Quick Guide to The Affordable Care Act

 Many people have questions about the Affordable Care Act and how it applies to people with Parkinson’s disease. Here are some answers to these frequently asked questions:

What is the Affordable Care Act?

The Affordable Care Act (ACA) is the healthcare reform act passed in 2010.

The first thing you need to know is that if you are covered by Medicare, Medicaid, a veteran health program, an employer, or a employer-sponsored health plan you don’t need to go out and get a new insurance plan. However, it is important that you understand the changes that the Affordable Healthcare Act will bring. From October 1, 2013 to March 31, 2014, you will be able to enroll in a new health plan if you are uninsured, have an individual health policy, or can’t currently afford health insurance. If you enroll before Decemeber 31, 2013, your new insurance coverage starts January 1, 2014.

In the section below you will be able to find important information about how you may be impacted by this new Affordable Care Act.

How does this affect someone with Parkinson’s or a preexisting condition?

Health Insurance (other than Medicaid and Medicare):

  • If you already have health insurance under your employer there is good news. You don’t need to go out and get a new insurance plan right now. The insurance plan offered by your employer will continue to cover you. Now, there may be some changes in fees or services, and you should talk to your employer about changes to your plan. You should know that no insurance company will be able to charge you more because you have a chronic condition.
  • If you currently don’t have any health insurance plan, you will need to get one or you will be penalized. Individual insurance plans – the kind you buy yourself, not through an employer – may present some problems if you have Parkinson’s. Why? Because this type of insurance plan doesn't have to cover pre-existing conditions. While searching for the best health insurance plan for yourself, consider this information. You need a plan that covers you and your specific needs, for example, good drug coverage and coverage of allied health professional services.
  • All health plans will cover a set of 10 essential benefitsincluding 15 preventive health services and chronic disease management. Depression screening, included among the preventive health services, is especially important for all those diagnosed with Parkinson’s.
  • What if you cannot afford insurance?  You will be able to apply for premium credits.

Medicare and the Affordable Care Act:

  • As mentioned above, individuals with Medicare don’t need to go out and change their insurance plan.  No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now.
  • If you are adversely impacted by the Medicare Part D  prescription drug coverage gap (commonly referred to as the “donut hole”) you will receive a 50% discount on brand-name prescription drugs covered by Medicare when you reach the coverage gap this year. The discount is applied automatically in your pharmacy. The donut hole will be phased out by 2020.
  • More preventive services will be available for you. On top of a free yearly Wellness Visit you will be able to get services such as a colonoscopy or mammogram without having to pay for the Part B coinsurance or deductible.

How to apply?

To apply you need to find out first if your State or Federalgovernment runs the marketplace by visiting healthcare.gov. After that:

  • Apply for coverage
  • Compare your options
  • Enroll

Find a personalized list of programs you maybe eligible for and to a checklist to help you get ready.

Interesting tip: If you participate in research, health plans will be required to cover your routine patient care related costs.

How can I get help picking a plan?

The Marketplace, also known as the “Health Insurance Exchange” is like a virtual insurance mall. Once you fill out an application you will be able to:

  • View all the health plans in your area.
  • Find out if you can get lower costs on your monthly premiums for private insurance plans.
  • Find out if you qualify for free or low-cost coverage available through Medicaid.

The Marketplace is run by either your state or federal government. To find out who runs the Marketplace in your state starting Oct. 1st 2013 please visit healthcare.gov.

Cost is an issue for everyone. From now and until October 1 you can get a rough estimate of costs and savings by using theKaiser Family Foundation calculator.

Other helpful resources:

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