to have

health insurance. Now that this

law has passed, almost every

American will have to have

health insurance.* This will begin

in January of 2014.

The ACA makes it easy to

choose the right plan. It does

this through a Health Insurance

Marketplace.

So let’s go over some of the

most important parts of the ACA.

You need to stay in charge

of your health.

Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.

Penalty Tax: If you don’t have health insurance, you will pay additional taxes on your tax return. These taxes will increase over time.

Open Enrollment: A period of time during the year when people can buy or make changes to a health insurance plan.

2010 2013 2014 2015 2016

WORDS TO KNOW

MARCH: Open enrollment ends

Everyone must have health insurance*

*except some religious groups and some financial situations

Penalty tax begins Bigger penalty taxes begin

OPEN ENROLLMENT

JANUARY: If you have enrolled, your health insurance starts

4

The ACA brings a lot of new changes to

the way that our healthcare system works.

Here are some of the main benefits that

you might notice.

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5

How does the ACA make healthcare better?

Coverage for those with pre-existing conditions.

If you have a pre-existing condition, you are able

to obtain coverage. Some examples of pre-existing

conditions are diabetes, pregnancy or a history

of heart problems.

No lifetime limits.

Your health insurance company will keep paying

your healthcare needs no matter how much you

need. It won’t run out.

Increased coverage for children.

Kids can stay on a parent’s healthcare plan until

they are 26 years old. Some states may increase

this age limit.

6

How does the ACA make healthcare better? (Continued)

Covered preventive care for women.

Some of these services are:

• Breastfeeding support and supplies

• Well-woman visits

• FDA-approved birth control methods

• Gestational diabetes screenings

Better benefits and more preventive care.

Yearly checkups are covered. And, a lot of preventive

services are also covered — such as blood pressure tests,

shots and some cancer screenings.

Continued care for Medicaid.

In most cases, there are no changes to how Medicaid will

operate in your state. And some states may expand their

Medicaid coverage to include even more people.

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Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.

Premium: The amount of money you pay each month in order to have health insurance. Premiums depend on:

• Your age

• Whether or not you smoke

• Where you live

If you are on Medicaid, you do not have to pay a monthly premium.

Subsidy: The amount of money the government pays to your insurer to help pay your premium.

Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.

Fair coverage at a fair cost.

Insurance companies can only look at your age,

where you live and whether or not you smoke to

figure out how much your health plan will cost.

More opportunities for subsidies.

One of the ACA’s main goals is to make sure

everyone can afford health insurance. In some

cases, the government helps pay for your

premium. This is called a subsidy.

Health Insurance Marketplaces.

By October 2013, each state will have its own

Health Insurance Marketplace.

WORDS TO KNOW

8

What is a Health Insurance Marketplace?

With the new healthcare law, you might have to shop for health insurance for the

first time. A Health Insurance Marketplace, an online shopping mall of healthcare

plans, makes it easier. Healthcare plans on Insurance Marketplaces come from

different insurance companies. The government approves these plans.

On the Insurance Marketplace, you will be able to see all the plans

at one time. This will let you compare your choices. You will be able to:

• Find out how much of a subsidy you can get

• Shop for a plan

• Sign up for a plan

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Subsidy: The amount of money the government pays to your insurer to help pay your premium.

Federal Poverty Level: The set minimum income a family needs for food, clothing, transportation and shelter. The government decides this level. It depends on your income and the size of your family. For more information on the Federal Poverty Level, visit http://aspe.hhs.gov/poverty/13poverty.cfm.

Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.

How do subsidies work?

You may qualify for a subsidy on a Health Insurance Marketplace.

In order to qualify for a subsidy, you must make between 100% and

400% of the Federal Poverty Level.* People who can get health

insurance through their employer or through public coverage, like

Medicaid, cannot, in most cases, qualify for a subsidy.

If you qualify, your subsidy is based on your income and family size.

*The Federal Poverty Level range, as it pertains to subsidy eligibility, may change based on the state you live in.

100% Federal Poverty Level 400%

Max

imum

Sub

sid

y

Subsidy

Income

WORDS TO KNOW

10

How will you use a Health Insurance Marketplace?

Shopping for health insurance on

a Health Insurance Marketplace

is simple. To find a plan on an

Insurance Marketplace, you can

go online or call a toll-free number.

An impartial person will be there to

help you over the phone.

There are four steps to buying a

plan on an Insurance Marketplace: • Enter your information (for example: family size, income) online to see your eligibility for Medicaid and/or an Insurance Marketplace healthcare plan. You can also submit your application by mail.

• You will see how much of a subsidy you may get, based on your status. This will show you how much you will pay for healthcare coverage.

