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Federal Health Care Reform

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Information for North Carolina Consumers

This website provides very general information about the Affordable Care Act. For the most complete and up-to-date information about the health care reform law, visit the federal website www.hhs.gov/healthcare. The Health Insurance Marketplace can be found at www.healthcare.gov or www.CuidadoDeSalud.gov and the federal Marketplace Consumer Call Center can be reached at 800-318-2596.

Am I required to have health insurance?

Beginning Jan. 1, 2014, U.S. citizens and legal residents will be required to have health insurance coverage or pay a penalty, with some exceptions. Coverage for individuals and small businesses will be available for sale through the new Health Insurance Marketplace. Coverage options will also be available outside the Health Insurance Marketplace, as it has historically been offered.

What is the Health Insurance Marketplace?

The Health Insurance Marketplace, also known as a health benefit exchange, can be accessed online through www.healthcare.gov and is a place where individuals, families and small employers can compare private health insurance options and shop for coverage. The Health Insurance Marketplace will also determine eligibility for federal tax credits and options to help eligible lower- and middle-income individuals pay for coverage. Coverage will still be available outside the Health Insurance Marketplace; however, to take advantage of tax credits for private insurance, you must purchase coverage through the Health Insurance Marketplace. Open enrollment for people shopping for insurance both on and off the Health Insurance Marketplace begins on Oct. 1, 2013, for coverage starting Jan. 1, 2014.

Per state law, the federal government will run the Health Insurance Marketplace in North Carolina. Find more information online at www.healthcare.gov or www.CuidadoDeSalud.gov. The federal government has also created a Health Insurance Marketplace consumer call center that can be reached toll-free at 800-318-2596. Hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.

Who can help me find a plan on the Health Insurance Marketplace?

The federal government is expected to have an in-person assistance program in place to help people with questions about the Health Insurance Marketplace. Find more information online at www.healthcare.gov or www.CuidadoDeSalud.gov. The Health Insurance Marketplace consumer call center can be reached toll-free at 800-318-2596. Hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.

How will the new law affect costs?

Premiums may go up for some people and down for others, depending on a number of factors. Premiums may change based on a person's age, medical history, tobacco use and family composition. The federal law prohibits insurers from refusing to insure or charging higher premiums to people with medical problems. The federal law also limits how much insurers can charge older people compared to younger adults. Also, health plans in the individual and small group market must cover services under the law that some did not cover before, and many plans will have lower out-of-pocket costs (deductibles, copayments and coinsurance) than they did before.

To help make coverage more affordable, many people who purchase health coverage in the individual market will be eligible for premium tax credits and individuals under age 30 or people who cannot afford coverage may be eligible to purchase catastrophic plans that cost less.

Under the Affordable Care Act, what services or benefits must be covered by health plans?

After Jan. 1, 2014, most plans* sold to individuals and small businesses must cover, at a minimum, Essential Health Benefits including:

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

Find more information about Essential Health Benefits at www.ncdoi.com/LH/LH_HCR_EHBAV.aspx.

*Excludes self-funded, large group and grandfathered plans.