ACA in 2014: What patients need to know

Abstract

Patient awareness of the Affordable Care Act (ACA) is increasing, but the Obama administration has a lot of work to do on promoting the controversial health care reform law as the clock ticks. Tied to 2014 are major provisions of ACA such as the option for states to expand Medicaid and the health insurance marketplaces, for which open enrollment begins October 1.While general awareness of ACA has risen to 74% of people in a recent survey by CVS Caremark, 36% of people who are likely to enroll in the marketplaces say they need more information—and 68% of those surveyed expect community pharmacies to offer health insurance information in stores or online.■Some pharmacies will have information for patients on the health care reform law.■The health insurance marketplaces for each state will open on October 1.■HealthCare.gov will be the marketplaces' online home.Some pharmacies will have information on ACA for patients. "We will be bringing awareness to the ACA," Lynn E. Connelly, BSPharm, owner of Medicine Mart Pharmacy in West Columbia, SC, told Pharmacy Today. He plans to learn of new information for his pharmacy and the patients from various pharmacy meetings throughout the state and the country. "In turn, I will share this information with the staff and the patients when possible," Connelly explained."It's important that ACA-related information is widely distributed and readily available for patients who have questions," said Stacie Maass, BSPharm, JD, APhA Senior Vice President of Government Affairs. This article, last in a Today series on the health care reform law, looks at what patients need to know for 2014.The latest on ACAThe law's cap on out-of-pocket costs of $6,350 for individuals will not be enforced for some employer-based health plans until 2015, as reported by Kaiser Health News in April and the New York Times on August 13. Consumers affected by the 1-year delay may be required to pay $6,350 for medical costs and an additional $6,350 for drug costs if their large employer has two benefit providers for medical and for drugs. "If a drug plan does not currently have a limit on out-of- pocket costs, it will not have to impose one for 2014," the Times reported.CMS: Direct patients to HealthCare.gov and 800-318-2596When it comes to the Affordable Care Act and the new health care insurance marketplaces for which open enrollment starts October 1, the Obama administration has your number. It also has just the website for you."Pharmacists can let their patients know about the critical date of October 1, when a new health insurance marketplace will open in every state, giving Americans a whole new way to shop for health insurance," a CMS spokeswoman told Pharmacy Today. "They can direct individuals to the new and improved Health- Care.gov, which will be the marketplaces' online home starting in October. For Spanish-speaking consumers, CuidadoDeSalud.gov has also been updated in preparation for the marketplace. … They can also direct individuals to the consumer call center that will be open 24 hours a day, 7 days a week." The call center number is 800-318-2596 (TTY/TDD: 855-889-4325).For information about the marketplace websites for each state, "pharmacists should refer patients to HealthCare.gov," according to the CMS spokeswoman. "If a state has a state-based marketplace, HealthCare.gov will direct the consumer to the state's marketplace." Information about federal subsidies—for people with incomes up to 400% of the poverty line who are not eligible for other affordable coverage—is available at HealthCare.gov. Information about the Medicaid expansion, including options for people in states where Medicaid is not expanding, is available at HealthCare.gov.HealthCare.gov will continue to add new consumer help functions that will assist consumers shopping for coverage, the CMS spokeswoman told Today.At HealthCare.gov, patients can find extensive information on the health care reform law. Following is information on ACA's individual mandate to have health insurance or pay a fee, unless the person is eligible for an exemption:■People who can afford, but don't have, health insurance coverage in 2014 may have to pay a fee. The fee in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher; the fee for uninsured children in 2014 is $47.50 per child, and the most a family would have to pay in 2014 is $285, according to the website. The fee increases every year. In 2016, it is 2.5% of income or $695 per person, whichever is higher.■People with qualifying health insurance coverage will not have to pay the fee. Such coverage includes any marketplace plan or any individual insurance plan that a consumer already has; any employer plan, including retiree plans; Medicare; Medicaid; the Children's Health Insurance Program; TRICARE; veterans health care programs; Peace Corps volunteer plans; and other plans."Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a preexisting health condition," added the CMS spokeswoman.On August 15, the Obama administration announced $67 million in grant awards to 105 "navigator" groups to serve as in-person resources for people who want more assistance in shopping for plans through the marketplaces.Practical approachWhether and how to provide information on ACA is a "tough question because there are so many parts to the new law," noted Michael Kim, PharmD, President of Grubb's Care Pharmacy and Grubb's NW Specialty Pharmacy. "I will have my pharmacists speak with patients about the new law, but the most practical approach will be to have my staff educated and prepared with information to share with our patients and customers." Kim plans to have his staff provide informational brochures, and information on where to go online such as HealthCare.gov "so that each consumer can research their options at their own pace," he said. (See sidebar for information from CMS on the revamped HealthCare.gov and a new ACA call center. Both are now operational.)Among the pharmacy chains that will make ACA information available in their stores are CVS Caremark and Wal- greens. Walgreens and the Blue Cross and Blue Shield Association launched a national campaign on July 10 to educate consumers on ACA, according to Walgreens spokesman Jim Cohn. The campaign includes a new website (LearnAboutReform.com) that provides information to consumers about the new ways of purchasing health insurance and the new benefits under ACA. Nearly all Walgreens stores across the country will also have informational brochures on the law.CVS Caremark will roll out an information and outreach program in its stores, according to CVS Caremark spokeswoman Carolyn Castel. The program includes online information (www.cvs.com/insurance), brochure displays, more than 375 health fairs around the country this fall, and events in stores to tell consumers about ACA, focused on states that have higher proportions of uninsured people. "Our stores and pharmacists will be ready with information to help customers throughout the open enrollment period starting October 1," Castel said. "We learned with the implementation of the Medicare prescription drug program that people aren't interested in finding information until they can take action."Today's series on the Affordable Care Act in 2014 will describe patient care opportunities for pharmacists (July), the business impact on pharmacies (August), and what patients need to know (September). The Health-System Edition will explain the impact on hospital pharmacists (September). Patient awareness of the Affordable Care Act (ACA) is increasing, but the Obama administration has a lot of work to do on promoting the controversial health care reform law as the clock ticks. Tied to 2014 are major provisions of ACA such as the option for states to expand Medicaid and the health insurance marketplaces, for which open enrollment begins October 1. While general awareness of ACA has risen to 74% of people in a recent survey by CVS Caremark, 36% of people who are likely to enroll in the marketplaces say they need more information—and 68% of those surveyed expect community pharmacies to offer health insurance information in stores or online.■Some pharmacies will have information for patients on the health care reform law.■The health insurance marketplaces for each state will open on October 1.■HealthCare.gov will be the marketplaces' online home. ■Some pharmacies will have information for patients on the health care reform law.■The health insurance marketplaces for each state will open on October 1.■HealthCare.gov will be the marketplaces' online home. ■Some pharmacies will have information for patients on the health care reform law.■The health insurance marketplaces for each state will open on October 1.■HealthCare.gov will be the marketplaces' online home. Some pharmacies will have information on ACA for patients. "We will be bringing awareness to the ACA," Lynn E. Connelly, BSPharm, owner of Medicine Mart Pharmacy in West Columbia, SC, told Pharmacy Today. He plans to learn of new information for his pharmacy and the patients from various pharmacy meetings throughout the state and the country. "In turn, I will share this information with the staff and the patients when possible," Connelly explained. "It's important that ACA-related information is widely distributed and readily available for patients who have questions," said Stacie Maass, BSPharm, JD, APhA Senior Vice President of Government Affairs. This article, last in a Today series on the health care reform law, looks at what patients need to know for 2014. The latest on ACAThe law's cap on out-of-pocket costs of $6,350 for individuals will not be enforced for some employer-based health plans until 2015, as reported by Kaiser Health News in April and the New York Times on August 13. Consumers affected by the 1-year delay may be required to pay $6,350 for medical costs and an additional $6,350 for drug costs