The Facts and Fiction Behind the Affordable Care Act

December 03, 2018

Note: Affordable Care Act enrollment runs from October 15, 2018 to January 15, 2019. AltaMed is ready to walk you through your options for free. Call us today at 877-462-2582

ACA, Obamacare, the Patient Protection and Affordable Care Act, Healthcare Reform…it’s known by a few different names, but the Affordable Care Act (ACA) is a law passed by President Barrack Obama in 2010. Its basic goals are to help more people get coverage, ensure health plans provide certain essential benefits, and help control costs for everyone. 

Since it was passed, the Affordable Care Act has become incredibly popular, but it’s under attack by politicians and interest groups who want to do away with it. There’s been a lot of misinformation spread about it, so we want to give you information about what it is and what it actually does, so you can feel confident when enrolling in a plan and using your benefits.
 

The Facts:

 

It provides safeguards for people with preexisting conditions.
woman at desk

A preexisting condition is any type of disease or condition that you have before the start date for your new health care plan. For example, asthma, diabetes, thyroid disorders, cancer or even pregnancy have all been considered preexisting conditions.

In the days before the ACA, if you had a preexisting condition, an insurer could refuse to sell you coverage, charge you extremely high prices for a plan, or sell you a plan that did not provide coverage for the care required by your condition. But under the ACA, if you have a preexisting condition, you cannot be denied coverage and you can’t be charged more.
 

By helping more people get care, it keeps costs down for everyone.
man at doctors office


Here’s a scenario that was all too true before the ACA: say a person with diabetes had a plan that did not cover their doctor visits or testing supplies. Instead of getting routine care at the doctor’s office, they let their diabetes spin out of control to the point where they had an emergency, then had to be rushed in an ambulance to an emergency room. Now, instead of paying $30 copay, which they would have received had they visited their primary care physician, they may be left with a bill for thousands of dollars. Some of which would have been paid for through their insurance plan; this would end up raising costs for everyone. 

But under the ACA, a person with diabetes would get lower cost office visits – and in some cases, they might even get their testing supplies covered for free. They stay healthier and save their plan money.


The ACA provides essential coverage to keep people healthier.
hospital hall

The ACA required insurance plans to cover many routine preventive services. Like the example used above, accessing these services early can help people stay healthy and reduce their risks for conditions that require complex medical treatment. 

Some of these services include: 

  • Prescription drugs
  • Laboratory services
  • Mental health and substance use disorder services
  • Maternity and newborn care
  • Pediatric services

 

The Myths:

 

The government decides what treatments you get, and you can be denied a treatment if it’s too expensive.
letter

Not true. What treatments you receive are between you and your doctor. Your insurance may decide how much to pay – and in a few very rare cases, they may decide not to cover certain treatments, but you always have the option to still receive that treatment. The government has nothing to do with it.


The government forces people to buy plans.
wallet

Up until recently, anyone who didn’t purchase coverage was charged a penalty. But starting with coverage year 2019, the penalty no longer applies.

The government does want everyone to purchase a plan. The way insurance works is that it’s a big risk pool – odds are that in large group, there will be some people who are sick and need care, but most people will be healthy. And this only works when everyone, including young, healthy people who don’t need very much care, purchases a plan.
 

You can only buy a plan on the Covered California website.
website

You can actually buy a plan from any company you like – if you want a specific plan from an insurance company like Aetna or Blue Cross, you can go to a broker and ask for it. You can also get a plan through your employer, if it’s offered.
 
If you qualify for a subsidy from the state to help you purchase a plan, then you most purchase it through Covered California (also known as “the marketplace”). About 88 percent of those who enroll through Covered California are eligible for a subsidy!


Take Action and Enroll Now
You and your family’s health matters! Take steps now to make sure you’re covered in a plan that fits your needs and your budget. AltaMed can help walk you through your options for free. Call us at 877-462-2582.

 

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For Your Health: 6 Top Questions About Open Enrollment

October 15, 2018

We’re dedicated to helping everyone get the care they need to grow healthy—and that means empowering you to make the best decisions about you and your family’s health. We’ve answered some of your most important questions about the insurance Open Enrollment period.

Don’t forget, we’re here to help, and we can walk you through your options for free. 

Get help in English: 833-444-5560
Get help in Spanish: 833-444-5570

 

What is Open Enrollment?
couple on couch

Open Enrollment is a period of time when you get to make important decisions about your health care and your insurance coverage for the next calendar year. You can stay on the plan you’re on, but you can also choose a new plan that works better for your budget or your health needs.  

The plan you pick can have a big impact on you: it will affect how much you pay for a doctor’s visit or prescription, which treatments and services are paid for, and which doctors you can see. 
 

When is Open Enrollment?
calendar

It depends on what kind of insurance or medical coverage you have.  If you get your benefits through Medicare, your Open Enrollment period runs from October 15 to December 7. If you get your care through Covered California, your Open Enrollment period runs from October 15 to January 15.
 

