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Aug. 31, 2012
Kansas Insurance Commissioner answers frequently asked questions about the Affordable Care Act, the national health reform law passed in 2010 and upheld by the U.S. Supreme Court this summer.
This is the fourth in a four-part series of questions and answers.
Q: I buy my own health insurance for my family and myself. How will this law help me?
A: Some benefits of the law, like allowing a child to remain on a parent’s policy until age 26 and the removal of lifetime dollar limits, are already in place. Starting January 1, 2014, most Kansas health insurance plans will offer minimum coverage requirements called “essential health benefits.” The plans will be priced in levels that relate to how much of your health care costs the health insurance company will pay. The levels are labeled bronze, silver, gold and platinum. The cost of coverage varies from level to level; the essential health benefits, however, remain the same in each level. This should make it easier to compare plans when shopping for health insurance. Also, depending on your income, you may qualify for a tax credit (federal prepayment for premiums) and/or a subsidy (reduced out-of-pocket payments) if you are buying coverage on the health insurance exchange.
Q: I’ve heard that young people are going to pay more for coverage. Why is that?
A: The Affordable Care Act requires premiums for older individuals to be no more than 3 times the amount young people pay. Today, the difference in premiums is often much greater. With the change, some people may pay more and others may pay less. One part of the law that may be financially helpful to people under the age of 30 is their option to purchase a “catastrophic” health plan. This plan will provide coverage in the event of serious illness or injury. It will be cheaper than comprehensive coverage, but it will provide limited primary care and preventive benefits.
Q: What about dental coverage under the law?
A: The ACA only requires health insurance plans to include “pediatric (children’s) dental” benefits in the approved plans. We expect adult dental plans and riders may also be offered as optional coverage on the exchange, and they will also be available for purchase outside the exchange, just as they are now.
Q: All I hear about the Affordable Care Act involves exchanges and insurance. Is there anything in the law to make health care affordable?
A: While health insurance exchanges and insurance get most of the attention, there are many other parts to the law. The ACA uses private health insurance to provide coverage for those who are uninsured. That means that competition determines the price. There are new programs to find ways to improve the quality of care, to lower costs, and improve access to healthcare. Some involve improvements in the Medicare and Medicaid programs; others encourage finding ways to help people stay healthy throughout their lifetimes. There are also parts of the law that crack down on health care fraud. To increase access to care, new scholarships will be available to medical students who agree to work in underserved areas. And, the law expands funding for specialized public dental health training for dentists and community health centers.
Q: I want health insurance but I can’t afford it. What can I do?
A: The law specifically assists people who have not been able to afford coverage in the past. Depending on your annual income, you may qualify for tax credits and/or subsidies to help pay for health insurance premiums and out-of-pocket costs. These will be available for people who have incomes up to 400 percent of the federal poverty level (FPL). There is a sliding scale of income to determine the 400 percent level of FPL. It is based on the number of family members. For example, in 2012, 400 percent of the FPL is $44,680 for an individual and $92,200 for a family of four.
—Sandy Praeger, a Republican, is the Kansas commissioner of insurance.