if their large employer has two benefit providers for medical and for drugs. "If a drug plan does not currently have a limit on out-of- pocket costs, it will not have to impose one for 2014," the Times reported.CMS: Direct patients to HealthCare.gov and 800-318-2596When it comes to the Affordable Care Act and the new health care insurance marketplaces for which open enrollment starts October 1, the Obama administration has your number. It also has just the website for you."Pharmacists can let their patients know about the critical date of October 1, when a new health insurance marketplace will open in every state, giving Americans a whole new way to shop for health insurance," a CMS spokeswoman told Pharmacy Today. "They can direct individuals to the new and improved Health- Care.gov, which will be the marketplaces' online home starting in October. For Spanish-speaking consumers, CuidadoDeSalud.gov has also been updated in preparation for the marketplace. … They can also direct individuals to the consumer call center that will be open 24 hours a day, 7 days a week." The call center number is 800-318-2596 (TTY/TDD: 855-889-4325).For information about the marketplace websites for each state, "pharmacists should refer patients to HealthCare.gov," according to the CMS spokeswoman. "If a state has a state-based marketplace, HealthCare.gov will direct the consumer to the state's marketplace." Information about federal subsidies—for people with incomes up to 400% of the poverty line who are not eligible for other affordable coverage—is available at HealthCare.gov. Information about the Medicaid expansion, including options for people in states where Medicaid is not expanding, is available at HealthCare.gov.HealthCare.gov will continue to add new consumer help functions that will assist consumers shopping for coverage, the CMS spokeswoman told Today.At HealthCare.gov, patients can find extensive information on the health care reform law. Following is information on ACA's individual mandate to have health insurance or pay a fee, unless the person is eligible for an exemption:■People who can afford, but don't have, health insurance coverage in 2014 may have to pay a fee. The fee in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher; the fee for uninsured children in 2014 is $47.50 per child, and the most a family would have to pay in 2014 is $285, according to the website. The fee increases every year. In 2016, it is 2.5% of income or $695 per person, whichever is higher.■People with qualifying health insurance coverage will not have to pay the fee. Such coverage includes any marketplace plan or any individual insurance plan that a consumer already has; any employer plan, including retiree plans; Medicare; Medicaid; the Children's Health Insurance Program; TRICARE; veterans health care programs; Peace Corps volunteer plans; and other plans."Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a preexisting health condition," added the CMS spokeswoman.On August 15, the Obama administration announced $67 million in grant awards to 105 "navigator" groups to serve as in-person resources for people who want more assistance in shopping for plans through the marketplaces. The law's cap on out-of-pocket costs of $6,350 for individuals will not be enforced for some employer-based health plans until 2015, as reported by Kaiser Health News in April and the New York Times on August 13. Consumers affected by the 1-year delay may be required to pay $6,350 for medical costs and an additional $6,350 for drug costs if their large employer has two benefit providers for medical and for drugs. "If a drug plan does not currently have a limit on out-of- pocket costs, it will not have to impose one for 2014," the Times reported.CMS: Direct patients to HealthCare.gov and 800-318-2596When it comes to the Affordable Care Act and the new health care insurance marketplaces for which open enrollment starts October 1, the Obama administration has your number. It also has just the website for you."Pharmacists can let their patients know about the critical date of October 1, when a new health insurance marketplace will open in every state, giving Americans a whole new way to shop for health insurance," a CMS spokeswoman told Pharmacy Today. "They can direct individuals to the new and improved Health- Care.gov, which will be the marketplaces' online home starting in October. For Spanish-speaking consumers, CuidadoDeSalud.gov has also been updated in preparation for the marketplace. … They can also direct individuals to the consumer call center that will be open 24 hours a day, 7 days a week." The call center number is 800-318-2596 (TTY/TDD: 855-889-4325).For information about the marketplace websites for each state, "pharmacists should refer patients to HealthCare.gov," according to the CMS spokeswoman. "If a state has a state-based marketplace, HealthCare.gov will direct the consumer to the state's marketplace." Information about federal