How Does the Health Care Law Protect Me?

The Affordable Care Act was designed with you in mind. With it, you’ll have new rights and protections that make health care coverage more fair for all. Starting in 2014, you’ll enjoy more choice and control over your health coverage thanks to new health care laws.

Some protections apply to plans in the Health Insurance Marketplace or other individual insurance plans, some apply to job-based plans, and some apply to all types of health coverage. Read on to find out more…

Many new rights and protections regarding health insurance go into place in 2014.

1. The Health Insurance Marketplace creates a new way for individuals, families and small businesses to purchase health coverage. Through the Marketplace, you can also find out if you can get lower costs on monthly premiums or lower out-of-pocket costs, or if you qualify for Medicaid or CHIP.
2. Insurance companies are required to cover people with pre-existing conditions. You cannot be turned down for health coverage because you are sick, even if you have been refused coverage in the past. This does not apply to grandfathered individual health insurance plans.
3. New laws ensure you understand the coverage you’re getting. Insurance companies and group health plans are required to provide you with a short, easy-to-understand Summary of Benefits & Coverage (SBC), as well as a Uniform Glossary of terms used in health coverage and medical care. If you do not speak English, you may be able to receive the SBC and Uniform Glossary in your native language.
4. Insurance companies are held accountable for rate increases. Rate Review requires insurance companies to publicly rationalize any rate increase of 10% or more. This does not apply to grandfathered plans.
5. Insurance companies cannot arbitrarily cancel your coverage. This means your coverage won’t be canceled because you made an honest mistake on your application, left out information that has little bearing on your health, or got sick. However, your coverage can be canceled if you intentionally put false or incomplete information on your insurance application, or you don’t pay your premiums on time. Your insurance company must give you at least 30 days notice before cancellation.
6. In general, young adults under 26 years of age can be covered under their parents insurance plan. This is true even if they are married, financially independent, in school, not living with their parent(s), or eligible for an employer’s plan.
7. Most health coverage plans are required to give you access to free preventive care services. This means you’ll be able to receive preventive screenings, as well as vaccines, at no cost to you. This does not apply to grandfathered plans.
8. Insurance companies cannot have lifetime and yearly dollar limits for coverage of essential health benefits. There are a few exceptions to this — check your plan’s materials or contact Independent Benefit Advisors to find out whether or not this applies to you.
9. You are guaranteed the right to appeal. If a claim is denied, you can appeal internally. If payment is still denied, you can have an external review by an independent organization. However, rights do vary depending on the state you live in and your type of plan. These rights do not apply to grandfathered health plans. To find out more about appealing a private health care decision in NC, contact IBA.

For more information about rights under the new health care law, as well as which rights apply to you, call Independent Benefit Advisors at (919) 303-9690.

Independent Benefit Advisors looks forward to helping you understand and navigate new health care laws and the NC Health Insurance Marketplace. We serve Apex, Raleigh, Durham, Cary, Charlotte, Fuquay-Varina, Greensboro, Rocky Mount, Sanford, Wake Forest and other locations throughout North Carolina.