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Questions and Answers

Table of Contents

Health Care Reform Overview

What is health care reform?

In March 2010, President Obama signed federal health reform into law. Health reform consists of two laws. The first and larger of the two is the Patient Protection and Affordable Care Act, signed on March 23, 2010, and the second is the Health Care & Education Reconciliation Act, signed on March 30, 2010. Federal health reform contains many provisions which affect both public health insurance programs, such as Medicaid and Medicare, and private health insurance including the health insurance many people either get through their employer or purchase directly. The provisions of the health reform laws go into effect on a staggered basis, with some provisions going into effect immediately, but most going into effect in 2014.

Many provisions of federal health reform are general in nature, so details must be clarified by the U.S Department of Health and Human Services or other federal agencies. As a result, answers to every question cannot be given until further details are provided. These questions and answers will be updated as additional information becomes available.

How does health reform work?

Federal health reform uses a "building blocks" approach that starts with the health insurance system we currently have in place in the United States. Health reform builds upon our current health insurance system to provide more people with access to health insurance coverage, establish legal protections for consumers, and set up mechanisms for consumers to shop knowledgeably for insurance.

Health reform includes the following key steps:

  • Expand Medicaid to allow more people at the lowest income levels to qualify for coverage.
  • Encourage employers to offer health insurance.
  • Provide credits to purchase private health insurance coverage to moderate income Americans who do not qualify for Medicaid.
  • Streamline the purchase of health insurance through the establishment of the Health Insurance Exchange.
  • Strengthen consumer protections and require transparency.
  • Impose protections to guard against unreasonable rate increases.
  • Encourage primary and preventive care.
  • Require most Americans to purchase health insurance.

What are grandfathered policies?

Grandfathered policies are health insurance policies that were available when health care reform passed on March 23, 2010. Some of the changes under health care reform will not apply to these policies. These changes are described on the Summary of Health Care Reform page. The U. S. Departments of Health and Human Services (HHS), Labor, and Treasury have issued a rule that protects the ability of individuals and businesses to keep their current grandfathered health insurance plan while providing important consumer protections and providing stability and flexibility to insurers and businesses that offer health insurance coverage. Information on how this new rule will affect grandfathered plans is available in HealthReform.gov Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and "Grandfathered" Health Plans and the HealthReform.gov Questions and Answers: Keeping the Health Plan You Have: The Affordable Care Act and "Grandfathered" Health Plans page.

Where can I learn what parts of federal health care reform go into effect in 2010 and later years?

A list of the changes that take effect in 2010 is available on the Summary of Health Care Reform page. A list of the changes that take effect from 2010 through 2015 is available at HealthCare.gov.

How will health reform make health insurance more affordable?

Federal health reform legislation makes coverage more affordable for many low to moderate income Americans by (1) capping the percentage of income that they must contribute towards health insurance, (2) providing subsidies to assist with the purchase of insurance, and (3) providing cost-sharing support to limit out-of-pocket costs (such as deductibles, copayments and coinsurance). These forms of assistance work in tandem with the Insurance Exchange (described on this Questions and Answers page), which will become available by January 2014.

Increased choice and premium assistance for moderate income Americans will ensure that coverage is available and affordable to more people. Individuals with incomes of approximately $43,000 and families with incomes up to approximately $88,000 for a family of four (which are equal to 400% of the federal poverty level) will receive credits to apply towards the purchase of health insurance. Eighty-seven percent of New York's currently uninsured population is expected to qualify for premium assistance.

There are a number of benefits to having everyone covered with health insurance. First, the purpose of health insurance is to spread risks and costs among as many people as possible so that no one is bankrupted by high cost illnesses or forced to go without care. Therefore, including more people should mean that the cost of health insurance premiums will be lower overall. Second, people with health insurance generally seek care earlier and access care in doctors' offices rather than expensive emergency rooms. This means illnesses will be caught earlier, when they are less expensive to treat, which reduces the cost of health care. Finally, health reforms will help employers. A healthier workforce will lead to increased productivity and less lost man hours.

What changes under health care reform will help me?

There are many changes under health care reform that will help provide you with better health insurance coverage by banning insurance company practices that limit the medical care you are able to receive. To learn about these changes, read this factsheet on The Affordable Care Act's New Patient's Bill of Rights (PDF). For additional information, visit the Benefits of Health Care Reform for Specific Groups page.