subsidies—for people with incomes up to 400% of the poverty line who are not eligible for other affordable coverage—is available at HealthCare.gov. Information about the Medicaid expansion, including options for people in states where Medicaid is not expanding, is available at HealthCare.gov.HealthCare.gov will continue to add new consumer help functions that will assist consumers shopping for coverage, the CMS spokeswoman told Today.At HealthCare.gov, patients can find extensive information on the health care reform law. Following is information on ACA's individual mandate to have health insurance or pay a fee, unless the person is eligible for an exemption:■People who can afford, but don't have, health insurance coverage in 2014 may have to pay a fee. The fee in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher; the fee for uninsured children in 2014 is $47.50 per child, and the most a family would have to pay in 2014 is $285, according to the website. The fee increases every year. In 2016, it is 2.5% of income or $695 per person, whichever is higher.■People with qualifying health insurance coverage will not have to pay the fee. Such coverage includes any marketplace plan or any individual insurance plan that a consumer already has; any employer plan, including retiree plans; Medicare; Medicaid; the Children's Health Insurance Program; TRICARE; veterans health care programs; Peace Corps volunteer plans; and other plans."Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a preexisting health condition," added the CMS spokeswoman. CMS: Direct patients to HealthCare.gov and 800-318-2596When it comes to the Affordable Care Act and the new health care insurance marketplaces for which open enrollment starts October 1, the Obama administration has your number. It also has just the website for you."Pharmacists can let their patients know about the critical date of October 1, when a new health insurance marketplace will open in every state, giving Americans a whole new way to shop for health insurance," a CMS spokeswoman told Pharmacy Today. "They can direct individuals to the new and improved Health- Care.gov, which will be the marketplaces' online home starting in October. For Spanish-speaking consumers, CuidadoDeSalud.gov has also been updated in preparation for the marketplace. … They can also direct individuals to the consumer call center that will be open 24 hours a day, 7 days a week." The call center number is 800-318-2596 (TTY/TDD: 855-889-4325).For information about the marketplace websites for each state, "pharmacists should refer patients to HealthCare.gov," according to the CMS spokeswoman. "If a state has a state-based marketplace, HealthCare.gov will direct the consumer to the state's marketplace." Information about federal subsidies—for people with incomes up to 400% of the poverty line who are not eligible for other affordable coverage—is available at HealthCare.gov. Information about the Medicaid expansion, including options for people in states where Medicaid is not expanding, is available at HealthCare.gov.HealthCare.gov will continue to add new consumer help functions that will assist consumers shopping for coverage, the CMS spokeswoman told Today.At HealthCare.gov, patients can find extensive information on the health care reform law. Following is information on ACA's individual mandate to have health insurance or pay a fee, unless the person is eligible for an exemption:■People who can afford, but don't have, health insurance coverage in 2014 may have to pay a fee. The fee in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher; the fee for uninsured children in 2014 is $47.50 per child, and the most a family would have to pay in 2014 is $285, according to the website. The fee increases every year. In 2016, it is 2.5% of income or $695 per person, whichever is higher.■People with qualifying health insurance coverage will not have to pay the fee. Such coverage includes any marketplace plan or any individual insurance plan that a consumer already has; any employer plan, including retiree plans; Medicare; Medicaid; the Children's Health Insurance Program; TRICARE; veterans health care programs; Peace Corps volunteer plans; and other plans."Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a preexisting health condition," added the CMS spokeswoman. CMS: Direct patients to HealthCare.gov and 800-318-2596When it comes to the Affordable Care Act and the new health care insurance marketplaces for which open enrollment starts October 1, the Obama administration has your number. It also has just the website for you."Pharmacists can let their patients know about the critical date of October 1, when a new health insurance marketplace will open in every state, giving Americans a whole new way to shop for health insurance," a CMS spokeswoman told Pharmacy Today. "They can direct individuals to the new and improved Health- Care.gov, which will be the marketplaces' online home starting in October. For