Advocacy at the Greater Northwest Chapter of the National Multiple Sclerosis
(MS) Society Jim Freeburg is educating people about the many advantages of the
Affordable Care Act (ACA), including people who have MS.
During the MC/Cancer telephone support group meeting on September 25th Freeburg said, “The
existing health care industry in this country is badly broken for people with
chronic diseases, is not available for everyone and is not coordinated. Those
are some of the many reasons why the reformed health care law was enacted in
coverage is important because everyone becomes ill at some point. When someone
doesn’t have health care coverage, everyone else has to pay for his or her care
through higher premiums.
requires everyone to have health care insurance, called the Individual Mandate.
If you are insured through your job, Medicaid or Medicare, you are not required
to make a change. If you are uninsured, you must purchase insurance for
yourself or pay a tax. If the health care policy costs more than 8 percent of
your household income, you are exempt and will not have to pay a penalty.
available to people with low and moderate incomes (by percentage of federal
poverty level). For example, a family of four that earn $92,000 or less will
receive sliding scale discounts to the cost of the insurance policy.
ACA and People with MS
Care Act, often referred to as Obamacare, will help people with MS and other
The National MS
Society has advisors to help individuals to make decisions and the ACA. Many
states have benefits advisors that are well-trained volunteers to help people
figure out their options. Call the Society at 1-800-344-4867 for more
information, Freeburg said.
are highlights of benefits and details of the ACA.
Advantages of the Affordable Care Act
or annual caps
of 2010, the lifetime caps on health insurance benefits are eliminated.
health insurance plan will not be able to drop your coverage.
caps on health benefits started to be phased out beginning in 2010.
of 2010: children (ages 0-18) cannot be denied coverage based on pre-existing
in 2014: No one can be denied
insurance due to pre-existing conditions.
in 2014: No one can be charged
more because of health history or condition.
three things lead to higher premiums: age, tobacco use and geography.
Preventive care includes annual well check-ups, routine care,
vaccines, birth control, mammograms, colonoscopy and screenings.
of 2010: Children, seniors and disabled on Medicare receive preventive care
free with no co-payment.
1, 2012: Women can receive contraceptives and well-woman care free with no
in 2014: All insured adults and kids get free preventive care with no co-payment.
care availability and coverage
in October 2013, most people who do not have health insurance will be able to
sign up for coverage that takes effect in January 2014.
will no longer be able to deny coverage or charge more because of a
pre-existing condition like MS or any health problem. If you had coverage that
was limited or cost more due to your pre-existing condition, these limits and
higher rates will be eliminated.
health insurance plan in the new Marketplace will offer comprehensive coverage,
including hospitalization, doctors’ visits, prescriptions and more. You can
compare all your insurance options based on price, benefits, quality and other
features that may be important to you.
health insurance, Medicare and Medicaid plans must cover recommended preventive
care such as cancer screenings and vaccines at no additional cost to you.
for coverage will be easier when the new Health Insurance Marketplaces (or
Exchanges) start up in October 2013. You can apply for coverage online, over
the phone, by mail and in person in some places.
help will be available from new Navigators who are health insurance counselors
offering un-biased information, education and enrollment assistance to
consumers at no cost.
credits and other help with costs will make coverage more affordable for
individuals, families and small businesses.
The ACA has
built-in limits on insurers. Insurers have to spend 80 percent of premiums on
health care. Only 20 percent can go to overhead and profits.
insurance increase 10 percent or more goes through an automatic review process
on whether or not the increase is justified. It is up to states as to whether
unjustifiable rate increases can be stopped.
Essential benefits of the Affordable Care Act
2014, through the Affordable Care Act, all health insurance policies will cover
these essential health benefits:
and newborn care
health and substance use disorder services, including behavioral health
and habilitative services and devices
and wellness services and chronic disease management
10. Pediatric services, including oral
and vision care.
Changes to Medicare
one quarter of all people with MS rely on Medicare as their primary source of
health insurance. The Affordable Care Act (ACA) makes some changes to Medicare
that can be particularly helpful for beneficiaries living with MS. Learning
about these changes will give you or your family member with MS peace of mind
about your Medicare benefits and costs.
following lists conditions that do not change for Medicare
You can continue to use your same doctors, hospital and
You still can coordinate your Medicare benefits with other coverage
you have such as a retirement health plan, Medigap policy or Medicaid.
You still can switch Medicare prescription drug (Part D) or
Medicare Advantage plans if you need to under certain circumstances.
Facts concerning the ACA and
The prescription drug coverage gap or “donut hole” is being phased
out. In 2013, the coverage gap begins when total prescription drug costs reach
$2,970, and ends when total costs reach $4,750. (During the gap, beneficiaries
must pay the full cost of their medications.) The ACA gradually eliminates the
coverage gap by providing automatic discounts for any drugs needed during the
gap period. In 2013, brand name drugs needed during the gap are discounted by
more than 50 percent.
Medicare now covers certain preventive services, such as screening
mammograms, colonoscopies, bone density tests and more – at no cost to the
individual. No deductibles or copayments are required for these and other
recommended tests and vaccines that help keep people healthy. An individual also
can get an annual wellness visit (or check-up) at no additional cost.
Many doctors, hospitals and other providers are taking advantage
of new programs to help them work better as teams that share information
quickly and easily. The new law encourages these arrangements and will continue
to evaluate new ways of paying for care that are meant to provide you with the
best quality care possible while reducing inefficient or ineffective
The ACA builds on efforts to combat fraud and abuse in Medicare,
saving billions for taxpayers. As a result, the trust fund that finances the
Medicare program will be more financially secure.
Learn more about
the new law at www.healthcare.gov, the official website of the Affordable Care
Act. You can use this site to sign up for
free updates by email or text or ask questions through the online chat or toll-free
Multiple Sclerosis Society website at www.nationalmssociety.org