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Published on November 27, 2013

What You Need To Know About the Affordable Care Act

In Brief

  • In accordance with the Affordable Care Act, open enrollment for uninsured citizens to purchase health coverage on the Health Insurance Marketplace is available between Oct. 1, 2013 and March 31, 2014, but to qualify for insurance coverage by Jan. 1, 2014, individuals should enroll by Dec. 15, 2013.
  • In choosing a plan, individuals should consider a number of factors, such as the medical and financial needs of themselves and their families, and extra services (such as dental and vision) that are not covered in standard benefits packages.
  • To help people better understand the new law, Crozer-Keystone Health System has created a Health Insurance Marketplace resource guide for patients, providers and the community on its website.  Also, Crozer-Keystone has been designated as a Certified Application Counselor Organization by the Centers for Medicare and Medicaid Services (CMS) and is providing counseling service for people who need help

There’s been a lot of discussion about the Affordable Care Act (ACA or Obamacare), but little of it has covered exactly what it means to the average citizen. Yes, the ACA has garnered intense debate and stirred up a storm of controversy over the last couple of years. But now that some of the law’s policies went into effect on Oct. 1, there are some crucial things you should know about it beyond the political debate.

It’s important to note that the implementation of the new law may vary from state to state, so your friend’s choices in another part of the country may be different from yours. Here’s an overview of what the ACA does and how you can start taking advantage of it in Pennsylvania:

What Does the ACA Entail?

Starting October 1, 2013, open enrollment is available for uninsured citizens to purchase health coverage on the Health Insurance Marketplace. Even those with pre-existing health conditions, who have had difficulty purchasing health coverage, will have the ability to purchase individual coverage that will become effective Jan 1, 2014. Open enrollment is available until March 31, 2014, but to qualify for insurance coverage by Jan. 1, 2014, individuals should enroll by Dec. 15, 2013. Rates will be determined for individual and small group plans based upon the following criteria: individuals who will be covered under the plan, their age, where they live, if they smoke, and the type of plan selected.

The ACA also requires essential health benefits to be provided to those who purchase their own health insurance and those who receive benefits from a small business employer (50 or fewer employees). Employees are also now considered full-time if they work at least 30 hours a week.

To further increase health insurance coverage, many states will begin expanding their Medicaid programs.

What Are the Essential Health Benefits?

The ACA requires that all health plans offered to individuals and small businesses must include the following core benefits:

1.     Preventive, Wellness, and Disease Management Services
2.     Emergency Care
3.     Ambulatory Services
4.     Hospitalization
5.     Maternity and Newborn Services
6.     Pediatric Services
7.     Prescription Drugs
8.     Laboratory Services
9.     Mental Health and Substance Abuse Services
10.    Rehabilitation and Habilitation Service

There are no annual or lifetime limits on the amount your health insurer will pay for these essential benefits. Your health insurer will be prohibited from increasing fees if you become sick.

How Do You Choose a Plan?

First, you need to determine the medical and financial needs of you and your family. Consider what types of health services you require that may not be covered in the core benefits; for instance, dental and vision are often not covered in standard benefits packages. Note any type of medication you take and specific doctors or specialists you need or want to continue seeing. This will help you choose the right insurance plan that either covers your prescription and includes your doctors in its network, or that has low co-pays and out-of-network fees.

You should also decide how much you want to pay in monthly premiums (the fee you pay your insurance company each month) and for cost-sharing fees, such as deductibles and co-payments.

To purchase an insurance plan, visit the Health Insurance Marketplace, which allows you to review and compare all available insurance plans. You can also use the tool to verify your eligibility for Medical Assistance or tax credits.

Most insurance companies now provide similar tools on their websites to help you find a health care plan, which is a good option if you already know the company you want to go with.

Once you’ve narrowed down which health plans you’re interested in, you should then research the insurance companies. Some insurance companies offer more perks than others, such as extra support for chronic diseases or wellness programs.

These tips just scratch the surface of selecting a health care plan; for more information, visit https://www.healthcare.gov/.

How Crozer-Keystone Health System Can Help You with the Affordable Care Act

Attention Seniors on Medicare: No new changes for you.
If you are a senior on Medicare, your Medicare benefits are not changing, and you do not need to make any changes related to the Affordable Care Act. Medicare Open Enrollment will be offered Oct. 15 through Dec. 7, 2013, as scheduled, but it is not part of the new Health Insurance Marketplace.

The United States Department of Health and Human Services cautions seniors who are on Medicare to beware of fraudulent activity, especially during the Medicare Open Enrollment period. It is against the law for someone who knows you have Medicare to sell you a Marketplace plan. For more information, visit StopMedicareFraud.gov.

For more information about the Affordable Care Act, visit https://www.healthcare.gov/. To review and compare all available insurance plans and make a purchase, visit the Health Insurance Marketplace https://www.healthcare.gov/marketplace/individual/ pages. For more information about fraudulent sales activity directed at seniors on Medicare, visit StopMedicareFraud.gov.

Contact Us

Crozer-Keystone Health System

Grant Gegwich, Vice President

Phone: 610-447-6316
Fax: 610-447-2015
Pager: 610-604-1728

Crozer-Chester Medical Center

Grant Gegwich, Vice President

Phone: 610-447-6316
Fax: 610-447-2015
Pager: 610-604-1728

Kate Stier, Director

Phone: 610-447-6314
Fax: 610-447-2015
Pager: 610-541-3130

Community Hospital

Grant Gegwich, Vice President

Phone: 610-447-6316
Fax: 610-447-2015
Pager: 610-604-1728

Kate Stier,  Director

Phone: 610-447-6314
Fax: 610-447-2015
Pager: 610-541-3130

Springfield Hospital

Grant Gegwich, Vice President

Phone: 610-447-6316
Fax: 610-447-2015
Pager: 610-604-1728

Kate Stier,  Director

Phone: 610-447-6314
Fax: 610-447-2015
Pager: 610-541-3130

Healthplex Sports Club

Grant Gegwich, Vice President

Phone: 610-447-6316
Fax: 610-447-2015
Pager: 610-604-1728

Kate Stier, Director

Phone: 610-447-6314
Fax: 610-447-2015
Pager: 610-541-3130

Delaware County Memorial Hospital

Mary Wascavage
Director of Public Relations and Marketing

Phone: 610-284-8619
Fax: 610-284-8606
Pager: 610-318-0861

Taylor Hospital

Mary Wascavage, Director

Phone: 610-284-8619
Fax: 610-284-8606
Pager: 610-318-0861