Q&A: How the Affordable Care Act affects you

On Oct. 1, some Tri-State residents will be able to sign up for health insurance through new health care exchanges, dictated by the Affordable Care Act.

Here's a breakdown of what you need to know:

Where do I go to shop/enroll?

Just log onto the federal government's website at: Healthcare.gov

What if I have questions - who do I call?
Folks with questions about using the Health Insurance Marketplace can call 1-800-318-2596, 24 hours a day, 7 days a week.

What does this mean for the average American family's health coverage?

For individuals and families, it means they will remain covered through health plans sponsored by employers, which cover just less than 60 percent of Americans. Recent surveys suggest most employers that offer insurance will continue to do so, and by 2014, when the health law takes full effect, 86 percent say they will offer it.

People who get their insurance as individuals in the "individual" insurance markets still will have to wait until January 2014 to shop in new state health exchanges but may get some early benefit from other insurance market reforms.

What if I'm self-employed?

If you're self-employed, you'll have more health coverage options in 2014.

Starting October 1, 2013, you can use the Health Insurance Marketplace to find health coverage that fits your budget and meets your needs. You can compare important features of several plans side-by-side, all of them offering a full package of health benefits . You can see what your premium , deductibles , and out-of-pocket costs will be before you decide to enroll.

You can't be denied coverage or charged more because you have a pre-existing health condition .

If you currently have individual insurance--a plan you bought yourself, not the kind you get through an employer--you may be able to change to a Marketplace plan. Learn more about changing individual insurance plans.

What about the subsidies and other incentives for companies to offer insurance to employees, and the fines if they don't?

Those provisions will continue as planned. Small-business tax credits that have been available since 2010 will continue for eligible firms, and penalties against firms with at least 50 full-time employees whose workers get a subsidy from the government to help pay their premiums all stay in place.

What happens to the expansion of Medicaid coverage?

This could be the biggest impact of the decision. By expanding Medicaid coverage to adults with incomes up to 133 percent of poverty ($18,310 for a family of three in 2009), the law is expected to cover as many as 17 million more Americans.

Although the court says the government can't dock a state's existing Medicaid payments for not expanding coverage, the ruling allows the feds to offer to pay, first, 100 percent, and later, 90 percent of the cost of the expansion between 2014 and 2020 and beyond.

What will happen with the health insurance exchanges the law requires every state to have, although only about a dozen have set them up?

Only 15 states have not accepted federal grants to establish the new insurance marketplaces, and some of them have made some plans on their own. The arrangements are supposed to be in place by November, and federal money to set up the exchanges expires in 2015.

Does the ruling change any of the law's restrictions on private health insurance plans that are already in place?

No. Many advocates had worried that if the court struck down the mandate to buy insurance, the law's market reforms also would be dropped. But some major insurers already had pledged to keep some of the more popular provisions.

With the law upheld, all those restrictions will remain: Insurers will not be able to drop you because you get sick, refuse insurance to children because of pre-existing conditions or impose a lifetime maximum on the amount of your benefits. Insurers also will have to spend 80 percent to 85 percent of premiums on medical care, and they must allow parents to continue coverage for adult children up to age 26 if the children can't get insurance on their own.

Which insurance companies will be participating for Ohio?

For the individual market in Ohio, 12 companies will offer a total of 200 plans for individuals and families. They are Anthem, AultCare, Buckeye Community Health Plan, CareSource, Coventry, HealthSpan, Humana Health Plan of Ohio, Kaiser, MHIC, Molina, Paramount, and Summa.

Which insurance companies will be participating for Kentucky?

For the individual market in Kentucky three companies will offer plans: Anthem, Humana and the new Kentucky Health Cooperative. Learn more here: Kynect

For more on the Affordable Care Act, go to http://www.wcpo.com/affordable-care-act

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