What Families Should Know About Health Reform
• Children under the age of 19 can no longer be denied coverage because of a preexisting condition, like asthma or diabetes. Starting in 2014, no one can be denied because of a preexisting condition. Read more about coverage of preexisting conditions.
• Until 2014, there are options for those who are denied coverage in the private market, including the Minnesota Comprehensive Health Association, the Preexisting Condition Insurance Plan and Minnesota health care programs. Read more about alternatives when denied for coverage.
• Insurance plans can no longer place a dollar limit on the health care that is covered in a lifetime. Starting in 2014, there will be no dollar limits on the care that is covered in one year. Read more about restrictions on lifetime and annual limits.
• In 2014, most Minnesotans will be required to have health coverage through their employer, a public program or a private insurance plan. Read more about the requirement to have health coverage.
• Starting in 2014, Medical Assistance will expand to cover more people, including families making up to 138 percent of the federal poverty level—about $30,000 for a family of four in 2011. Read more about Medicaid expansion.
• Starting in 2014, families without employer coverage will be able to shop for and compare health insurance plans through the Minnesota Health Insurance Exchange. Depending on income, tax credits may be available to help pay for coverage. Read more about an Exchange.
• Starting in 2014, prenatal and newborn care along with vision as well as dental care for kids will covered in all new health plans sold through an Exchange. Read more about services for breaks for nursing mothers.
- Where can I find information on public programs available in Minnesota to provide health coverage for families with children?
The Minnesota Department of Human Services has information on their website regarding public programs for families with children. Follow this link: Minnesota Health Care Programs for Families with Children.
- I have heard that reforms have already been put in place that prevent health plans from excluding preexisting conditions for kids. Is that true?
- If plans cannot exclude preexisting conditions for kids under age 19, can they deny an application for coverage based on a child's health condition?
No. If plans offer coverage to kids under age 19, they must offer coverage to all kids under age 19 regardless of preexisting conditions. If the child is applying for coverage with the rest of the family, coverage can be denied for the entire family because of an adult’s health condition but not because of a child’s health condition.
- Does this mean that plans are required to offer child-only coverage to new applicants?
No. The Affordable Care Act (ACA) does not require plans to offer child-only coverage.
- What plans can I buy now in Minnesota to cover children under age 19?
While health plans in the private market are not offering child-only coverage, all carriers are offering family coverage options. When applying as a family, health conditions of the children cannot be used to deny coverage. If a family is denied coverage based on a parent's health condition, they can apply to the Minnesota Comprehensive Health Association (MCHA).
The Minnesota Comprehensive Health Association (MCHA) remains available for those looking for child-only coverage. Applicants looking for child-only coverage can produce a rejection letter from a carrier or agent indicating that no child-only policy is available and use that to apply to MCHA.
Child-only plans are also available through the Pre-Existing Condition Insurance Plan if the child has been without coverage for at least six months and meets the PCIP eligibility requirements. Proof that the child has a preexisting condition is required.
Finally, there are options for coverage of children under Minnesota Health Care programs. The Minnesota Department of Human Services has information on their website regarding public programs for families with children. Follow this link: Minnesota Health Care Programs for Families with Children.
Follow this link for a chart summarizing Coverage Options for Families and Children.
- I am applying for a family policy. My child has a health condition. Can the company charge me more because of my child’s health condition?
Yes. The company can charge higher rates because of a child’s health condition, though there are limits under Minnesota law. In Minnesota, plans may charge up to 25 percent more than their base rate due to health conditions at the time of application.
- I will be becoming a grandparent soon. My grandchild will be living with me. Does health reform have any special provisions for grandchildren? What happens if the baby is born with a health condition?
No. Health reform does not include any requirements related to coverage of grandchildren.
However, if a plan is subject to Minnesota law, there are existing requirements for coverage of grandchildren. Under Minnesota law, newborn grandchildren who are financially dependent on a covered grandparent and who reside with that covered grandparent continuously from birth must be covered. Newborn grandchildren are covered immediately from the moment of birth and thereafter -- including coverage for illness, injury, congenital malformation or premature birth. Additional premium may be due for the newborn grandchild.
If a person doesn’t know if their plan is subject to Minnesota law, they can ask their human resources department or the company that processes their health claims. If the plan is self-insured, Minnesota’s law does not apply.
- Which plans are required to extend dependent coverage up to age 26?
