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Consumers

The five most important things to know about Obamacare now

October 30, 2017
by Paula Bussard, Chief Strategy Officer, HAP

After so much talk of “repeal and replace,” even people who work in health care—like me—can feel confused about the Affordable Care Act, known to many as Obamacare.

Fortunately, a few basic facts can help straighten things out.

Are you one of about 400,000 Pennsylvanians who last year enrolled through healthcare.gov? Do you need to buy your own insurance this year?

Here’s what you should know—and do—now.

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Selecting Health Coverage

Health Insurance Coverage Remains Available to Everyone

Despite what you may read or hear, health insurance coverage is still available to everyone, regardless of a medical condition, sex, or age.

However, if you need to buy or renew your own health insurance, the open enrollment period is shorter this year. You have from November 1 through December 15, 2017, to make changes for coverage starting in 2018.

Everyone needs health insurance. Even though you may not plan on getting sick or hurt, chances are that you will need medical care at some point.

There are many plans available to meet your needs and budget; and financial assistance may be available.

Whether you need health insurance for the first time, or already have health insurance and are comparing your options, the time to get covered and stay covered is now!

Get Covered. Stay Covered.

Whether you’re signing up for health insurance for the first time or renewing your existing health insurance plan, there’s a few simple steps to get covered and stay covered:

  1. Check to see if you qualify for financial help. (GO)
  2. Get Covered: Shop for a plan that fits your needs and budget. (GO)
  3. Stay Covered: Keep or change your existing plan. (GO)

Where Can I Get Health Insurance?

Starting November 1, you can go to the online Health Insurance Marketplace to sign up for health insurance coverage that starts January 1, 2018. If you’re signing up for health insurance the first time or renewing your existing health insurance, the Health Insurance Marketplace is a great place to begin.

By providing your state, county, and what type of coverage you need (individual, family, etc.), you will see what plans are available to you. By providing some information about your household size and income, you will find out if you qualify for financial help in the form of “premium tax credits” that lower your premium cost. You also can learn if you qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Plan Choices

Shop for a plan that fits your needs and budget. There are different insurance plans available. Each plan may have different rules and costs, but all plans will cover doctor visits, preventive care, maternity care, hospitalization, prescription drugs, and more.

The plans that are available to you will be organized into four categories based on how you and the plan expect to share the costs for health care. The category you choose affects how much your insurance will cost each month (premium) and your other costs, such as deductiblecoinsurance, and copayment. Though these costs can vary from plan to plan, all plans offer the same set of essential health benefits such as doctor visits, preventive care, maternity care, hospitalization, prescription drugs, and more. Be sure you find out whether you will be able to keep your doctors and go to the same hospital.   

Importance of Insurance

There are many benefits of having health insurance. Some of the major benefits include access to “everyday” care, access to emergency care, and preventive care.

Key Benefits of Health Insurance:

  • Immediate, “everyday” care—such as primary care, children’s health and dental care, specialty care, mental health care, and prescriptions
  • Emergency, inpatient, and follow-up care—such as when you receive emergency medical care, are admitted to the hospital, and after you leave the hospital
  • Preventive care and chronic care management—such as vaccinations, health screenings, and care to manage conditions like diabetes and asthma

Need Assistance?   

If you need personal assistance applying for health insurance coverage or have more questions, there is help available close to home. These individuals are known by different names, depending on who provides the service and where they are located, but all can help you with your choices and application.

  • Your Local Hospital—Your local hospital is taking an active role in helping individuals enroll in health insurance coverage. Contact your local hospital or find a hospital in your community through the online directory
  • In Person Help and Enrollment Events—You can find free, in-person assistance and enrollment events near you at Pennsylvania Health Access Network and via Healthare.gov
  • Phone Assistance—You can call (800) 318-2596, 24 hours-a-day, 7 days-a-week (TTY: 1-855-889-4325) for assistance
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