Does New York have a role in implementing health reform or will the federal government be completely responsible?

States, including New York, have a role in health reform. For example, states have the option to set up their own health insurance exchange. For the most part, federal health reform establishes a "floor, not ceiling," allowing states to provide protections greater than those established under federal law. This is good news for New York, which already provides strong consumer protections, such as open enrollment and community rating that ensures access to health insurance coverage without regard to age, sex, health status and occupation. New York will work in partnership with the federal government to implement the federal law and coordinate it with New York law. States also provided input to the U.S. Department of Health and Human Services in developing guidance in a number of areas including consumer assistance and the review and disclosure of premium rate adjustments.

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Health Insurance Exchanges

What are health insurance exchanges?

Federal health reform establishes competitive health insurance exchanges or markets for individuals and small businesses to more easily navigate the health care system. A health insurance exchange is designed to be a "one stop shopping" option to purchase health insurance, assist consumers in selecting coverage, calculate costs, compare options, and learn about public programs. Health insurance exchanges may be run by states or by the federal government, and will start no later than 2014. Discussions concerning the New York health insurance exchange are currently underway.

New York's current individual market offers limited coverage options, and exchanges will introduce many new coverage options for people purchasing coverage in the individual and small group market. Larger businesses may eventually be able to seek health insurance coverage for their employees in the exchange.

Who will be in charge of the New York health insurance exchange?

Under federal health reform, states, including New York, have the option to either set up an exchange themselves or to allow the federal government to set up an exchange for them. New York will develop a plan for its new exchange and how it will operate by January 1, 2013 in order to meet the federal requirement that exchanges are up and running by 2014. The year 2014 is an important date in federal health reform because it coincides with a number of other key building blocks such as the availability of subsidies for people who don't quality for Medicaid and have incomes up to 400% of the federal poverty line (which is about $43,000 for an individual and about $88,000 for a family of four).

Are there any standards health insurance companies in exchanges will have to follow, or will they be able to cover only what they want to?

Federal health reform sets forth the minimum requirements for health insurance coverage offered through the exchanges, including prohibitions on annual and lifetime coverage limits, coverage of preventative care, etc. In addition, through the Exchange insurers will offer four standardized coverage levels: bronze, silver, gold, and platinum. Insurers in the New York Exchange will offer a range of coverage, with higher levels of coverage costing more and lower levels of coverage costing less.

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The Effect on Employers

Will my small business get help providing health insurance?

Many uninsured people work for small businesses that struggle to contribute to the cost of health insurance for their employees. The new law provides tax credits to small businesses to help employers provide coverage. The credits will be available starting in 2010. More questions and answers regarding the small business tax credit are available on the IRS website. Another program to help employers provide health insurance is a temporary reinsurance program starting in 2010 will help employers that provide retiree coverage retain such coverage by reimbursing a percentage of high cost claims. More information on this program is available on the Benefits for Early Retirees page.

Where can I find more information on how health care reform affects employers?

More information on this topic is available at the HealthCare.gov Employers page. Questions and answers on how health care reform will affect small businesses are available on the HealthReform.gov Questions and Answers page. Information is also available on the Benefits of Health Care Reform for Small Businesses page.

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Help for the Uninsured

I don't have insurance, and really can't afford it. Is there anything in health reform to help me now?

New York State already has a lot of programs for people that don't have insurance. Visit the Health Insurance Coverage in New York State page for more information. You can also call 1-800-698-4KIDS for more information about health insurance for children, or 1-877-9FHPLUS (1-877-934-7587) for more information about health insurance for low income adults.

Health reform will further expand the Medicaid program starting in 2014, making it easier for more low income adults and children to get help. If you would like more information, go to Putting Americans In Control of Their Health Care, and click "I do not have insurance."

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The Effect on Health Insurance Programs: Medicaid, Family Health Plus, Child Health Plus, and Medicare

Does health reform change my family's Medicaid or Family Health Plus?

Health reform does not change your Medicaid or Family Health Plus coverage or benefits. The state is not allowed to impose any new rules or eligibility conditions that would make it harder for your family to get or keep their Medicaid or Family Health Plus through 2014.