The expansion of dependent coverage applies to individual family health plans and to new employer plans. It also applies to existing employer plans unless adult children have coverage available through their own employer. Beginning in 2014, children up to age 26 can stay on a parent’s employer plan even if they have another offer of coverage through their own employer.
The federal requirements apply to self-funded employer plans and plans offered by insurance companies in all states.
- Can plans require that my young adult child be a full-time student in order to stay on my plan until age 26?
No. Under health reform, young adult children do not need to be full-time students to be covered under a parent’s health plan.
- Does my young adult child have to live with me or be financially dependent on me to be covered under my health plan until age 26?
No. Under health reform, the parent’s health plan cannot require that the young adult child live with their parent or be financially dependent on the parent to be covered under the parent’s health plan.
- My child is disabled. Is there any extension available to keep my disabled child on my plan?
Yes. Under Minnesota law, if a child is incapable of self-sustaining employment because of a developmental disability, mental illness or disorder, or physical disability, a parent may be able to keep the child on their plan. The child must be chiefly dependent upon the parent for support and maintenance.
The parent must notify the insurance company of the child’s disability within 31 days of the child reaching the age that coverage would otherwise terminate under the plan. The family will be required to provide documentation.
- Do all plans that cover Minnesotans have to follow Minnesota law about disabled young adult children?
No. If covered is under an out-of-state plan or if the employer is self-insured, Minnesota’s law does not apply. If an employee does not know whether their employer is self-insured, they can ask the human resources department or the company that processes their health claims.
- How does health reform support healthy youth development?
Under health reform, Minnesota is implementing programs to decrease risk of pregnancy and sexually transmitted infections (STIs) among our most vulnerable youth. A three-pronged approach targeting teens, parents of teens, and caring adults will help to address Minnesota’s high rates of teen pregnancies and births, as well as soaring chlamydia rates. These efforts include Ramsey County, the most densely populated and racially diverse county in Minnesota.
Other populations in Minnesota that experience high rates of teen births and STIs will receive high quality medically accurate and evidence-based programs. These populations in Minnesota include young people of color and American Indian youth, youth in foster care or aging out of foster care, youth in juvenile detention or on probation, runaway and homeless youth, and youth in alternative learning centers. Minnesota will target these populations geographically, with a special emphasis on the top 25 counties with the highest rates in teen pregnancies.
- I have been denied coverage because I have a preexisting condition. What will health reform do for me?
In the meantime, a temporary federal high-risk pool program has been set up in every state, including Minnesota. This temporary federal pool is known as the Preexisting Condition Insurance Plan (PCIP) and provides coverage to U.S. citizens and legal residents with preexisting conditions who have been uninsured for at least six months. Benefit plans offered by the PCIP provide coverage without a preexisting condition exclusion.
The PCIP is operating in addition to our state high-risk pool, the Minnesota Comprehensive Health Association (MCHA). The eligibility requirements for the two pools differ. If you do not qualify for the PCIP plan, MCHA may be an option. MCHA’s website provides information about eligibility requirements for MCHA, how to qualify for a waiver of MCHA's preexisting condition exclusion, etc.
- Will preventive services be covered under my health plan?
If you are enrolled in employer health coverage or a health insurance plan that was created after March 23, 2010, preventive services are covered at no cost to you. In 2014, all plans will cover preventive services, including those purchased on the Minnesota exchanges. Please note that the health plan is only required to cover preventive services at 100 percent if you are using an approved, in-network provider. Also, if the preventive service is not the primary reason for your doctor’s visit, you may be charged some of the cost of the visit. If you have questions, it’s always best to check with your employer or insurance carrier directly to confirm.
- What services are considered “preventive services”?
Depending on your age and health plan, you may receive the following preventive services at no cost to you. For a full list of preventive services, visit healthcare.gov.
• Blood pressure, cholesterol and diabetes screenings
• Cancer screenings, including mammograms and colonoscopies
• Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression and reducing alcohol use
• Routine vaccinations against diseases such as measles, hepatitis or meningitis
• Flu and pneumonia shots
• Counseling, screening, and vaccines to ensure healthy pregnancies
• Regular well-baby and well-child visits, from birth to age 21
- What is an Exchange?
A Health Insurance Exchange is a marketplace for individuals and businesses to compare, choose, and buy affordable health insurance for high quality care. An Exchange can make health care easier to navigate for consumers and small businesses. It can allow Minnesotans to easily compare health insurance options based on cost, quality, and consumer satisfaction. It can also foster fair and equitable competition to encourage insurers and health care providers to place a greater focus on value and affordability.
