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What is the Affordable Care Act?

The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people the stability and flexibility they need to make informed choices about their health. As of January 2014, the Affordable Care Act enabled children and adults the opportunity to purchase health insurance (in the event of a medical emergency) and obtain access to preventative health care (e.g. well women checkups, HIV testing, flu vaccinations).

What is the Patient’s Bill of Rights?

The Departments of Health and Human Services, Labor and Treasury collaborated on the Patient’s Bill of Rights – which will help children (and eventually all Americans) gain health care coverage and keep it, protect all Americans’ choice of doctors and end lifetime limits on the care consumers may receive. These new protections create an important foundation of patients’ rights in the private health insurance market that puts Americans in charge of their own health.

What is Health Insurance?

Health insurance is a contract between a consumer and an insurance company. Consumers purchase a plan, and the company agrees to pay part of the consumers’ medical costs when sick or hurt. Through the Affordable Care Act, consumers can purchase health insurance through the Health Insurance Marketplace.

After consumers complete a Marketplace application, they will learn if they are eligible for lower costs on monthly premiums. Most people who apply for health coverage through the Marketplace will qualify for some kind of savings.

What is the Health Insurance Marketplace?

The Marketplace is where consumers can compare insurance options in simple, easy to understand language. At the Marketplace, consumers will be able to compare insurance options based on price, benefits, quality and other factors with a clear picture of premiums and cost-sharing amounts to help them choose the insurance that best fits their needs.

Financial help to lower costs is available for people who quality. Depending on family size and income level, consumers may be eligible for a low cost plan or savings that lower monthly premiums right away.

When is the upcoming Health Insurance Marketplace open enrollment?

November 15, 2014 to February 15, 2015

What does the Health Insurance Marketplace insurance cover?

Health insurance plans offered through the Marketplace are run by private companies. All private health insurance plans offered in the Marketplace offer the same set of essential health benefits. Below are services all plans must cover.

The essential health benefits include at least the following items and services:

Ambulatory patient services (outpatient care you get without being admitted to a hospital)

Emergency services

Hospitalization (such as surgery)

Pregnancy, maternity, and newborn care (care before and after your baby is born)

Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

Prescription drugs

Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services (well baby checkups)

How do patients obtain coverage at Legacy through the Health Insurance Marketplace?

Contact Legacy Community Health Services at 832.548.5000

Legacy will connect consumers to a Certified Application Counselor (CAC) who can help complete the paper or online application and assist with scheduling an appointment to see a health care provider

In order to complete the application, consumers must provide the following information

Proof of income and employer information for all family members (e.g. W-2s (statement of income and taxes)

Information about any existing insurance and/or policy numbers of your current medical insurance plan

Social security number (or document numbers for legal immigrants)

Will Legacy Certified Application Counselors (CAC) be able to assist businesses with enrolling their employees into the Marketplace?

No, Legacy’s CACs are not certified to assist businesses. Marketplace Navigators are certified to assist consumers and businesses; however, Legacy can connect businesses to Navigators for assistance.

How many people did Legacy enroll during the first enrollment period?

Legacy assisted more than 5,000 families in the enrollment process which is the highest number of assists in the state of Texas.

How many people does Legacy anticipate to enroll in year two?

Legacy expects to assist more consumers in the Marketplace enrollment process for the following reasons

The nonpartisan Congressional Budget Office has projected that 13 million people will use the Health Insurance Marketplace in year two, five million more than did in year one

If consumers don’t have health coverage during 2015, a fee may be issued. The fee in 2015 is higher than it was in 2014 – 2 percent of their income or $325 per adult / $162.50 per child, whichever is more.

Sources: Department of Health and Human Services and Legacy Community Health Services