Starting Jan. 1, 2014, Health Insurance Exchanges under the Affordable Care Act (ACA) will allow individuals in every state to shop for and compare health insurance plans online. Everyone under age 65 will be able to use the exchanges to gain coverage with no denials of coverage because of pre-existing conditions. In addition, younger patients are now eligible to stay on their parent’s health insurance plan until they are 26 years old.
Note: If you already have health insurance, are happy with your plan and it has not been cancelled, you do not need to buy a plan on a health insurance exchange.
Here’s what you should consider when evaluating plan options:
- Premium levels, coverage, and cost: Each plan offered on the Health Insurance Exchanges will offer four levels of coverage–Bronze, Silver, Gold, and Platinum–ranging from lowest cost/least cost coverage, to highest cost/most cost coverage. Because most transplant patients have a high-cost medical condition, they should consider plans with higher levels of coverage, such as Gold or Platinum plans.
- Bone marrow transplant (BMT) benefit: Contact the health insurance company directly and ask about the plan’s specific BMT benefit. Get information about specifics including donor search coverage, prescription drug coverage, maximum benefit amounts, waiting periods for coverage, travel and lodging benefits, and clinical trial coverage. We are closely monitoring proposed BMT benefits across the country and are working to ensure that patients in need will have access to life-saving transplant coverage.
- Assistance with premiums: Patients may be eligible to receive federal assistance to help cover premiums for plans on the Health Insurance Exchanges. Individuals are eligible if they make up to $45,960 annually. A family of four is eligible if they make up to $94,200 annually. Amounts vary depending on income. For information about your state’s Health Insurance Exchange, visit www.healthcare.gov. If your income is up to 133% of the Federal Poverty Level ($15,000 for an individual and $30,000 for a family of four) you may be eligible for Medicaid if your state chose to expand its Medicaid program. Visit www.kff.org to find out if your state chose to expand its Medicaid program.
- Cost-sharing features: When evaluating a plan, look for information on deductibles, out-of-pocket costs, co-payments, and co-insurance. All of these cost-sharing features will help you determine the total possible cost of different insurance plans. Think about the number of visits you will make to your primary care physician and any specialists, as well as potential hospital visits.
- Networks: Each health insurance plan has a designated set of in-network providers. Any providers outside of their network are considered out-of-network and will charge higher costs for care. Check the network of hospitals and providers to ensure that your physicians and transplant center are included.
Open enrollment for the Health Insurance Exchanges begins October 1, 2013 and runs through March 31, 2014. Coverage begins on January 1, 2014 as long as your first premium is paid by December 15, 2013.
Watch for more information about how these changes affect transplant patients and recipients. We will continue to provide updates on the ACA and Health Insurance Exchanges as information becomes available. If you have questions or need more information check the resources below. You can also contact Be The Match at 1 888 999 6743 or email firstname.lastname@example.org.
www.healthcare.gov (HHS’s Main Page for Health Insurance Information, including links to each state’s Health Insurance Exchange)
www.kff.org (Kaiser Family Foundation)
www.cancerinsurancechecklist.org (Cancer Insurance Checklist)