Spanish-speaking consumers, CuidadoDeSalud.gov has also been updated in preparation for the marketplace. … They can also direct individuals to the consumer call center that will be open 24 hours a day, 7 days a week." The call center number is 800-318-2596 (TTY/TDD: 855-889-4325).For information about the marketplace websites for each state, "pharmacists should refer patients to HealthCare.gov," according to the CMS spokeswoman. "If a state has a state-based marketplace, HealthCare.gov will direct the consumer to the state's marketplace." Information about federal subsidies—for people with incomes up to 400% of the poverty line who are not eligible for other affordable coverage—is available at HealthCare.gov. Information about the Medicaid expansion, including options for people in states where Medicaid is not expanding, is available at HealthCare.gov.HealthCare.gov will continue to add new consumer help functions that will assist consumers shopping for coverage, the CMS spokeswoman told Today.At HealthCare.gov, patients can find extensive information on the health care reform law. Following is information on ACA's individual mandate to have health insurance or pay a fee, unless the person is eligible for an exemption:■People who can afford, but don't have, health insurance coverage in 2014 may have to pay a fee. The fee in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher; the fee for uninsured children in 2014 is $47.50 per child, and the most a family would have to pay in 2014 is $285, according to the website. The fee increases every year. In 2016, it is 2.5% of income or $695 per person, whichever is higher.■People with qualifying health insurance coverage will not have to pay the fee. Such coverage includes any marketplace plan or any individual insurance plan that a consumer already has; any employer plan, including retiree plans; Medicare; Medicaid; the Children's Health Insurance Program; TRICARE; veterans health care programs; Peace Corps volunteer plans; and other plans."Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a preexisting health condition," added the CMS spokeswoman. When it comes to the Affordable Care Act and the new health care insurance marketplaces for which open enrollment starts October 1, the Obama administration has your number. It also has just the website for you. "Pharmacists can let their patients know about the critical date of October 1, when a new health insurance marketplace will open in every state, giving Americans a whole new way to shop for health insurance," a CMS spokeswoman told Pharmacy Today. "They can direct individuals to the new and improved Health- Care.gov, which will be the marketplaces' online home starting in October. For Spanish-speaking consumers, CuidadoDeSalud.gov has also been updated in preparation for the marketplace. … They can also direct individuals to the consumer call center that will be open 24 hours a day, 7 days a week." The call center number is 800-318-2596 (TTY/TDD: 855-889-4325). For information about the marketplace websites for each state, "pharmacists should refer patients to HealthCare.gov," according to the CMS spokeswoman. "If a state has a state-based marketplace, HealthCare.gov will direct the consumer to the state's marketplace." Information about federal subsidies—for people with incomes up to 400% of the poverty line who are not eligible for other affordable coverage—is available at HealthCare.gov. Information about the Medicaid expansion, including options for people in states where Medicaid is not expanding, is available at HealthCare.gov. HealthCare.gov will continue to add new consumer help functions that will assist consumers shopping for coverage, the CMS spokeswoman told Today. At HealthCare.gov, patients can find extensive information on the health care reform law. Following is information on ACA's individual mandate to have health insurance or pay a fee, unless the person is eligible for an exemption:■People who can afford, but don't have, health insurance coverage in 2014 may have to pay a fee. The fee in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher; the fee for uninsured children in 2014 is $47.50 per child, and the most a family would have to pay in 2014 is $285, according to the website. The fee increases every year. In 2016, it is 2.5% of income or $695 per person, whichever is higher.