Affordable Care Act Information Center

Affordable Care Act: 

What does it mean and what do I need to know?

The Affordable Care Act (ACA) is national legislation which makes numerous changes in how health care is offered to many Americans.  For a general overview, see the following video:

kff.org/health-reform/video/youtoons-obamacare-video/

A key feature of the ACA is the availability of new health insurance options (Qualified Health Plans) which can provide better insurance at a more affordable price for many Americans.  These options are provided through the Health Insurance Marketplace. 

Individuals have until March 31, 2014 to enroll in a Qualified Health Plan through the Marketplace for 2014.  To have Marketplace insurance coverage that begins in January 2014, individuals must enroll by December 23, 2013.  Consumers who enroll in a Marketplace insurance plan by that date will have until January 10, 2014 to pay their first month's premium.  (Blue Cross Blue Shield customers in TN will have until January 15, 2014). 

Please note:

There is a scheduled outage at the Federal Data Services Hub starting Saturday, February 15, at 3PM EST / 2PM CST and ending on Tuesday, February 18, at 5AM EST / 4AM CST for the Social Security Administration's annual systems maintenance. During this period, verification of Social Security Numbers and other related data via the Hub will be unavailable.
 
 
Individuals attempting to complete the application process on HealthCare.gov during this period will not be able to immediately receive an eligibility determination/assessment from the Marketplace. return to HealthCare.gov on or after February 18 to complete the enrollment process for coverage beginning April 1.    Upon completion, consumers will need to save their application and
 
If consumers want coverage effective on March 1, 2014, they need to sign up by February 15 before 3PM EST / 2PM CST. If consumers sign up during this outage period, they will not be able to find out what they qualify for until after 5AM EST / 4 AM CST on Tuesday, Feb. 18. Those individuals who signed up during the outage should call the Federal Call Center at 800-318-2596 starting on February 18 to request March coverage. A blog post from Healthcare.gov is available here.  
 
All other services of the Hub should function as usual.
 

Residents of Tennessee, Arkansas and Mississippi will be able to shop for these options on the national Marketplace websites www.healthcare.gov/  or in Spanish www.cuidadodesalud.gov/es/ .  They can call also the national 24 hour hotline at 1-800-318-2596 (TTY 1-888-871-6594) for information and assistance in choosing a plan .

Call LINC/2-1-1 at 2-1-1 (alternate numbers 901-415-2790 or toll-free 1-855-354-4211) for information on where to get in-person assistance with Marketplace enrollment, how to access public computers, etc.

 

 

Do I have to get insurance? What is the "individual mandate"?

Do I have to get insurance?  What is the "individual mandate"?

Individuals have until March 31, 2014 to enroll in a Qualified Health Plan through the Marketplace for 2014. To have Marketplace insurance coverage that begins in January 2014, individuals must enroll by December 23, 2013.

Who is exempted from the individual mandate?

 

How do I get help with exploring options and enrolling?

How do I get help with exploring options and enrolling?

Websites

The national websites for the Health Insurance Marketplace www.healthcare.gov/ (in English) and www.cuidadodesalud.gov/es/ (in Spanish) are up and running right now, and provide lots of information about the ACA and what information individuals will need to enroll in the new QHPs.  Consumers can also see if they may be eligible to apply for Medicare, Medicaid and CHIP.  

Enrollment will begin October 1, 2013 and go through March 31, 2014.  Details about all the approved Qualified Health Plans are posted on the websites.  

The deadline to enroll to have coverage by January, 2014 is December 23, 2013.  However, consumers who enroll in a Marketplace plan will have until January 10, 2014 to pay their first month's premium.  (Blue Cross Blue Shield consumers in TN will have until January 15, 2014).  Coverage will be retroactive to January 1.

The deadline to enroll in the first enrollment period and have Marketplace coverage in 2014 is March 31, 2014.

Other online assistance

Other online assistance such as chat and email or text updates are available on the websites. 

For more information, see www.healthcare.gov/help-center/ .

Hotlines

The national toll-free Call Center for individuals is open now, and is available 24 hours a day, seven days a week, 360 days a year (closed some federal holidays).  Telephone support for 150 languages is available.  Call Center staff are able to answer many questions about the Affordable Care Act and the Marketplace, and to assist people with comparing insurance plans and enrolling over the phone.

1-800-318-2596       TTY 1-888-871-6594

The Small Business Health Options Program (SHOP) toll-free hotline provides information to employers about health care options for employees.  It is open Monday - Friday, 8 AM - 4 PM Central Time.

