Staying
healthy will be easier with more no-cost preventive
care like immunizations, diabetes and cancer screenings,
and help quitting tobacco.
Why are preventive
services important?
Too many Mainers don't get the preventive health care they need to stay healthy. Many expensive and chronic diseases, such as heart disease, cancer, and diabetes can often be prevented if people have access to preventive care. When people have high co-pays, co-insurance and deductibles they are less likely to get the preventive services they need.
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more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
How does the Affordable
Care Act (ACA) increase your access to preventive services?
The ACA helps make preventive services affordable by requiring health plans to cover recommended preventive services with no co-pay, co-insurance, or deductible. Under a health plan offered through a workplace or an "individual" (purchased outside a workplace) health plan that was created after March 23, 2010, you must be provided with certain preventive services without charging you a co-pay, coinsurance, or deductible.
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more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
Which preventive
services can you get at no additional cost?
You may have free access to many preventive services including blood pressure tests, diabetes tests, cholesterol tests, many cancer screenings, counseling from your health care provider on a variety of topics, routine vaccinations, and many other preventive services! For a complete list go to www.healthcare.gov/law/about/provisions/services/lists.html. Ask your provider which covered preventive services are right for your age, gender, and health status. You can also go to www.healthfinder.gov.
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more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
Does this new rule
apply to your health plan?
This applies to people enrolled in health plans through a workplace and individual health plans that are not "grandfathered." Your health plan must state in its plan materials whether it considers itself to be a grandfathered plan and must also tell you whom to contact for more information.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
Anything
in the "fine print" that you should know about?
If your health plan uses a network of providers, your plan is only required to provide these no-cost services through an in-network provider. Your health plan may allow you to get these services from an out-of-network provider with an out-of-pocket fee added.
Also, your doctor may provide a preventive service as part of an office visit. Your plan can require you to pay some costs of the office visit if the service is not the main purpose of the visit or if your doctor bills you for that service separately from the office visit.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
There
will no longer be upper limits on covered benefits over
a lifetime, even for expensive or ongoing medical care
How does this affect my health coverage?
Maine already passed a law that prevents total lifetime and annual limits in most individual and group health insurance plans. The Affordable Care Act (ACA) added additional protection to Maine's law by including all plans in this prohibition on total lifetime limits and by preventing lifetime limits for specific services as well. The ACA will also add these protections to annual limits in phases.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
How does the ACA phase-in protections on annual limits?
By preventing all plans from setting annual dollar limits on most benefits lower than:
- $750,000—for a plan year or policy year starting on or after September 23, 2010, but before September 23, 2011.
- $1.25 million—for a plan year or policy year starting on or after September 23, 2011, but before September 23, 2012.
- $2 million—for plan year or policy year starting on or after September 23, 2012, but before January 1, 2014.
- No annual dollar limits are allowed on most covered benefits in a plan year or policy year that begins on or after January 1, 2014 and which is not an individual "grandfathered" plan.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
The ACA includes many consumer protections that apply to most health coverage plans. These include rules that:
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care programs
and resources.
Definitions
What is the Affordable
Care Act (ACA)
The
Affordable Care Act is the name given to the comprehensive
health care reform law enacted on March 23, 2010.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is a preexisting
condition?
If you went without health insurance for 90 days (in
most cases) before enrolling in a health plan, any diagnosed
physical or mental health condition, disability, or
illness is a preexisting condition.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is a "plan
year" or "policy year"?
A plan year refers to a 12-month period of benefits
coverage-which may not be the same as the calendar year.
This period is called a policy year for individual health
insurance policies. To find out when your plan or policy
year begins, you can check your plan or policy documents
or contact your employer or insurer. For example: if
your plan has a calendar plan year, the new rules would
apply to your coverage beginning January 1, 2011.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is an "Individual"
health insurance plan?
An individual health insurance plan is purchased directly
by an individual - not something offered by a workplace.
"Individual" plans can be purchased for one
person, a couple, or a family.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is a self-insured
plan?
Type of plan usually present in larger companies where
the employer itself collects premiums from enrollees
and takes on the responsibility of paying employees'
and dependents' medical claims. These employers can
contract for insurance services such as enrollment,
claims processing, and provider networks with a third
party administrator, or they can be self-administered.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is a "grandfathered"
plan?
A grandfathered plan is one that was created or purchased
on or before March 23, 2010 that have not been changed
in ways that would cause them to lose grandfathered
status. If a plan is grandfathered, some new health
care reform rules will not apply.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is a co-pay?
Amount you pay per covered service. Some co-pays can
be very high for things like Emergency Room visits.
Other co-pays can be much lower for things like regular
check ups.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is a deductible?
Amount you pay out of your own pocket for most covered
services before insurance starts to pay. Co-pays do
not count toward meeting your deductible.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What is coinsurance?
Amount you pay for covered services after your deductible
is met. It is the percent of a bill you pay for covered
services like 20% or 30% of a bill while the policy
pays the remaining percent.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
