Make Your Gift
Make Your Gift

Planned Parenthood

Western Pennsylvania

How Does the ACA Affect Me?

woman_with_blue_scarf.jpg

The health care law, also known as Obamacare or ACA (Affordable Care Act), makes health insurance more affordable for millions of people, and says most Americans need to get insurance. Planned Parenthood is here to help you figure out what the law means for you.

 

What does the health care law cover?

All plans are required to offer coverage for essential health services including hospitalizations, maternity care, prescription drugs, and preventative care without a copay.  Preventative care includes annual well-woman exams and a range of free birth control options (although some brands of birth control will require a copay. You will have to check with your insurer to find out if your brand is free or not).

There will be a variety of plans available to choose from, which will vary in terms of cost and services covered. 

 

Do I qualify?

How you qualify for new health insurance will differ based on a variety of factors, including income and citizenship (you must be a citizen or legal resident to qualify). Also, what type of coverage you’re eligible for varies from person to person, even within one family.

Under the age of 26? If your parent has health insurance, you can remain on that plan until your 26th birthday. If you turn 26 after the open enrollment period ends, you can qualify for a special enrollment period

If your income is below $16,105, then you do not have to get insurance and will not face a fine.

Do I Qualify even if I have a pre-existing condition?

Also, if you have a pre-existing condition, you need not to worry. Health insurance plans are no longer able to deny you coverage for a pre-existing condition such as diabetes or breast cancer. In addition, they can no longer charge women more than men for health care.

 

What if I have insurance through my employer?

If you already have insurance through your employer, you will not need to enroll in the Marketplace. You can, however, choose to compare pricing of the plans in the Marketplace to your employer-offered plan. If you find a lower, comparable plan in the Marketplace, you can apply for it. 

The law has new benefits for people who already have insurance, like prescription birth control and annual well-woman exams covered for free, without a copay. It also makes sure that insurance companies can’t put limits on how much they will pay for care you might need in a year or in your lifetime. And you can stay on your parents’ health insurance plan until age 26.

 

What will the cost be?

The health care law makes quality health insurance plans more affordable, and millions of Americans will get financial help in paying for their new insurance plan. In fact, most individuals making less than $46,680 per year, and most families of four making less than $95,400 can get financial help. For an estimate on what you may pay and what financial help you may receive, you can use the Kaiser Foundation’s Subsidy Calculator.

There are four different types of plan options, depending upon what you want to pay and how extensive you want the coverage to be. These are referred to as Bronze, Silver, Gold, and Platinum. The Bronze will be the most affordable plan, offering all of the basic coverage (up to 60%). The Platinum plan will most likely cost the most in premiums, but will also provide more comprehensive coverage (up to 90%).

 

When do I enroll?

Enrollment for 2015 coverage is November 15, 2014 through February 15, 2015.

If you have a life event that changes your family status, such as having baby, or if you lose coverage due to something like changing jobs, you may qualify for a special enrollment period

 

What do I need to enroll?

You need a list of items to enroll as well as a calculation for your annual household income for 2015. We have provided a printable version of the form. 

 

How do I enroll?

You can enroll online or you can get in-person help. We have navigators to help you through the process of signing up and picking a plan.

 

If I get insurance, will Planned Parenthood still be available to me?

 Planned Parenthood will continue to provide quality health care—whether or not you have insurance.

You will have to check your insurance plan’s network. A network is a list of providers where you can use your insurance. Not every plan will include every provider, so you will have to check to see if your provider is included in the plans you are considering.

If you want to come to Planned Parenthood or have us as an option for care, look for a plan that includes us as a provider.

 

What if I don’t qualify for insurance?

Planned Parenthood will continue to provide quality health care even if you don’t qualify for health insurance. Our Select Plan is a popular option for women. You can still come to us for the care you need when you need it.

select_plan.jpg

 

 

 

What if I don’t enroll by February 15, 2015?

The health care law requires that most Americans get health insurance by February 15, 2015 or face a fine.  The fine for not getting covered in 2015 is $325 or 2% of your income—whichever is higher.

Many Americans will receive financial help paying for their insurance plans. In fact, most individuals making less than $46,680 per year, and most families of four making less than $95,400 can get financial help.

If your income is below $16,105, then you do not have to get insurance and will not face a fine.

 

What happens if my coverage changes after February 15?

If you have health insurance now and something happens in your life that changes your coverage, such as changing jobs or having a baby, you may qualify for a special enrollment

 Qualifying life events include:

  • Losing insurance coverage (unless this loss of coverage resulted from failure to pay premiums or was a voluntary cancellation);
  • Getting married or divorced;
  • Giving birth or adopting a child;
  • Becoming a lawfully present immigrant or citizen;
  • Having a change in income that affects eligibility for premium tax credits or cost-sharing reductions (if you are already enrolled in a Marketplace plan);
  • Permanently moving to a new state or area with different health coverage options; or
  • Discovering a problem with your enrollment or non-enrollment due to an error by the Marketplace.

 

What should women consider when choosing a plan?

Does the plan cover the prescription birth control you use?

Every plan on the Marketplace must cover the full range of prescription birth control methods (pill, implants, IUDs, etc.) for free, without copay. Some plans may charge a copay for certain brands. Check with the plan to see if your brand is covered with no copay. If it is not covered, ask how much it will cost.

Does the plan have OB-GYN providers “in-network” close to where you live or work?

OB-GYN providers are the main source of health care for many women. Pick a plan that includes OB-GYN providers, like Planned Parenthood. Look to see where the providers are located to find one that is near you.

What maternity care services are covered?

Every plan will cover basic maternity care. Plans on the Marketplace will offer some prenatal services and screenings for free with no copay, as well as breastfeeding counseling, services, and supplies. The amount you will pay for maternity care will depend on each plan. Check with the plan to see how much you will have to pay out-of-pocket.

 

What if I want to learn more?

Check out our Resources page. We’ve provided different resources such as videos and articles to help you better understand how the health care law will affect you. 

Or, you can contact us at healthcareinfo@ppwp.org or at 412.258.9563.


 

  • tumblr icon
  • google plus icon
  • twitter icon
How Does the ACA Affect Me?