This is Part 1 of a 3-Part Segment on Healthcare Reform
1. The Basics
2. Money and Missouri
3. Get Ready
1. The Basics: What You Need to Know About Health Care Reform In Case You Didn’t Know
Many changes take effect starting in 2014.
You’re one of the people that health reform may benefit if:
● You make too little to afford health insurance but make too much or can’t otherwise qualify for Medicaid.
● You have young adult children who need insurance coverage.
● You have an existing chronic or serious health condition, including depression or another mental health concern.
Fewer Limits on Your Coverage
You can have a long-standing health problem (also known as a ‘pre-existing condition’) and still get insurance. No matter how good or bad your health might be, every health plan must let you buy insurance. Plus, having a health problem won’t increase how much you pay for your insurance. This is a big change.
You also don’t have to worry that your health coverage will run out. Insurance companies used to be able to put a yearly or lifetime cap on the amount they would cover. Starting in 2014, your health plan can no longer limit what it spends on your covered benefits each year or in your lifetime. This is another big change. You’ll never “run out” of insurance.
More Affordable Health Plans
Most people are required by law to have health insurance by 2014. But don’t panic – the government has set up new ways to help you. You may be able to buy affordable, even subsidized, insurance through a Marketplace, also called a Health Insurance Exchange or HIE. Every state will have a Marketplace to help you sort out your coverage options and select a plan that best fits your needs. This may help if you don’t have insurance nowor if you have trouble paying for it.
You can begin reviewing your new insurance options right now through your state Marketplace. You can get more information and sign up by phone, in person, or online by visiting www.healthcare.gov. Trained assistants called navigators can answer your particular questions and provide help in signing up. Once you’ve selected a health plan, coverage starts Jan. 1, 2014.
Financial Help to Buy Insurance
In addition to finding a cheaper health plan, you may also qualify for financial help, or subsidies, to help further reduce its cost. You may be able to get a tax credit to lower the cost of your insurance. Whether you qualify for assistance will depend on your income — how much money you think you will make in 2013 — and how many people are in your family. You can find out if you qualify for a tax credit when you apply to buy health insurance through your state’s Marketplace.
Expansion of Medicaid
For others, you might be able to qualify for Medicaid for the first time. In some states, Medicaid is changing its rules because of health reform, and more people will be able to participate. I’ll be covering this in more detail in a later segment because our state has not yet expanded Medicaid.
What’s Already in Effect
Many benefits are already here, but you should check with your health plan about any you’re interested in and haven’t used yet.
● KIDS – Children must be covered by insurance even if they already have a health problem, called a pre-existing condition. If your child develops a chronic condition, such as diabetes or asthma, your insurance still must cover your child.
● ADULT KIDS – You can keep your kids on your existing health insurance longer. As of now, children can stay on your policy until they are 26 years old.
● PREVENTION – You can get some types of care for free. Certain tests and checkups, called preventive services, are now completely paid for by your insurance. These include a well-child visit each year, blood pressure and cancer screenings, and flu shots. This means NO copays and NO deductibles for this preventive care.
● GUARANTEE – You’re better protected by insurance. If you or someone in your family gets sick, your insurance company can no longer cancel your coverage.
● ESSENTIAL HEALTH BENEFITS must be covered by all qualified health insurance plans. These include emergency services, hospitalization, maternity and newborn care, prescriptions, and more.
● PRIMARY CARE PROVIDER CHOICE – You can choose who will be your primary care provider, often referred to as PCP. Your PCP is your lead health care professional — the one you see for screenings and when you’re sick. A PCP can refer you to specialists if you need them.
● APPEALS – You now have an easier way to complain about insurance problems. Each plan must have an appeals process, which are the steps you must go through to ask a health plan to pay for something they said wasn’t covered. Every health plan must tell their members what their appeals process is.
Affordable Primary & Urgent Care Options, without using insurance…
With many employers moving to a high-deductible plan for their employees, there is a grassroots movement called Direct Medical Care or Direct Primary Care, which is similar to concierge medicine for the masses. This means you get “customized” care, but at an accessible and affordable price.
You can find out more at DirectMedicalCareUSA.com, which is the main one in St. Louis. All the St. Louis Urgent Cares facilities actually participate in this program.
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St. Louis Urgent Cares presently has 4 locations in St. Louis: Downtown Urgent Care, Eureka Urgent Care and Creve Coeur Urgent Care, and North City Urgent Care.
Incidentally, the Ribbon-Cutting Ceremony for North City Urgent Care is tomorrow (Tuesday 22nd October) from 9am to 11am, at 6113 Ridge Avenue, 63133. Be there to join in the celebration if you can make it.
St. Louis Primary Care also operates at each of these locations. All eight practices participate in DirectMedicalCareUSA.com
You can get a cholesterol profile and a flu vaccine for no extra charge at each facility whenever you come in as a patient for any illness or injury.