What do I need to know about health-care reform?

Beginning Oct. 1, Americans can virtually browse health insurance plans as if they were doing some online shopping at their favorite store's website. The insurance exchange marketplaces are a major provision of President Barack Obama's Affordable Care Act, which aims to overhaul the American health-care system and provide coverage to all Americans.
At times, though, these changes have been met with confusion. Here are some things you need to know come Oct. 1.
Q: What is the Affordable Care Act?
A: Also known as Obamacare, the president signed this legislation in March 2010 aimed at making health insurance more accessible and affordable. It's met staunch Republican resistance, and the Supreme Court examined the law's constitutionality, upholding the major provisions of the act in June 2012.
Q: What does the Affordable Care Act do?
A: It's a broad-scope piece of legislation aimed at completely reforming the health-care system with a roll-out time of at least four years.
Essentially, the Affordable Care Act requires all Americans who can afford it to have health insurance by 2014. The penalty for not signing up for minimum essential coverage? A fee that starts at 1 percent of an adult's annual income or $95 per person, whichever is higher, in 2014. It increases, too, and will be set at 2.5 percent of one's income or $695 per person - whichever is higher - for an adult in 2016, according to healthcare.gov, a federal government website managed by the Centers for Medicare and Medicaid Services.
In 2014, the fee is $47.50 for every uninsured child, and the maximum payment is capped at $285 for next year.
Here's a timeline of some of the law's key provisions, according to the U.S. Department of Health and Human Services' website:
2010: A new Patient's Bill of Rights went into effect, which aims to protect individuals from the insurance industry's worst abuses. Additionally, many young adults were permitted to remain on their parents' health insurance plan until they turn 26 years old.
2011: Senior citizens began receiving preventative services for free under Medicare, the federal insurance program for those age 65 years and older. These include an annual wellness visit, tobacco cessation counseling and various screenings, from bone mass measurement to mammograms.
2012: The law created incentives for physicians to establish partnerships called Accountable Care Organizations. This means doctors come together to better coordinate patient care, help prevent disease and reduce unnecessary hospital admissions.
Oct. 1, 2013: Open enrollment in the health insurance exchange begins for individuals and families and ends March 31. Qualified health-plan coverage becomes effective Jan. 1.
Jan. 1, 2014: Maryland small businesses can shop around for health insurance; this means businesses with one to 50 full-time employees. Additionally, Americans of all ages cannot be denied coverage if they have a pre-existing condition. Companies cannot charge higher rates due to gender or health status.
Jan. 1, 2015: Employers with more than 50 employees will be required to provide health insurance or pay a fee.
Q: I currently do not have health insurance. How do I avoid paying a fee next year?
A: A person must be enrolled in a plan that has minimum essential coverage.
This includes any marketplace plan or individual insurance plan a person may already have; any employer plan, including COBRA; Medicare; Medicaid; The Children's Health Insurance Plan; Tricare for service members and retirees; veterans health-care programs; Peace Corps Volunteer Plans and others, according to healthcare.gov. If uncertainty remains, a health-care provider should be able to answer that question.
Q: So, I've been hearing the date Oct. 1 being thrown around a lot. What exactly happens then?
A: That's when the health insurance marketplaces, also known as the "exchanges," go live.
An exchange is a website that allows individuals to compare coverage options side-by-side, see if they can receive lower costs on monthly premiums and learn if they qualify for free or reduced-cost programs. Such benefits include the federal-state health insurance program for the poor known as Medicaid or the Children's Health Insurance Program, according to healthcare.gov.
The Affordable Care Act gives states the options of hopping on the federal government's marketplace. Some, like Maryland and 16 more, decided to create their own. About 27 are using the federal exchange and seven are creating a partnership between federal and state marketplaces as of Sept. 16, according to the Kaiser Family Foundation, a nonprofit that analyzes major health-care issues.
Q: If I have a job, can I still sign up for health insurance through the exchange?
A: Anyone can try to apply for health insurance. But if their employer offers minimum value, affordable health coverage, that person won't be eligible to sign up for a plan through the exchange. Affordable health coverage means that it's not costing an employee more than 9.5 percent of their annual income, according to Maryland Health Connection's website.
All legal Maryland residents who don't have access to health coverage through an employer are eligible to sign up for a plan through Maryland Health Connection. About 14 percent of Maryland's population is uninsured, which equates to about 800,000 people, according to Maryland Health Benefit Exchange's website. A little more than 8,000 of those live in Carroll, which is about 5.6 percent of the county's population, according to an analysis done by the Centers for Medicare and Medicaid Services and the Office of the Assistant Secretary for Planning and Evaluation.
Q: How do I apply?
A: In Maryland, that website is Maryland Health Connection, http://www.marylandhealthconnection.gov.
It's a one-stop shop to compare rates and determine financial assistance eligibility, such as tax credits, to reduce the cost of monthly premiums, according to Maryland Health Connection's website. Filling out a single application online will determine eligibility for Medicaid or private insurance. The website will help individuals through the process.
Q: What information do I need to have compiled before I apply?
A: You'll need the Social Security numbers for you and your family members; birth dates and general information; employer and income information for everyone in the family; policy numbers for any current health insurance and information about any job-related health insurance available to your family, according to Maryland Health Connection.
Q: What do all plans have to offer?
A: The Affordable Care Act mandates Americans receive essential health benefits from their plans. This includes flu and pneumonia shots, birth control, routine vaccinations, cancer screenings and more, according to Maryland Health Connection.
Q: What kinds of plans does Maryland Health Connection offer?
A: The state exchange offers 45 total medical plans offered from different parent companies. About 24 of those plans offer statewide coverage, according Maryland Health Connection's September 2013 individual marketplace plan analysis presented at its Exchange Board of Trustees meeting.
There are five ranges of plans available, which from least to greatest coverage are: catastrophic, bronze, silver, gold and platinum.
Premiums will vary based on the chosen level of plan, by age (to a limited extent), geographic region, whether tobacco is used and family size, according to the Kaiser Family Foundation.
There are a total of 20 stand-alone dental plans, according to Maryland Health Connection's individual marketplace plan analysis.
Q: I'm not sure if I'll be able to afford a health insurance plan. What are my options?
A: First, there's Medicaid, the federal-state health care for low-income and disabled residents, which more state residents will now be eligible to receive. Maryland chose to expand Medicaid eligibility in the state, and families earning up to 138 percent of the federal poverty level will qualify on Oct. 1.
Medicaid will now cover those individuals earning up to $15,856 a year or a family of four with an income total of about $32,500, according to the Door to HealthCare.
Tax credits may also help reduce the cost of monthly premiums, and how much that could be depends on income levels and family size, according to Maryland Health Connection. Qualifying for this financial assistance will be determined through the application process.
Q: What if I need help using Maryland Health Connection's website?
A: The state is essentially employing personnel to help residents navigate the new health insurance marketplace. And it's a free service to the consumer.
Navigators and assisters will be positioned in locations around the state and in Carroll, such as at local health departments, departments of social services, etc.
Navigators can help enroll residents in Medicaid and in qualified health plans, according to Maryland Health Benefit Exchange.
Assisters can only enroll residents in Medicaid.
There's also the Maryland Health Connection's call center at 1-855-642-8572 or 1-855-642-8573.
Call 1-855-288-DOOR(3667) or go online to http://www.doortohealthcare.org to schedule a local appointment.

Recommended on Baltimore Sun