Sept. 13, 2013
“Hey, Doc” Answers Questions You Never Thought to Ask
About the New Health Insurance Marketplace
Physicians are Americans’ most trusted source for information on the Affordable Care Act (ACA), according to a new national poll; but people are not turning to their doctors to learn about it. The Texas Medical Association is about to change all of that.
TMA’s “Hey, Doc” education campaign will provide objective and nonpartisan answers to the most frequently asked questions about the new ACA health insurance marketplace. We want to make sure all Texans understand what the marketplace does and what steps they need to take.
The ACA marketplace will begin accepting applications Oct. 1, 2013. We need your help to get the word out.
TMA will send you pertinent, objective, and timely content each week for your use. Please feel free to use the content in its entirety or as a basis for a story. We have physician experts standing by to answer your questions. In fact, every Wednesday, TMA will post a new video featuring TMA Board of Trustee Chair Carlos Cardenas, MD, answering questions about the ACA. You can find the videos and a lot more information at MeAndMyDoctor starting Sept. 18.
Introducing TMA’s first week of “Hey, Doc” education programming.
Week 1: Introduction, Where to Get Help, When to Sign Up
What exactly is this Marketplace, and why should I care?
The Affordable Care Act (ACA) requires most individuals to have health insurance in 2014. So the law requires that so-called health insurance exchanges — now referred to as marketplaces — be established in every state as another avenue for individuals to purchase private health insurance on their own. Most people get insurance through their jobs. But if you don’t have that option, you can shop in the marketplace instead of buying directly from insurance companies. Or maybe you have a certain condition that in the past prevented you from getting health insurance because it was too expensive or simply hard to get. Now, you will have options in the marketplace.
Changes under the ACA also require all private health plans to provide a minimum package of “essential health benefits,” which include a basic set of services like physician visits, hospital and emergency care, preventive services like vaccines and screenings, and prescription drugs. So any health plan you purchase on the exchange must cover these services, and they cannot deny you coverage because of a preexisting condition.
Instead of having to search out health plans on your own, the marketplace is designed to be a one-stop shop where you can go online to check out your coverage options in one place, get easy-to-understand information, and compare plans before you make a decision. Kind of like Orbitz or Travelocity, but for health insurance instead of travel. You can also find out right then and there if you qualify for a tax break on your private insurance premiums — another feature of the health reform law — or for state programs like Medicaid or the Children’s Health Insurance Program (CHIP).
The time to sign up for plans offered in the marketplace is approaching fast: Open enrollment is slated to begin Oct. 1 for coverage beginning Jan. 1, 2014. Unless you qualify for an exemption under the federal law, you must get insurance starting Jan. 1 or you could have to pay a fine.
Where can I get more questions answered?
Because Texas chose not to launch its own marketplace, the federal government will run the exchange here and serve as the main resource for information and enrollment.
Right now, you can visit Healthcare.gov and CuidadoDeSalud.gov. to find checklists, videos, and other resources to get ready for open enrollment, although actual plans and price comparisons won’t be available until Oct. 1. That’s when you’ll actually apply, too, but you can get ready now. A toll-free call center is available to help answer questions 24/7 at (800) 318-2596. There also will be people in your community known as “navigators” to help with the enrollment process beginning in October.
Blue Cross and Blue Shield of Texas (BCBSTX) also launched a campaign called “Be Covered Texas” to help Texans understand the federal health reform law and navigate the new insurance marketplace in Texas. Call (866) 427-7492 Monday through Friday, 8 am to 5 pm (CT), or go online any time to BeCoveredTexas.org.
If you have questions about insurance you already bought in Texas or receive through your employer, you can contact the Texas Department of Insurance at (800) 578-4677 or www.tdi.texas.gov/index.html.
If you think you are eligible for Medicaid or CHIP, you can contact the Texas Medicaid Program at (800) 252-8263 or www.hhsc.state.tx.us/medicaid/.
Where can I find out more about the Marketplace?
There is a lot of information out there that can be difficult to sort through. Here are a few resources we have found helpful on the insurance marketplace, what to expect, and how to sign up:
- Healthcare.gov is the federal government’s official website for consumer information on the marketplace and the health care law overall.
- Another federal resource with explanations; checklists; and official forms, applications, and language materials, for instance, is .
- BeCoveredTexas.org is an English-Spanish website that BCBSTX set up to help Texans understand how the marketplace will work in this state and to get signed up. The site offers materials like printable fact sheets on the marketplace and the health reform law and checklists.
- The Kaiser Family Foundation developed an interactive map detailing each state’s insurance marketplace (http://kff.org/state-health-exchange-profiles/), and a subsidy calculator tool (http://kff.org/interactive/subsidy-calculator/) to help families estimate how much they can spend on health insurance and whether they qualify for financial assistance.
You can find this information and more at MeAndMyDoctor.com and HeyDoc.texmed.org.
Below is TMA’s “Hey, Doc” content schedule through Oct. 30, 2013. We have content in the works through January 2014.
Where to Get Help, When to Sign Up
Sept. 16: What exactly is this marketplace, and why should I care?
Where can I get more answers?
Where can I find out more about the marketplace?
Sept. 25: Where can I get help signing up?
When can I create an account at the marketplace?
How can I get ready to sign up?
Sept. 30: When can I sign up?
How do I sign up?
Who can/must enroll? Who doesn’t have to? What are the penalties?
Oct. 7: Who can enroll?
Oct. 14: Who must enroll?
If I have insurance through my work or my spouse or my parents, do I have to give that up and buy insurance through the marketplace?
Does the individual mandate mean I have to buy health insurance through the marketplace?
TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 112 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
Contact: Pam Udall
cell: (512) 413-6807
Contact: Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320
Click here to follow TMA on Twitter. Or visit TMA on Facebook.
Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.