1-800-706-7893       TTY  1-800-706-7915 

In-person assistance

In-person assistance is available through Navigators and Certified Assistance Counselors (CACs).  These people are specially trained to help people understand their options and compare costs and benefits of different insurance plans so they can make a fully-informed choice.  For more information about the Navigator program in Tennessee, see www.seedco.org/about-us/tennesseenavigator/ .

To schedule an appointment for in-person enrollment assistance, call SEEDCO at 901-528-8341 or 1-866-720-1711.  You may also contact the following SEEDCO partners:  Christ Community Health Center 901-260-8500, Community Development Council 901-725-3124, Memphis Health Center 901-261-2000, Planned Parenthood Greater Memphis Region 901-725-2008, or Porter-Leath 901-577-4090.  Please allow 2-3 days for a call-back.

Paper Applications

Paper applications for enrolling in the Health Insurance Marketplace can be found at www.cms.gov/CCIIO/resources/Forms-Reports-and-Other-Resources/index.html .

There are three different applications/instructions, so be sure to pick the one that applies to you:

1. Individual Short Form (with possible financial assistance)
Application: marketplace.cms.gov/getofficialresources/publications-and-articles/individual-short-form.pdf
Instructions: marketplace.cms.gov/getofficialresources/publications-and-articles/individual-short-form-instructions.pdf

2. Family (with possible financial assistance)
Application: marketplace.cms.gov/getofficialresources/publications-and-articles/marketplace-application-for-family.pdf
Instructions: marketplace.cms.gov/getofficialresources/publications-and-articles/marketplace-application-for-family-instructions.pdf

3. Individual OR Family (without financial assistance)
Application: marketplace.cms.gov/getofficialresources/publications-and-articles/marketplace-application-without-financial-assistance.pdf
Instructions: marketplace.cms.gov/getofficialresources/publications-and-articles/marketplace-application-without-financial-assistance-instructions.pdf

Libraries and 2-1-1s

Other community organizations such as public libraries have updated information about the Affordable Care Act and how to navigate the Marketplace website.  Some library locations host information sessions and enrollment events.  Many libraries also have public access internet computers or free wi-fi access for customers to explore their options and apply online.  Consumers who wish to use the public computers at Memphis Public Library will need to have a Memphis Public Library card.  For information on the Memphis Public Library locations, see www.memphislibrary.org/libraries/map .

Call LINC/2-1-1 at 2-1-1 (alternate numbers: 901-415-2790 or toll-free 1-855-354-4211) for more information on where to get in-person assistance, how to access public computers, etc.

How is this better than what I have now?

How is this better than what I have now?

 

In-person Information Sessions & Enrollment Assistance

In-person Information Sessions & Enrollment Assistance

Special WALK-IN sessions for people who have already started the process by March 31 but have not yet completed enrollment:

Fri, April 11           10:30 AM - 3:30 PM
                                Benjamin L Hooks Central Library
                                3030 Poplar Avenue, 38111 -  Meeting Room C

Sat, April 12          9:00 AM - 1:00 PM
                               Breath of Life Christian Center
                               3795 Frayser-Raleigh Road, 38128

Mon, April 14        10:30 AM - 5:00 PM
                                Cordova Branch Library
                                 8457 Trinity Road, 38018
                       
Navigators from SEEDCO will provide information and assist with in-person enrollment in Marketplace health insurance options.  

For possible in-office appointments Monday, April 14 and Tuesday, April 15:

Call SEEDCO at 901-528-8341 or call one of the partner agencies listed below:  

Christ Community Health Services 901-260-8500
Community Development Council 901-338-7867
Memphis Health Center 901-261-2000
Porter-Leath 901-577-4090

 

For general information about the insurance companies offering ACA health insurance plans in TN, see information from US News and World Report, health.usnews.com/health-insurance/tennessee/marketplace-plans. For ratings by US News and World Report of those and other health insurance plans available in Tennessee, see health.usnews.com/health-insurance/tennessee/plans . 

Ten Essential Benefits

Ten Essential Benefits

  1. Ambulatory patient services (outpatient care)
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance abuse disorder services, including behavioral health
  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


What information do I need to apply?

What information do I need to apply?

