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Health Insurance and Health Care Reform - What's coming in 2013

February 26, 2013

Now that 2013 has arrived, we are less than a year away from the time when most Americans are expected to be enrolled in a health insurance plan, according the Affordable Care Act signed into law by President Obama in March 2010. This year, you will see more changes affecting the availability of health insurance to many segments of our population, according to the tenets of the sweeping health care reform law.

"Since the law was passed, there have been a number of changes to the availability of insurance and covered benefits," said Kristi Caracappa, health insurance information service coordinator for Washington Hospital in Fremont. "Probably the biggest change people will notice this year will be the opening of the California Health Benefit Exchange, which is intended to give people who have no coverage - due to pre-existing conditions or other circumstances - access to affordable, competitive insurance options and improved benefits."

With open enrollment scheduled to begin Oct.1, the exchange is intended to be a transparent, competitive marketplace that can be accessed through the internet. On the exchange's Web site, individuals and small businesses will be able to compare health plans, get questions answered and enroll in the plan they select. There will also be a toll-free consumer assistance phone hotline.

Low income families who are not eligible for other types of affordable coverage, such as Medicaid, will be able to receive tax credits to help pay for insurance premiums. Coverage purchased through the exchange will begin January 1, 2014.

"Our service is currently following the exchange as it begins to roll out with more comprehensive information available each week," added Caracappa. "We plan to offer assistance to help people understand how the exchange works, and we also hope to be able to provide help with enrollment."

Washington Hospital's Health Insurance Information Service is a free, confidential and unbiased program that helps people get the information they need to make informed decisions about their health insurance. To contact the Service, call (800) 770-9447. They are open weekdays between 8 a.m. and 5 p.m. The coordinators can answer questions over the phone, or you may set up an appointment for a personal consultation.

Other changes that have already occurred due to the Affordable Care Act have affected the availability of insurance coverage and additions to covered services. For example, parents can now keep their children on their family coverage until they are 26 years old, if the child does not have other job-based health insurance.

In addition, the law is making Medicare prescription drug coverage more affordable for seniors by gradually closing the prescription drug donut hole. Previously, recipients were required to pay for their drugs once they had reached a certain threshold in total annual prescription costs. According to the law, the donut hole will close by 2020.

Another change that has already taken affect enables a child to qualify for health insurance even when the parents do not have coverage due to pre-existing conditions.

The Healthy Families Program is also changing. This is a state-sponsored, very low premium insurance designed for low income children under age 19 who do not qualify for Medi-Cal. Benefits include health, dental and vision services.

"Healthy Families is ending, and these children will continue to receive coverage through the Medi-Cal for Families program," reported Caracappa. "Our service can help with enrollment."

As of Jan. 1, no new enrollments are being accepted into the Healthy Families Program. The State of California is sending letter to all Healthy Families members explaining the changes to the program and any steps they should take to ensure that they are transferred to Medi-Cal for Families.

The Affordable Care Act has also expanded the preventive services covered by insurance with no deductible or co-payment. Covered prevention-related services for women include well-woman visits, support for breastfeeding equipment, domestic violence screening and counseling, and more.

Additional covered benefits for adults include blood pressure and cholesterol tests, mammograms, colonoscopies, and screenings for osteoporosis. Many children's vaccinations are also covered.

Learn more

To learn more about Washington Hospital's free Health Insurance Information Service, go online to www.whhs.com/health-insurance. To find out more about the Affordable Care Act of 2010, California's Affordable Insurance Exchanges and the transfer of Healthy Families to Medi-Cal, go online to www.healthcare.gov

Are You Eligible for Medicare?
Health Insurance Seminar Will Discuss Qualifications and What Medicare Offers
Medicare offers a wealth of health benefits, once you understand the details. That's where many people become overwhelmed. This year, there are four Medicare Advantage plans, 7 Medigap plans, and 29 different Medicare Part D plans to choose from - and every year elements of the Medicare Part D plans change.

"For those not yet on Medicare, or who may have heard scary things about it, choosing a plan can cause a lot of anxiety," according to Kristi Carracappa, Health Insurance Information Service Coordinator at Washington Hospital.

"But it's really an easy process once you have the right tools and information," she adds.

To help people learn about qualifications for Medicare and what Medicare offers, Washington Hospital is offering a free seminar on Wednesday, March 6 from 6:30 to 8:30 p.m. in the Conrad E. Anderson M.D. Auditorium located at 2500 Mowry Avenue (Washington West) in Fremont. To register for the free seminar, visit www.whhs.com or call (800) 963-7070.