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Policy shopping?

Getting informed on reform is a good place to start

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POSTED December 19, 2012 5:23 p.m.

Health care reform is a hot topic, and not just for candidates running for political office. The cost of health care impacts the financial well-being of most Americans. Even though you may have heard a lot about health care reform, you may be wondering what it all means - or at least what it means for you and your family.

From the name of the health care reform law itself, the Patient Protection and Affordable Care Act (which is often shortened to the acronyms PPACA or just ACA), to terminology like ‘Individual Mandate’ or ‘American Benefit Exchanges’ there’s plenty to be confused about.-

Starting in 2010, new Patient Protection and Affordable Care Act rules, called provisions, began to go into effect. -PPACA focuses on providing every American with quality health coverage they can afford.

Here are a few examples of provisions that have already gone into effect:

• Insurance plans must cover preventive care such as routine physicals and immunizations at no cost to consumers.

• Emergency services must cost the same in or out of the insurance carrier’s network.

• Children may now stay on their parent’s health plan until age 26.

In 2014, the final provisions of the law will be implemented such as:

• The creation of health benefit exchanges (online marketplaces) from which individuals or small businesses will be able to shop for health insurance.

• The requirement that insurers may not deny coverage to someone for a pre-existing condition, regardless of age.

• Implementation of the individual mandate (which requires all Americans to purchase health insurance or pay a tax penalty).

The individual mandate has been one of the most debated components of PPACA. But as Lisa Lough of Cigna, a global health service company, explains: ‘There are many reasons to purchase health insurance, other than the coming Federal mandate. Compelling reasons not to go without health coverage include accessing care and services that can help improve your health and providing financial protection from potential large, unforeseen medical expenses.’

In fact, medical bills are a leading cause of personal bankruptcy, multiple studies have found. With familiar medical emergencies like an appendectomy costing $10,000 or more, a single hospitalization can wipe out a family’s resources. Having health insurance can help mitigate the risk of a health-related financial crisis. What’s more, many insurance plans offer incentives and programs to encourage the healthy habits and preventive care that can help you stay healthy, feel well and avoid a costly medical problem.

If you don’t have health insurance benefits through an employer, you can purchase individual or family plans directly from many insurance companies.- When shopping for health insurance, you need to find a plan that meets your individual needs. Lough offers some tips for finding the health insurance plan that’s right for you and your family:

• Look for a plan that is offered in your state and provides a high-quality network of health care professionals, hospitals and facilities.- You can check company websites for information on where they sell Individual health insurance plans.

• Seek an insurer that offers a personalized website and online tools that can help you manage your health care, including a doctor locator, treatment cost comparison charts, viewing your claims history, online bill pay, downloadable forms and the option to print temporary identification cards.

• Even with good online services, sometimes you’ll want to speak to someone. Look for an insurance company that offers a 24/7 customer service call center.

• For times when you’re not sure if you need to see a doctor, or when the doctor’s- unavailable, a 24/7 health information line can be a great help. Look for one staffed by trained nurses.

• Seek plans that offer affordable prescription drugs through either a retail pharmacy or home delivery which can save you money and provide a great convenience.

• Comprehensive plans will offer discounts on health and wellness programs, such as weight management and nutrition, fitness, tobacco cessation etc.

• If you prefer using your smart phone to access information, look for plans that offer tools like mobile apps.

‘With this check list in hand, people can go online and research plans,’ Lough says. ‘For example, at Cigna we have a website dedicated just to customers looking to purchase individual or family plans at www.cignaforyou.com. I also recommend calling the insurance provider and talking to a knowledgeable licensed agent to make sure you understand all the options and get the best coverage at the best price that makes the most sense for you and your family. There are so many options now with Health Savings Accounts and other types of plans offering a variety of coverage and deductible levels, so talking to an expert to understand which choice is right for you is important.’-

For more health care reform terms and definitions, check out Cigna’s Glossary of Health Care and Health Insurance terms at www.cigna.com/health-care-glossary. -You can also use ‘Health Care Reform For You’; an interactive online tool that delivers personally relevant information on how the health care reform law impacts your individual situation which you can print or share through social media. Find it here: www.cigna.com/hcrforyou.

 

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