Uninsured Get New Health Options

If you or a family member isn’t covered by health insurance at work, you can take advantage of a new health insurance marketplace the federal government is launching on Oct. 1 that will offer a range of coverage, even if you have a preexisting condition. Coverage begins Jan. 1, 2014. Check out the details online.

To sweeten the deal, the government is offering tax credits that are expected to help 93 percent of the state’s 1.3 million uninsured residents pay for coverage. The payoff to the state could be significant; uninsured people often wind up in the emergency room, the most expensive way to access health care. If they default on their ER bills, the costs are absorbed by the hospitals, and then passed along in the form of higher insurance premiums to everyone who has insurance. Ouch.

Consumer Protections

Coverage under the Affordable Care Act includes a number of consumer protections (although the State Health Plan, which covers most employees, is grandfathered under the law and does not provide all of these protections).

As many as four million non-elderly North Carolinians have some type of pre-existing health condition, including 500,000 children. Thanks to the new law, insurers can no longer deny coverage to children because of a preexisting condition, like asthma or diabetes. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a preexisting condition.

Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund.

In every state and for the first time under federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. North Carolina has received nearly $5 million under the new law to help fight unreasonable premium increases.

The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits.

The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.

The health care law increases the funding available to community health centers nationwide. In North Carolina, 32 health centers operate 183 sites, providing preventive and primary health care services to 400,000 people. Health Center grantees in North Carolina have received $96 million under the health care law to support ongoing health center operations and to establish new health center sites, expand services and support major capital improvement projects.