Big changes are coming for health care consumers starting tomorrow, October 1, 2013, with the launch of health insurance exchanges, or marketplaces, where consumers can shop for and apply for private health insurance plans. The exchanges are going online, here in New Mexico and nationally for both individuals and businesses.
What is the Health Exchange Marketplace?
With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll. Under the Affordable Care Act you can’t be denied coverage, even if you have a pre-existing condition, and insurance companies can’t cap or deny your benefits if you get sick. You’ll be able to buy insurance with more choices and at lower costs than ever before.
When you visit the New Mexico Health Insurance Marketplace or HealthCare.gov tomorrow, you will be able to shop for the private health insurance plan that meets your needs. Insurance policies take effect on January 1, 2014.
What does Marketplace health insurance cover?
All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover.
The essential health benefits include at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
Learn more about how the Health Insurance Marketplace works, the kinds of plans available, and the four categories of coverage, or “Bronze,” “Silver,” “Gold,” or “Platinum” plans.
What if the Republicans Shut Down the Government?
The Health Insurance Marketplaces will begin enrolling in affordable health care plans on Tuesday, even if Republicans in Congress shutdown the federal government over Tea Party demands to stop the Affordable Care Act.
- New Mexico’s Health Insurance Marketplace is run by the State of New Mexico, and health insurance policies under the plan are private insurance policies, not “government health care.” The State of New Mexico will not be shutting down no matter what Republicans in Congress do.
- Mandatory funding in the federal government, including health services will not shut down no matter what Republicans in Congress do. That includes funding for the Affordable Care Act, Medicare, Medicaid, Veterans health services, and the Indian Health Service, all of which are unaffected by Congressional delays approving annual discretionary appropriations, which Republicans are targeting.
Learn more about the Affordable Care Act, also called ‘Obamacare’
- www.HealthCare.gov — the health insurance marketplace
- cuidadodesalud.gov — En Español
- www.BeWellNM.com — New Mexico’s health insurance marketplace page
- www.GetCoveredAmerica.org — a nonprofit, nonpartisan campaign of Enroll America
HealthReform — a White House website
- www.HHS.gov/HealthCare — a U.S. Health and Human Services website
- Albuquerque-Bernalillo County Public Library — Affordable Care Act Page
- State-by-State Health Insurance Marketplace Premiums — Lower Costs, More Choice
More Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)