“Hey, Doc” Answers Questions About the ACA Marketplace

Nov. 19, 2014

Enrollment for the Affordable Care Act's (ACA's) health insurance marketplace opened last week. Texas physicians want to make sure patients have all the information they need to make informed decisions when purchasing their insurance coverage.

This installment of Texas Medical Association's (TMA's) "Hey, Doc" weekly education campaign answers these questions:

What if I have insurance through my work or family? Do I have to give that up and buy insurance through the marketplace?

Not necessarily. Generally, if you already have health insurance, you satisfy the ACA's requirement to have coverage. But there are a few things you may want to look into. 

Check with your employer to make sure it will continue providing coverage. 

Check the status of your current plan to make sure it meets the new minimum requirements under the ACA. 

If you have your own insurance or a job-based plan that was "grandfathered in" because it existed before the health reform law was enacted in 2010, it is exempt from some of the new requirements under the ACA. It could be that nothing needs to change, but check with your insurance company or employer to find out. 

Children under the age of 26 can stay on their parents' plan. 

If you already have coverage, you can still look at your options in the marketplace, but you may not qualify for financial assistance. 

What happens if my insurance company canceled my plan? Can I still keep it?  

No. If your insurance company decided to cancel your insurance plan, you have a few options for finding something else: 

  • You can shop for and buy a new plan either in or outside of the marketplace.
  • You can buy a plan that your insurance company is offering instead of the old one.
  • Your insurance company might make changes to your old plan instead of completely canceling it, and give you the chance to renew.
  • In some cases, if your plan is canceled, you might be able to buy a catastrophic plan temporarily if you can't afford anything else. 

Just be sure that in each of these cases, you review what your plan covers, any price changes, and whether you can keep your current doctor.

You can find each week's "Hey, Doc" Q&A and a lot more attexmed.org/Heydoc as well as in TMA's patient blog at MeAndMyDoctor.com. And TMA produced "Hey, Doc" videos to help people understand how to navigate the marketplace.

Below is TMA's "Hey, Doc" content schedule through Dec. 17, 2014.

Week of Nov 26: What are the subsidies? Who gets a subsidy? How do I apply for a subsidy?

Week of Dec. 3: What will it cost me to buy this insurance? What different kinds of insurance can I buy?

Week of Dec. 10: What is catastrophic insurance? What does this insurance cover?

Week of Dec. 17: Who can sell me insurance through the marketplace? How do I pick a plan? How many plans can I pick? Can I keep the plan I have now?

 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 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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Contacts: 

Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320
 
Brent Annear  

Marcus Cooper
phone: (512) 370-1382
cell: (512) 650-5336
Marcus Cooper 

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.

Last Updated On

March 14, 2018