July 30, 2014
Answers to Your Questions About the ACA Marketplace
More than 730,000 Texans have purchased health insurance coverage through the new Affordable Care Act (ACA) health insurance marketplace. Since April, many people have used their coverage for the first time but don’t understand what they purchased, what it covers, or how to use it. They are confused. Texas physicians want to help clear up some of the confusion by reminding people about a beneficial resource.
Last fall the Texas Medical Association (TMA) launched its “Hey, Doc” educational campaign to provide answers to patients’ most frequently asked questions about the ACA marketplace. TMA answered 32 questions in the six-month series.
As the confusion continues about these new plans, many of the “Hey, Doc” Q&As are more relevant today than when TMA first published them for patients (and for our media colleagues who cover health care and the ACA marketplace). So “Hey, Doc” is back!
One question that keeps reemerging is “What Will My Marketplace Health Insurance Cover?” The answer is:
All plans in the ACA’s health insurance marketplace must offer what’s called “essential health benefits.” This is a basic package covering 10 categories:
• Doctor visits;
• Hospital visits;
• Prescription drugs;
• Lab tests;
• Emergency room visits;
• Care when you are pregnant and when you have your baby;
• Care for children;
• Preventive services that help you stay healthy, like shots and screenings;
• Mental health care like counseling; and
• Treatments that help you recover from injuries.
Some plans might cover more, but that’s the minimum. You also can find dental coverage in the marketplace, either included in a plan you buy or separately.
Marketplace plans also must cover what are called “preexisting health conditions.” This means even if you are already sick or pregnant at the time you enroll and buy the coverage, the health plan cannot deny you.
Upcoming TMA “Hey, Doc” installments, and their release dates:
Aug. 6: What Will It Cost Me to Use This Insurance?
Aug. 13: What Are Deductibles, Coinsurance, and Copayments?
Aug. 20: My Doctor Can’t Get a Straight Answer From My Insurance Company. How Do I Know If I Can Use My Insurance?
Aug. 27: What If My Doctor Isn't In My Marketplace Health Plan After All?
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.
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