Millions of people are now able to enroll for health care coverage through the Affordable Care Act (ACA). Explore your health plan coverage options through the Health Insurance Marketplace website, Open enrollment begins November 15, 2014, and you must enroll by February 15, 2015 for coverage starting March 1, 2015. There are also special enrollment periods based on certain qualifying events including marriage or loss of other health coverage.

Key features of the Affordable Care Act include:

  • People with pre-existing conditions, including cancer, can buy health insurance through online insurance Exchanges, also known as Marketplaces. Exchanges allow you to compare plans by benefits, price, provider participation and pharmaceutical coverage.

  • Health plans must cover essential health benefits including cancer treatment and follow-up care.

  • Health plans must also cover check-ups and preventative services (e.g., cancer screenings, including mammograms and colonoscopies), and there are no co-payment or deductible costs. If you’ve had a history of cancer, these tests may be considered diagnostic, not preventative, and you may be responsible for the cost. Please check with your insurer.

  • U.S. citizens and legal residents are required by law to have health insurance as of January 1, 2014. People who do not will have to pay a fee (tax penalty). Certain limited exceptions apply.

  • Health plans on the Exchanges are grouped by the percentage of your medical costs they cover and are divided into 4 tiers–platinum, gold, silver and bronze.

  • Approximately half the states have expanded Medicaid eligibility guidelines for people under the age of 65 to include those whose income is up to 138% of the Federal Poverty Level ($15,856 for a single person in 2014).

  • Individuals and families with low to moderate incomes can receive help (known as subsidies) to purchase health insurance. The Kaiser Family Foundation offers a subsidy calculator.

  • Young adults can stay on their parent’s insurance plan until age 26.

  • In 2014, Seniors receive a 52.5% discount on brand-name drugs in the drug coverage gap known as the “doughnut hole”; the federal subsidy for generic drugs in the doughnut hole is 28% in 2014. In 2015, anyone reaching the Donut Hole will receive a 55% discount on brand-name formulary drugs and a 35% discount on all generic formulary medications

  • Insurance companies cannot deny coverage to people based on their medical history or charge people who have existing health issues more.

  • Insurance companies can no longer end coverage or impose lifetime or annual dollar limits on coverage because a person gets sick.

  • Insurance companies are required to provide more details about their health care plans.

  • Health care plans on the Exchanges limit the out-of-pocket costs and deductibles for patients.

  • New rules and rights exist to help patients appeal claims that are denied.

Need help with insurance issues? Call 800-813-HOPE (4673) and speak with a CancerCare professional oncology social worker who can help you explore your insurance options and find appropriate resources.

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Last updated November 11, 2014

The information presented in this publication is provided for your general information only. It is not intended as medical advice and should not be relied upon as a substitute for consultations with qualified health professionals who are aware of your specific situation. We encourage you to take information and questions back to your individual health care provider as a way of creating a dialogue and partnership about your cancer and your treatment.

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