Arch Health Medical Group

Affordable Care Act

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  • 15 Oct 2013
  • Feature
  • Arch Health

Affordable Care Act - Health Insurance Exchanges (ObamaCare)

How does the Patient Protection and Affordable Care Act (ObamaCare) affect me?
 
If you are currently insured by your employer’s health plan and see an Arch Health Partners physician, you do not need to do anything. Simply renew your coverage and you'll continue to receive great care from us. If you are uninsured or purchase your own insurance, you may remain or become an Arch Health Partners patient by selecting a plan that is accepted by Arch through an insurance broker or the Covered California insurance website.
 
Which Health Plan in the Exchange should patients sign-up for in order to see an Arch Health Partners doctor?
 
Sharp Health Plan HMO and Health Net PPO have been confirmed. More may follow soon.
 
What are the exchanges?
 
The exchanges are online marketplaces in each state where individuals and small businesses will be able to buy health insurance that meets certain benefit and cost-sharing standards. The purpose of the exchange is to allow consumers to more easily compare similar insurance products and purchase coverage as part of a larger risk pool than is currently available to individuals and small businesses. A term that has become synonymous with the insurance exchange is ObamaCare.
 
What is the timeframe for the exchanges?
 
Enrollment for exchange plans opened in all states beginning Oct. 1 2013, running through February 28, 2014, with coverage beginning Jan. 1, 2014.
 
Does California have an exchange?
 
Yes. It is named Covered California.
www.CoveredCA.com

Who runs the exchanges?
 
The federal government is operating exchanges in 34 states. The other 16 states and the District of Columbia will run their own exchange. California has been at the forefront in supporting this key provision.
 
What type of health insurance will be sold in the exchanges?
 
Private insurers (like Sharp Health Plan, Health Net, Kaiser, etc.) will sell insurance products to individuals and small businesses that meet benefit criteria outlined by the government. The insurance products will vary somewhat by state, but will include items and services within at least the following 10 categories:
 
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
 
Who is eligible to purchase insurance through the exchanges and what will the cost-sharing be?
 
Individuals and small businesses are eligible to purchase coverage through the exchanges. Beginning in 2014, tax credits will be available to help certain consumers purchase insurance in the exchanges.
 
Cost-sharing, including premiums and deductibles, for those purchasing coverage in the exchanges will vary depending on the state and the level of the plan purchased. There are four tiers of plans (from low to high): bronze, silver, gold and platinum.
 
Which insurers will participate in the exchanges?
 
In the San Diego region, the following insurance companies are participating in the exchange: 

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