Many people have their healthcare coverage through new individual and small group plans created to comply with the federal healthcare reform (also known as the Affordable Care Act or ACA). Healthcare reform makes federal subsidies available to qualified individuals and families to help them pay for their coverage.
These changes may have an effect on your patients. It's important that you and your staff will need to prepare by understanding the benefits and the requirements of these new plans.
The ACA’s new rules primarily affect people who:
- Havent had coverage in the past
- Buy their plan without going through an employer
- Receive their coverage through a small employer
Washington State’s Exchange, is called
Washington Healthplanfinder. The Exchange marketplace is one of the key components of federal healthcare reform.
Frequently Asked Questions
What exactly are Exchanges?
Exchanges are places where patients can go to compare and purchase health plans. Patients can shop for plans online, over the phone or even in person. The Exchange is also the place to find out if a patient can qualify for a federal subsidy to help pay for their health plan.
Will preventive services be covered?
The new law requires that some preventive service must be covered without copayments or co-insurance to meet deductibles when delivered by a network provider. This applies to all individual and small group plans that are non-grandfathered. For a list of covered preventive services under the law, please visit
HealthCare.gov.
What are grandfathered plans?
Grandfathered plans are health plans that existed before March 23, 2010 (the day the Affordable Care Act became law). They may be exempt from following certain provisions in the Affordable Care Act.
What are essential health benefits?
All individual, small-group, and non-grandfathered plans (those that existed after March 23, 2010) must cover the following 10 essential health benefit categories:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive & wellness services & chronic disease management
- Pediatric services including oral and vision care, to age 19
- Mental health and substance use disorder services, including behavioral health treatment
Where can I learn more?
Here are a few helpful links for more information about healthcare reform and the Exchange.