■People with qualifying health insurance coverage will not have to pay the fee. Such coverage includes any marketplace plan or any individual insurance plan that a consumer already has; any employer plan, including retiree plans; Medicare; Medicaid; the Children's Health Insurance Program; TRICARE; veterans health care programs; Peace Corps volunteer plans; and other plans. "Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a preexisting health condition," added the CMS spokeswoman. On August 15, the Obama administration announced $67 million in grant awards to 105 "navigator" groups to serve as in-person resources for people who want more assistance in shopping for plans through the marketplaces. Practical approachWhether and how to provide information on ACA is a "tough question because there are so many parts to the new law," noted Michael Kim, PharmD, President of Grubb's Care Pharmacy and Grubb's NW Specialty Pharmacy. "I will have my pharmacists speak with patients about the new law, but the most practical approach will be to have my staff educated and prepared with information to share with our patients and customers." Kim plans to have his staff provide informational brochures, and information on where to go online such as HealthCare.gov "so that each consumer can research their options at their own pace," he said. (See sidebar for information from CMS on the revamped HealthCare.gov and a new ACA call center. Both are now operational.)Among the pharmacy chains that will make ACA information available in their stores are CVS Caremark and Wal- greens. Walgreens and the Blue Cross and Blue Shield Association launched a national campaign on July 10 to educate consumers on ACA, according to Walgreens spokesman Jim Cohn. The campaign includes a new website (LearnAboutReform.com) that provides information to consumers about the new ways of purchasing health insurance and the new benefits under ACA. Nearly all Walgreens stores across the country will also have informational brochures on the law.CVS Caremark will roll out an information and outreach program in its stores, according to CVS Caremark spokeswoman Carolyn Castel. The program includes online information (www.cvs.com/insurance), brochure displays, more than 375 health fairs around the country this fall, and events in stores to tell consumers about ACA, focused on states that have higher proportions of uninsured people. "Our stores and pharmacists will be ready with information to help customers throughout the open enrollment period starting October 1," Castel said. "We learned with the implementation of the Medicare prescription drug program that people aren't interested in finding information until they can take action."Today's series on the Affordable Care Act in 2014 will describe patient care opportunities for pharmacists (July), the business impact on pharmacies (August), and what patients need to know (September). The Health-System Edition will explain the impact on hospital pharmacists (September). Whether and how to provide information on ACA is a "tough question because there are so many parts to the new law," noted Michael Kim, PharmD, President of Grubb's Care Pharmacy and Grubb's NW Specialty Pharmacy. "I will have my pharmacists speak with patients about the new law, but the most practical approach will be to have my staff educated and prepared with information to share with our patients and customers." Kim plans to have his staff provide informational brochures, and information on where to go online such as HealthCare.gov "so that each consumer can research their options at their own pace," he said. (See sidebar for information from CMS on the revamped HealthCare.gov and a new ACA call center. Both are now operational.) Among the pharmacy chains that will make ACA information available in their stores are CVS Caremark and Wal- greens. Walgreens and the Blue Cross and Blue Shield Association launched a national campaign on July 10 to educate consumers on ACA, according to Walgreens spokesman Jim Cohn. The campaign includes a new website (LearnAboutReform.com) that provides information to consumers about the new ways of purchasing health insurance and the new benefits under ACA. Nearly all Walgreens stores across the country will also have informational brochures on the law. CVS Caremark will roll out an information and outreach program in its stores, according to CVS Caremark spokeswoman Carolyn Castel. The program includes online information (www.cvs.com/insurance), brochure displays, more than 375 health fairs around the country this fall, and events in stores to tell consumers about ACA, focused on states that have higher proportions of uninsured people. "Our stores and pharmacists will be ready with information to help customers throughout the open enrollment period starting October 1," Castel said. "We learned with the implementation of the Medicare prescription drug program that people aren't interested in finding information until they can take action." Today's series on the Affordable Care Act in 2014 will describe patient care opportunities for pharmacists (July), the business impact on pharmacies (August), and what patients need to know (September). The Health-System Edition will explain the impact on hospital pharmacists (September). Today's series on the Affordable Care Act in 2014 will describe patient care opportunities for pharmacists (July), the business impact on pharmacies (August), and what patients need to know (September). The Health-System Edition will explain the impact on hospital pharmacists (September).