Why Does It Matter to Me?
woman at doctors offices

Open Enrollment is really important! It is your chance to get the best care for you and your family. Which plan you choose affects:

  • The price of your premiums, or the amount you pay every month for your plan
  •  Which doctors and hospitals you can see
  •  How much you pay for your care, including office visits, prescriptions, and other services
  •  How much you will have to pay out of your own pocket for the entire year
  •  If you can get certain kinds of care (for example, dental or optometry visits)

 

What Happens If I Don’t Choose?
signing documents

If you already have insurance or Medicare, you will likely continue with the same plan you were already on. If you are on a plan through Covered California or your employer, and your plan goes away, you will automatically get assigned to a plan that offers similar coverage at a similar price.

 

What Happens If I Don’t Have Coverage and Miss the Deadline?
happy patient
 

If you are at a job and are offered coverage but miss your deadline, you won’t be able to enroll until the following year. But if you have certain life events, like getting married or having a baby, you may qualify for a special enrollment period. You can also get a short-term plan or you may be eligible for Medicaid or Children’s Health Insurance Program (CHIP).

The same is true for Covered California.

If you miss your deadline to sign up for Medicare, you can enroll during the General Enrollment Period that runs from January 1 to March 31 every year. Unfortunately, your coverage won’t start until July 1. 
 

How Can I Learn More? 

AltaMed is ready to walk you through your options for free. We’re right here to answer any questions, and to help you grow healthy, every day, at any age. Learn why AltaMed is your best choice and get started today. 

Get help in English: 833-444-5560
Get help in Spanish: 833-444-5570

 

 

Open Enrollment: How to Get the Most Out of Your Benefits

October 15, 2018

Your health care plan is about much more than simply going to the doctor and getting medication when you get sick. Medicare and most commercial plans offer a number of benefits that can help you stay healthy and save money.

Not every plan offers all of these benefits, so you should contact the number on the back of your health care ID card or visit your plan’s website before you schedule an appointment.
 

Preventive services
mom and daughter at doctor

Did you know there are a number of services that you can get that will keep you and your entire family healthier – and they’re at no cost to you? Under the Affordable Care Act, health care companies cover what are called preventive services. They’re called preventive services because they can help prevent illness and disease. All in all, there are 15 covered services for children and adults, and they include:

  •  Blood pressure screening
  • Cholesterol screening
  • Type 2 diabetes screening (for adults with high blood pressure)
  • Age-appropriate immunizations for hepatitis A & B; HPV; measles, mumps, and rubella; and many others 
  • Tobacco use screenings and cessations interventions for tobacco users

You should always check coverage with your plan. You’ll still have to see a doctor that is in your network to get these services, but it’s well worth your time.
 

No-cost wellness services
yoga mat

Many plans offer free programs to help members achieve important health goals, such as losing weight, becoming more active, cooking and eating healthier, or reducing stress. For example, your plan might offer you a weight loss program that allows you to log your weight and get easy-to-use tips, recipes, exercise videos, and words of encouragement. 

These health and wellness programs are designed to be fun and easy to use, even for those who may be new to healthy habits. 
 

Mental health care
man smiling

We all know how important your mental health is, and the affect it has on your body and your family. Many insurance plans, including Medicare Part B, provide coverage for members to see a specialist, such as a psychiatrist or someone who specializes in substance abuse. 

And FYI, a depression screening with your primary care doctor is considered a preventive screening. See them first and get recommendations for next steps.


Special screenings for moms-to-be
mom and baby

You and your health plan both win when you have a happy, healthy baby. That’s why plans are required to cover special preventive services for women who are either currently pregnant or trying to get there. Besides health screenings for conditions like anemia and gestational diabetes, you should be covered for lactation support and breast pumps.
 

Nurse Line
call center nurse

It’s 3 am and your six-year-old just woke you up with a cough and a temperature of 99 degrees. Maybe it’s nothing, but you’d sleep better if you could get some advice. Call the nurse advice line. It’s a great way to avoid an expensive trip to the emergency room, and you can get help right when you need it. 

Your health plan’s nurse advice line is available 24/7. Call them anytime to talk to a licensed, registered nurse to find out more about common health issues. You can also call the AltaMed nurse advice line at (866) 266-5092.

If you’re experiencing a true medical emergency, call 9-1-1 or go to your nearest emergency room.
 

Save on your medication
meds


If you have prescription coverage, you can save even more with generic drugs. In most cases, they are totally identical to the “name brand,” at a fraction of the cost. Be sure to ask your doctor or pharmacist about them.

Many health care plans also offer mail order services. In some cases, you could pay less for your prescriptions. Even if you don’t, you’re still saving several trips to the pharmacy. 

Still need some help for Open Enrollment?
AltaMed is here to walk you through your Open Enrollment options for free. Let us help you make smart choices to help you and your family grow healthy.

Get help in English: 833-444-5560
Get help in Spanish: 833-444-5570