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The Patient Protection and Affordable Care Act: 'Obamacare' in Arizona




In 2010, President Barack Obama and Congress succeeding in passing the Patient Protection and Affordable Care Act (a.k.a. PPACA, ACA, or Obamacare). The goal of the PPACA was to lower the cost of insurance for families who couldn't afford it, increase the rate of inoculation against preventable diseases among poor children, and to put an end to advantageous insurance company practices.

The PPACA hopes to extend affordable health insurance coverage options to over one million previously uninsured patients in California by 2015. It will offer this coverage through brand new public and/or private health insurance exchanges.



The New Health Insurance Exchange System - Arizona


These Health insurance exchanges or HIX are also referred to as Affordable Insurance Exchanges (AIX) or simply Health Exchanges. HIX and AIX will create a network of insurance providers willing to meet the minimum rights guaranteed to consumers by the new healthcare laws. These insurance companies must play by the rules in each state in order to participate in the health exchanges and keep costs down.

In addition to creating the Health Insurance Exchange system, the PPACA will also make changes to the healthcare system of the US in the following ways.


Arizona 'SBC's or Summaries of Benefits of Coverage

Summaries of Benefits of Coverage or 'SBC's are detailed descriptions of the benefits of an insurance plan presented in a standardized format. Participating Insurance Companies must produce an SBC for each of the health insurance plans they intend to sell through health insurance exchanges.

These SBCs will utilize terms standardized by the PPACA in the Universal Glossary of Health Insurance Terms available through the official healthcare reform website. By creating a standard format and verbiage across all of these summaries, SBCs will allow normal consumers to quickly and easily compare the pros and cons of individual health insurance policies side by side. This will empower common consumers to make well-informed decisions about their health insurance coverage, in some cases for the first time ever.


Appeals: Denials of Benefits

The appeal process if you have been denied funding by your insurer has been streamlined, and insurance companies are now enjoined by the laws of the PPACA to offer better consumer protections and act fast when it comes to resolving an appeal.

Before the PPACA, if you needed a medical procedure not covered by your health insurance, it could take months or years to appeal your insurer to pay-up, and even then you usually footed most of the bill yourself. The Affordable Care Act states that every insured person now has the right to a timely and efficient appeal of their health insurance provider's denial of benefits for a treatment or procedure as long as they purchased their policy after March 23, 2010. Policies puchased BEFORE this date are considered to be 'grandfathered'. See Grandfather Status below to learn more.

If you are a patient who is denied coverage for a treatment or service which your doctor feels would be of assistance to your recovery or continued health, your provider must now inform you of :

  1. why your appeal was denied
  2. your right to an “internal appeal” of the decision
  3. how to submit an “external appeal” through an independent review board if your initial appeal is unsuccessful
  4. and lastly, how to take advantage of Consumer Assistance Programs that may be available in your state to help you through the appeals process.



Presciption Drug Coverage

Older folks are always looking for a little help paying for the dozens of prescriptions they take daily, and by slowly adjusting the co-pays on both brand name and generic prescription medicines over the next 5 years, the ACA should be able to close the Medicare Part D Prescription Drug Coverage gap before 2020. The gap in the prescription drug coverage among Medicare recipients has come to be known as the Donut-Hole. The Donut-hole is a period in Medicare part D coverage during which the insured person has exhausted their regular prescription drug coverage, but has not yet reached their out of pocket maximum. In order for the part D coverage to kick back in, the insured person must meet their annual out of pocket maximum, at which point their Medicare suddenly covers 100 percent of their prescription costs. Closing this gap is essential to preserving the fiscal stability of our older generations, and the PPACA is ahead of schedule in closing that gap.

Preventive Care Coverage For Everyone

One of the biggest ways that the ACA is preventing the growth of future healthcare costs is by guaranteeing hundreds of preventive services to insured persons free of charge. These services are listed in full on the official healthcare reform website. Just a few of these services are blood pressure, cholesterol, and cancer screenings for adults and autism, drug use, and depression screenings for adolescents.By


Pre-Existing Conditions, the PCIP and Guaranteed Acceptance

Problems with the Pre-existing Condition Insurance Plan have led to some confusion about how persons with pre-existing conditions will be covered, and whether or not they will in fact be. When the PPACA first passed in 2010, provisions regarding pre-existing conditions created the PCIP or Pre-existing Conditions Insurance Plan. Less than three years later, the paltry $5 billion originally invested into the program has fallen short of its expenditures and the PCIP has been scrapped. So what happens to you if you have a pre-existing condition and you’re without health insurance? will you still be able to enroll in an Obamacare plan as promised? When? Call us today for immediate help at 1-800-771-7758.

Health Insurance Options for People with Pre-Exisiting Conditions

You can wait until January 2014, at which point all health insurance plans purchased through ACA compliant insurance exchanges become guaranteed acceptance. This option is most likely the most affordable if you can stick it out until the effective date of the new Obamacare provisions regarding guaranteed acceptance. If you are in need of medical treatment or urgent care however, this option is not likely possible for you.

If you’re concerned about being rejected before plans become guaranteed acceptance next year because of your pre-existing condition, you can always purchase a temporary indemnity policy for the meantime. Then when the time comes to make the switch to an official ACA compliant health insurance plan, you just have to enroll before March 2014. Visit our temporary insurance options page for more info and free quotes. We have several temporary health insurance options including indemnity and others. Call today to learn about more health insurance options for people with pre-existing conditions as well as get free quotes on temporary health insurance plans.


Essential Health Benefits

In addition to all of the aforementioned changes, The PPACA defines "essential health benefits" by specifying 10 categories of benefits that must be covered by all health insurance plans offered through an exchange. These categories are as follows:

    1. Ambulatory patient services
    2. Emergency services
    3. Hospitalization
    4. Maternity and newborn care
    5. Mental health and substance abuse disorder services
    6. Prescription drugs
    7. Rehabilitative and habilitative services and devices
    8. Laboratory services
    9. Preventive and wellness services and chronic disease management
    10. Pediatric services, including oral and vision care


How Will This Transition Affect Me?

Some details about the health insurance plans that will be offered at California health exchanges were recently released. Click on the following links if you're looking for details on the plans offered by Covered California including estimates of cost.

Covered California will serve many more people than just those living in poverty. The benefits of the subsidized health insurance options offered will reach as high as those families at four times the federal poverty level, which changes with inflation. Medi-Cal will also extend its benefits to 38 percent more families and individuals who prior to Obamacare were not eligible for the Medi-Cal program. To find out if you are one of the millions of Californians that stands to see some savings thanks to the ACA, call SkyBlue today and take advantage of a free health insurance consultation.


Call SkyBlue Insurance Agency Inc. Today, and get free insurance quotes and a free consultation from our full-service insurance agency.