An Exchange is an online marketplace where Minnesotans can purchase private health insurance or enroll in public programs like Medical Assistance and the Children's Health Insurance Program (CHIP). Subsidies and tax credits will be available to eligible individuals and small businesses to make coverage more affordable.
An Exchange can help small businesses provide affordable coverage choices to their workers and allow employees to choose the plan that is best for them and their families. Employees will be able to use contributions from one or more employers to purchase coverage for them and their families and keep that coverage if they become self-employed, lose their job, or if they change jobs. An Exchange can also simplify the administration of health insurance for small businesses and allow them to focus on growing their business instead of managing health insurance.
- When would an Exchange be effective?
Coverage through an Exchange would start effective Jan. 1, 2014. States have until Jan. 1, 2013, to create their own health insurance exchanges or the federal government will establish one for a state.
- What functions would an exchange perform?
An Exchange would perform a number of functions, including:
• Operating a toll-free hotline and website for providing information
• Ensuring that health insurance plans meet certain standards (for example, related to marketing, access to health care providers, and reporting on quality of care).
• Providing information in a standard format to help consumers compare insurance companies and benefit plans
• Determining eligibility for individual premium tax credits, cost-sharing assistance, and coverage requirement exemptions
• Determining eligibility for Medical Assistance
• Determining eligibility for small business premium tax credits
• Providing real-time enrollment in health benefit plans
• Making an electronic calculator available to display the cost of coverage
• Communicating with employers regarding employee tax credit eligibility, cancellation of coverage, etc.
• Establishing a Navigator program that connects Minnesotans with an individual or organization who assists consumers and businesses to navigate an Exchange.
- Who would be eligible to use an Exchange?
An Exchange would be available to be used by individual consumers and small businesses with up to 100 employees when it opens for enrollment effective Jan. 1, 2014. Minnesota may limit small business eligibility to those with less than 50 employees prior to 2016, but this decision has not yet been made. Large employers may be allowed to participate in 2017.
- Where is Minnesota in the process to plan for a Health Insurance Exchange?
The state is working with all stakeholders to plan and develop a Minnesota exchange. Minnesota received a $1 million planning grant in February 2011. This grant funded actuarial and economic research on the market impact of an Exchange, the development of an IT Infrastructure, Request for Proposals for prototypes to evaluate technical options and costs for an Exchange, and initial work to assess the operations of an Exchange.
Minnesota received a $4.2 million grant in August 2011 to support the design and development of a Minnesota Exchange. The grant funds the creation of an initial structure with human and other resources to support the design and development of an Exchange, development of technical infrastructure, and stakeholder engagement to help craft the design of an Exchange through an Advisory Task Force and other public forums.
- Does the health reform require me to purchase coverage?
Effective Jan. 1, 2014, all U.S. citizens and legal residents will be required to obtain health insurance coverage.
- What happens if I do not buy coverage?
Those who do not obtain coverage will pay a tax penalty beginning in 2014. The penalty is set to increase each year as follows:
In 2014, it will be the greater of $95 per adult or 1 percent of taxable income.
In 2015, it will be the greater of $325 per adult or 2 percent of taxable income.
In 2016, it will be the greater of $695 per adult or 2.5 percent of taxable income.
After 2016, the tax penalty increases annually based on a cost-of-living adjustment.
A person will only pay one-twelfth of the total annual penalty for each month without coverage. The penalty for a child is half that of an adult. A maximum penalty will be calculated based on premiums for plans offered through an Exchange.
- Will there be any exceptions?
Yes. The law provides exceptions for:
1) Individuals and families below a certain income
2) People who cannot afford the coverage that is available
3) Individuals who have been uninsured for less than three months
4) Members of American Indian tribes, and
5) People who do not obtain coverage because of religious objection.
- Why does health reform require people to have health insurance coverage?
The requirement for individuals to have health insurance coverage was part of the overall health reform package that provides subsidies to make coverage more affordable. This provision requires insurers to cover everyone, regardless of health status or history. Without the requirement to have health coverage, people with health problems are more likely to get health insurance while others would forgo insurance until they develop a health condition.
If healthy people don’t buy coverage, there would be only a small number of very expensive coverage choices available. The requirement to buy health coverage makes sure that people don’t wait until they have a health problem to purchase insurance. This brings healthy people into the pool, creates a larger pool of both sick and healthy individuals, and keeps average costs down.
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