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The Affordable Care Act: What it Means for You

For Vickie Wilkerson, 43, of Blanchard, La., not having health insurance means going without much-needed care for her severe psoriasis and psoriatic arthritis. Like many people with a chronic disease, Wilkerson has been denied health coverage because of her pre-existing condition.

She seeks treatment from general physicians at Louisiana State University because it's the only place that will accept her. The university doesn't have any dermatologists on staff, so while she receives medications to control her blood pressure and anxiety, her psoriasis and psoriatic arthritis remain mostly untreated except for an anti-itch cream. She pays for all three medications out of pocket.

The landmark Affordable Care Act will have a profound impact on people like Wilkerson who have chronic diseases such as psoriasis and psoriatic arthritis. The legislation, more commonly known by its acronym, ACA, requires everyone to have health insurance. States must either create a health insurance exchange or their residents can purchase health insurance through the federal government.

The Health Insurance Marketplace opened Oct. 1 and offers health insurance to those who are not insured, including people who have been denied insurance.

Coverage begins Jan. 1, 2014. There's lots of information about the marketplace, also known as exchanges, and also lots of misinformation.

Here are five things you need to know about the Affordable Care Act.

  1. Everyone is required to have health insurance.
    With few exceptions, everyone must have health insurance under the ACA or face a penalty. The good news for people with psoriasis and psoriatic arthritis is that, due to the ACA, people with pre-existing conditions can no longer be denied coverage by their insurance company. Insurance companies also cannot charge higher rates based on gender or health status.

    Marc Boutin, executive vice president and chief operating officer of the National Health Council, said many people with chronic diseases still don't believe that they won't be discriminated against because of a pre-existing condition.

    "I hear from many people who say, 'Well, that means they will still charge me more,'" Boutin said. "They don't believe that they can't have higher premiums or out-of-pocket costs."

    It's very important for people to know that these issues will not happen under the ACA, Boutin said. "[The pre-existing condition clause] is one of our most important benefits."

    To avoid penalties, you must enroll by Feb. 14, 2014.
  2. Each state and the District of Columbia will have a health insurance marketplace.
    Within each marketplace, you'll be able to research, compare and then enroll in the plan that is best for you. States that did not create a health insurance marketplace will default to a federally maintained exchange.

    Marketplace insurance plans are assigned a category, with bronze plans being the least expensive and least comprehensive, and platinum plans being the most expensive and most comprehensive. The lower the premium on the plan, the higher the patient's out-of-pocket costs.

    According to Boutin, people with psoriasis and psoriatic arthritis, or others who may be "high users" of their insurance, may find it beneficial to opt for a platinum plan. While individuals may have higher premiums, they will have lower out-of-pocket costs and more benefits.

    According to Boutin, people who select a plan with higher premiums who are high users could save up to $3,000 per year in out-of-pocket expenses. "It's counterintuitive," Boutin said.
  3. There is no employer mandate — at least not yet.
    The provision of the Affordable Care Act requiring all companies with at least 50 full-time employees to provide health insurance or pay penalties or taxes has been delayed until 2015. People without employer-provided health insurance will need to purchase individual insurance through their state's marketplace.
  4. There are no Obamacare cards.
    Health care fraud is on the rise leading up to the open enrollment period. If someone calls you claiming to be from the government and asks for your personal information for an insurance card, it is a scam. You also won't go to jail if you don't purchase health insurance. Consumer and state officials urge people to be aware of fake, look-alike exchange sites. The alternate websites are created by special interest groups, private insurance companies and even scammers, and have similar appearances and Web addresses to the official state exchange sites. Find your state's health insurance exchange at www.healthcare.gov.
  5. You may qualify for financial assistance.
    The criteria include a person's income level and family size. Other states are expanding Medicaid coverage to help low-income individuals. According to Boutin, as much as 60 to 70 percent of the population, or a single person making $45,000 a year, will be eligible for financial assistance.

    States have the option to expand Medicaid services to cover people at 138 percent of the federal poverty line, or about $33,000 for a family of four. The Kaiser Family Foundation has a calculator to help determine your insurance premiums and subsidies.

    In addition to government subsidies, people who are employed can use their health savings accounts, or HSAs, to pay for medications and health services, Boutin said. Starting in 2014, the IRS will raise the limit on health savings accounts to $3,300 for an individual and $6,550 for a family.

    You can withdraw funds from the account to pay qualified medical expenses even if you have not yet placed the funds in the HSA. People on a biologic drug, for instance, can meet their maximum out-of-pocket costs and pay for their treatment with an HSA card.

"I'm really looking forward to the exchanges and to not be given a reason why they can't insure me," Wilkerson said. However, she does worry about the cost of the insurance plans in her state marketplace. Louisiana has opted to have a federally run plan, and rates may be up to $500 per month for premium-level plans.

She was approved for one free year of the biologic drug Humira but stopped taking it after six months because it wasn't working for her.

"It cleared my hands, but nothing else," Wilkerson said. "The staff [at LSU] said they didn't have the doctors or the time to treat me like I need to be. Until insurance comes, I'm stuck in limbo."

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