When it comes to health insurance, what’s essential?

New laws, and new benefits.  From the elimination of catastrophic health plans to the introduction of metallic health plans, changes in health care are one of the hottest topics of discussion in the news lately.  So, what’s essential?

Individual and small group health plans are required under the Affordable Care Act to offer a minimum set of health services called “essential health benefits,” beginning in 2014.  People who have plans that do not meet these minimum standards may receive a notice that their plan is being replaced by one that includes additional mandatory benefits. 

Although the rule does not apply to all health plans, most individual and small group plans must now offer coverage for all of the following 10 essential health benefit categories:

• Ambulatory patient services
•  Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Mental health and substance abuse services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision

While the federal government has determined the broad categories that must be covered, each state determines the specific services that are covered under each category.  Each state has selected a “benchmark” health plan to define the specific services that must be included in the state’s essential health benefits package.

Many health plans have not traditionally included the services that are now required by the federal and state governments, such as pediatric oral and vision care.  For 2014, insurers must redesign such plans to cover all required services.  An insurer may also end plans that don’t meet the requirements and offer an alternative plan that does.

For more information about essential health benefits, click here to view an overview of essential health benefits, frequently asked questions or “FAQs,” and more.

Open Enrollment Season

It’s the time of year when many people are thinking of getting relief from the summer sun, taking in the colorful tree leaves and enjoying a pumpkin latte.  But for those of us in the health insurance industry, this is open enrollment season. With the launch of state and federal health insurance exchanges, ‘tis the season for lots of changes. 

Open enrollment season, usually between September and December, is when millions of Americans have the opportunity to select or switch their health insurance plan for the following year. This fall, the Congressional Budget Office estimates an additional 7 million people may participate in open enrollment as a result of the government’s newly created state health insurance exchanges, otherwise known as “marketplaces.” The exchanges are designed to give individuals, who are currently without health insurance, and small business owners, who sometimes find it too costly to provide, a resource to purchase health insurance.

Regardless of how you research and purchase your health insurance, it’s important to pay attention to the following open-enrollment dates and tips:

• Employer-Provided Coverage – September - December; specific time frame depends on the employer

Most Americans receive employer-provided health benefits. Large employers and some small employers typically schedule a two- to three-week period during the fall when their employees can select health benefits for the following year.

• Tip: Ask about wellness programs. Some health insurers, including UnitedHealthcare, offer incentive-based wellness programs that provide financial rewards for completing health assessments, lowering your cholesterol, losing weight, or even signing up for a health coaching program.
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•  Medicare – Oct. 15 through Dec. 7, 2013

For most Medicare beneficiaries, the Open Enrollment Period is their only opportunity all year to make changes to their Medicare coverage. 

• Tip: Think about what’s changed regarding your health and your options. A lot can change in a year. Consider if your current plan is still meeting your health and budget needs. Medicare plans can change each year, too, so spend time reviewing the options available. Some Medicare Advantage plans offer additional benefits that can help enhance your health and well-being and save you money, such as vision coverage and hearing aids. You can compare your options using the plan finder tool on www.Medicare.gov.
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• Health Insurance Exchanges – Oct. 1 through March 31, 2014

A public health insurance exchange may be a good option for people who don’t have health insurance since they may be eligible to receive a government subsidy that lowers monthly premiums.

• Tip: Find out if you qualify for a subsidy. In general, subsidies are available to individuals who meet household income requirements and who are not eligible for certain government insurance programs (such as Medicaid) or do not have access to affordable coverage through their employer.

Unfortunately, just 14 percent of Americans understand basic health insurance concepts such as deductible, copay, co-insurance and out-of-pocket maximum, according to a recent study published in the Journal of Health Economics.  So before you dive into the selection process, make certain that you understand the basic definitions, for example “what’s a copay?”

For helpful information that’s simple and easy to understand visit UHC.tv.com  or MedicareMadeClear.com. To learn more about health insurance exchanges visit www.healthcare.gov or your local state government website. 

Options for purchasing health insurance

One of the major goals behind health care reform is to give those without health insurance affordable options for health care.  For those who cannot get affordable insurance through their employers, the individual marketplace in each state offers a new way to purchase individual insurance.  Health reform also includes some incentives for employers to offer health coverage to employees, so employees should check first with their employers to find out if they qualify for coverage.

Here are a few different scenarios that people without insurance may experience, and some options they may want to consider:

• I work part-time, and I’m not eligible for my employer’s health insurance plan.  What can I do?  If your employer doesn’t offer you coverage or their coverage doesn’t meet the new government standards, you can buy a plan in your state’s Individual Marketplace.  You can also buy insurance from a health insurance company directly or through an insurance agent outside of the Marketplaces.

• I can’t afford my employer’s health insurance.  How can I get a plan I can afford?  Health reform includes some incentives for employers to offer affordable plans to their employees. First, check with your employer to see if they are offering new, more affordable plans. If so, their plan is likely to be your best choice.

If your employer doesn't offer a plan that is affordable, use an online subsidy calculator to see if you can get help paying for a plan through the Individual Marketplace in your state. But only the Marketplace can determine if you will be eligible for government financial assistance. If you have a low income you may be able to get a government subsidy to buy a plan in the Individual Marketplaces. You'll have a range of plans from which to choose.

• I’m new to this whole thing!  I don’t have health insurance.  Where do I start?  If you work at a small company, health reform is making it easier for your employer to offer a plan that meets the new government standards. Talk with the person in your company who handles benefits to learn what's available.

If you're not working, or your employer doesn't offer an affordable plan, you may be able to get a subsidy to help you buy a plan through the Individual Marketplace in your state.

For more information on health care reform and why it matters take a few minutes to view this video, then go to our website to learn more about your health care reform options.