Starting in 2014, more people will be able to qualify for Medicaid, and we expect there will be some additional health services and programs available to people enrolled in Medicaid. Examples of these services are more home and community based services that help keep people out of nursing homes, and services that help people who have diabetes or asthma better control their conditions. It is also expected that it will become easier for low-income employees who have employer-sponsored coverage to receive help in paying their premiums through Medicaid or Family Health Plus.

Does health reform change my child's insurance or health plan through Child Health Plus?

No. Health reform requires New York to continue its Child Health Plus program through at least 2019. The state is not allowed to impose any new rules or eligibility conditions that would make it harder for children to get and keep their Child Health Plus coverage (this is also true for coverage for children who are covered through Medicaid).

Over the next decade, health plans will be expected to show that they can offer comparable coverage for children through the state operated Health Insurance Exchange, which will be operating by 2014. The Exchange will allow individuals who don't have employer based coverage to buy affordable health insurance, and will provide tax credits and premium assistance on a sliding scale. The Exchange will also determine whether an individual is eligible for Medicaid or Child Health Plus, providing easy online, telephone, mail, and in-person application options.

Does health reform change my Medicare coverage?

Over the coming years, health care reform seeks to improve your Medicare coverage, by making it easier and cheaper for you to get preventive screenings and services you need, and by starting to close the prescription drug coverage gap (also called the "donut hole").

If you would like more information about how health reform will help your Medicare, please go to Putting Americans In Control of Their Health Care, and click on "I have Medicare." Brochures describing Medicare and health care reform are available at:

Do Medicare Part D enrollees need to do anything to receive their rebate check?

No. Starting in mid-June a tax free, one-time $250 rebate check will automatically be sent to Medicare Part D enrollees who reach the prescription drug coverage gap (also called the "donut hole") in 2010 and are not receiving Medicare Extra Help. There are no forms to fill out in order to receive this check. Medicare enrollees should not give out any personal information to anyone who calls them about the rebate check. More information about the rebate check is available in the "Closing the Prescription Drug Coverage Gap" (PDF) brochure.

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The Effect on New York State

Are there ways in which health reform affects New York differently than other states?

Yes. A description of these changes is available on the Summary of Health Care Reform page.

The new federal legislation allows parents to continue offering insurance coverage to children up to age 26. How does this impact New York?

Federal health reform requires insurers to provide coverage to adult children as dependents on their parents' policy up to their 26th birthday. This provision takes effect in September 2010, but many insurers have opted to implement this coverage extension early.

New York has a law allowing children to stay on their parents' plan until age 29, but under different terms than the federal health reform law. New York Law extends the availability of health insurance coverage to young adults through the age of 29 to assist young adults who do not have access to employer-sponsored health insurance. This law is sometimes referred to as the "Age 29" law, because it allows young adults to continue or obtain coverage under a parent's policy through the age of 29. The law provides two distinct ways in which coverage may be extended: a "young adult option" and a "make available" option. More information on this law is available on the New York State Department of Financial Services website.

New rules from the U.S. Department of Health and Human Services are being reviewed to determine how this "Age 29" law in New York State will interact with the provision in health care reform that allows young adults to stay on their parents' health insurance policy until age 26.

More information on this new coverage for children up to age 26 through health care reform is available on the U.S. Department of Health and Human Services website and this fact sheet.

What other things does New York State now have to do to implement federal health reform?

There are many federal and state deadlines and options that will affect states directly. Implementation of federal health reform is scheduled to take place over the next several years. More immediate implementation steps that New York will need to take include the following:

  • Establish a pre-existing condition insurance plan to provide health coverage to individuals with pre-existing medical conditions
  • Work with the federal government to establish a mechanism, including a website, to provide information for consumers on coverage options in the state
  • Work with the federal government to review any unreasonable premium increases for health insurance
  • Apply for a federal grant for the planning and implementing of a state health insurance exchange
  • Examine current laws and regulations for possible amendments/revisions to conform to new requirements where necessary
  • Coordinate among the various state agencies and programs impacted by the health reform
  • Approve health insurance products that meet the new requirements as well as any riders to make existing products conform with new requirements

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