• If you are eligible for an Insurance Marketplace product, you will get a list of plan options.

Filing a tax return

by the deadline every

year (April 15) will make this step

easier.

11 22Enter Your Information

Online

Compare Plans

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• Choose and buy a healthcare plan.

• After you enroll, you will receive a welcome packet and an ID card from your new health plan.

• Your coverage may begin as soon as January 2014.

• You can relax now.

Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.

Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.

Subsidy: The amount of money the government pays to your insurer to help pay your premium.

3 4Choose Your Plan

Start Coverage

WORDS TO KNOW

12

Every health plan on the Insurance Marketplace

will include these Essential Health Benefits:

Essential Health Benefits:

Emergency services

Prescription drugs

Laboratory services

Preventive and wellness services

Outpatient or ambulatory

services

Mental health and substance abuse services

Various therapy services (such as physical therapy)

and devices

Maternity and newborn care

Pediatric services

Hospitalization

What benefits will your new plan include?

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All Insurance Marketplaces will offer plans with four different levels of

costs. The Essential Health Benefits are covered and will be equal

across all plans.

Every insurance plan on the Marketplace is a primary health

insurance plan. It is not secondary or supplementary insurance.

No matter which plan you

choose, you may still be able to get a subsidy.

+

-+

-

Cost to You Based on Plan Choice

Monthly Premium Payment

Plans

Bronze

Silver

Gold

Platinum

Out-of-Pocket Expenses

(coinsurance and deductible)

Plan Options

What types of plans will be offered on the Insurance Marketplace?

14

How much you pay depends

on the plan you purchase.

Now that you know more about the

ACA, it’s important to understand how

paying for insurance works.

The next page shows what type of healthcare payments you’ll have

over a year. How much you pay depends on the plan you purchase

and how much medical care you need over a year.

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What type of healthcare payments might you make over a year?

PremiumWhat you pay every month, all year, for your health insurance.

Co-PayThe set amount of money you pay at the time of certain medical services.

DeductibleHow much you pay for certain services, in total, before your insurance starts to pay.

Depending on how much healthcare you need, you might meet your deductible or you might not.

Out-Of-Pocket MaximumThe total amount you’ll spend for healthcare, after which the insurance company pays for all your medical care until the year ends.

Depending on how much healthcare you need, you might meet your out-of-pocket maximum or you might not.

CoinsuranceThe portion of your medical bill you pay, for certain services, after you meet your deductible.

JANUARY

16

Coinsurance: This is the percentage you pay, for certain services, while your insurance company pays the rest (after deductible is met).

Example: You meet your deductible. You have 20% coinsurance, and your insurance company pays 80% for a $100 service. You will pay $20 and the insurance company will pay $80. The percent you pay remains the same until you reach your maximum out-of-pocket limit. Your plan will then pay 100% of the costs.

Co-pay: The set amount of money you pay at the time of a certain medical service. You also might pay this when you pick up a medication. Your co-pay depends on the type of covered service.

Deductible: The fixed amount of money you have to pay for certain services each year before your insurance company begins to pay. After you meet your deductible, your health insurance will begin to pay for these services. Plans with high deductibles usually have lower monthly premiums, and vice versa.

Federal Poverty Level: The set minimum income a family needs for food, clothing, transportation and shelter. The government decides this level. It depends on the size of your family. For more information on the Federal Poverty Level, visit http://aspe.hhs.gov/poverty/13poverty.cfm.

Health Insurance Marketplace: An online marketplace that makes it easy for you to compare and buy health insurance plans.

Medicaid: The healthcare program that provides medical coverage for low-income families. This program is managed by states, in partnership with the federal government.

Open Enrollment: A period of time during the year when people can buy or make changes to a health insurance plan.

Out-of-Pocket Maximum: This amount is the most you pay during a plan period (usually a year) before your health insurance plan starts to pay 100% of your medical services. This does not include your monthly premiums. It includes co-pays, deductibles and coinsurance that you pay.

Premium: The amount of money you pay each month in order to have health insurance. Premiums depend on:• Your age • Whether or not you smoke• Where you live If you are on Medicaid, you do not have to pay a monthly premium.

Subsidy: The amount of money the government pays to your insurer to help pay your premium.

Words to Know

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Want to learn more?

Stay informed. Stay in charge. Stay healthy.™

© 2013 Magnolia Health Plan. All rights reserved.

Knowledge is healthy. If you have more questions

about the ACA or Health Insurance Marketplaces,

call 1-877-687-1187 (TDD/TTY: 1-877-941-9235).

Some information contained in this brochure was

gathered from these helpful resources:

www.healthcare.gov and http://healthreform.kff.org

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