For all family members seeking insurance coverage:

* Social security numbers (or document numbers for legal immigrants)
* Birth dates
* Employer and income information (such as pay stubs, W-2 forms, Wage and Tax statements)
* Policy numbers for any current health insurance plans
* Information about any health insurance available through current employers -- Use the Employer Coverage Tool from www.healthcare.gov

What is "Medicaid expansion" and how is it related to my health insurance choices?

What is "Medicaid expansion" and how is it related to my health insurance choices?

Medicaid is a health insurance program for low-income people that is administered by the states.  The Affordable Care Act (ACA) was designed to offer insurance options for people who are working and can pay monthly premiums.  The ACA was also designed with the assumption that states would open (or "expand") Medicaid enrollment to more low-income people in their states.  The US Supreme Court ruled that states have the option of whether or not to "expand" their Medicaid enrollment in conjunction with the ACA.  Some states have chosen to do so; others (including Tennessee) have not at present.   Medicaid is called TennCare in Tennessee.  

Some low-income residents of states that are not "expanding" Medicaid will not qualify for the premium assistance or cost-sharing subsidies under the ACA, and will not be able to afford to pay the premiums.  Unless Medicaid opens up in their state, they will have no new health insurance options.  Staff and volunteers at some community health centers and hospitals are aware of the situation, and are preparing to help health consumers determine if they may be eligible for new insurance through the Marketplace or will continue to access clinic and hospital services on a fee-for-service or sliding scale basis.

Tennessee residents concerned about Medicaid expansion can find more information at www.tnjustice.org/resources/affordable-care-act/ , www.thcc2.org/state/ or www.ahealthytn.org/ .

What is "minimum essential coverage"?

What is "minimum essential coverage"?

 

What is available for employers?

What is available for employers?

For 2014, many small employers (50 or fewer full-time equivalent employees) have access to the Small Business Health Options Program (SHOP) to shop for employee health insurance plans.  Enrollment can begin by phone, mail, or FAX on October 1, 2013.  Information is available online now, and full online comparison of plans and online enrollment will begin November 1, 2013.

See more at www.healthcare.gov/small-businesses/ and www.sba.gov/healthcare .

Call the SHOP toll-free hotline 1-800-706-7893  TTY 1-800-706-7915  Monday - Friday, 8 AM - 4 PM, Central Time.

Check out the weekly ACA webinars for small businesses, hosted by the Small Business Administration and the Small Business Majority.  For more information, see www.smallbusinessmajority.org/blog/small-business-majority/healthcare/affordable-care-act-101-weekly-webinar-series/ .

What will be in the Qualified Health Plans (QHPs)?

What will be in the Qualified Health Plans (QHPs)?

Insurance companies may offer different levels of plans -- Bronze, Silver, Gold and Platinum-- which offer different levels of benefits, but all QHPS must include some level of the Ten Essential Benefits.  The choices will be arranged so consumers can compare the benefits and costs of each plan.  As with other private insurance now. plans which offer more benefits may cost more (have higher monthly premiums, higher deductibles, higher co-pays).

 

Consumer Protections

Consumer Protections

Protect yourself from fraud!  The best protection from fraud is being informed,  Here is valuable advice friom the Center for Medicaid and Medicare Services about how to protect your personal information, avoid scams and stay safe:

marketplace.cms.gov/getofficialresources/publications-and-articles/protect-yourself-from-fraud-in-health-insurance-marketplace.pdf

Remember: You should NOT have to pay for information about your health insurance options in the Healthcare Marketplace, or to get assistance in enrolling. 

If you suspect fraud, report it!  Call the national Health Insurance Marketplace call center at 1-800-318-2596, contact law enforcement (Memphis police 901-545-2677), or  Consumer Insurance Services at the TN Department of Commerce and Insurance (1-800-342-4029).   If you suspect identity theft, call local law enforcement and the Federal Trade Commission's ID Theft Hotline (1-877-438-4338).

Information about FREE in-person assistance from trained, certified Navigators is available in Tennessee through calling SEEDCO at 901-528-8341 or  866-720-1711You can also call the national Affordable Care Act Marketplace Hotline at 1-800-318-2596 to find free local help in your area.

If you have trouble remembering all these numbers, simply call 2-1-1 and the 2-1-1 staff will also be happy to provide the information you need.

For general information about the insurance companies offering ACA health insurance plans in TN, see information from US News and World Report,  health.usnews.com/health-insurance/tennessee/marketplace-plans.  For ratings by US News and World Report of those and other health insurance plans available in Tennessee, see health.usnews.com/health-insurance/tennessee/plans .