What you need to know about your health insurance benefits – National Consumers League

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stethoscope_heart_92.jpgIt’s no secret that choosing a health insurance plan isn’t as easy as ordering at a restaurant. Even after purchasing a plan, actually understanding what exactly you’ve purchased is yet another stressful task. Health insurance can confuse even the savviest consumers. Read on for a few tips every consumer should know when it comes to health insurance benefits.


Your health plan most likely offers essential health benefits.

All plans purchased through the Affordable Care Act (ACA) marketplace and the majority of health plans provided by employers are required to provide a core group of medical services called essential health benefits. These services include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care 
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

To find the full list of services your plan covers and how much those services cost, check your Summary of Benefits and Coverage (SBC). You can request a copy of this document through your insurance company or access it via your online account through your insurance provider’s website.

Staying in network will save you money.

Visits to health care providers or facilities within your plan’s network are generally much cheaper than visits to out-of-network providers or facilities. The type of insurance policy you have plays a role in who participates in your plan’s network and how much you will pay if you choose to visit an out-of-network provider not covered by your plan. For example, HMO (Health Maintenance Organization) plans require you to select one primary care physician who will coordinate all of your health care services. With this plan, out-of-network providers are typically not covered at all, expect for true medical emergencies.

On the other hand, PPO (Preferred Provider Organization) plans allow you to visit any provider or specialist, in-network or out-of-network, and without a referral. Though your PPO plan may cover your out-of-network visit, you will pay more out-of-pocket for those services. Regardless of the type of plan you enroll in, be mindful of the providers in your network, as it can have a huge effect on your out-of-pocket costs.

All qualified health plans have cost-sharing limits.

All qualified health plans have an out-of-pocket maximum, which is the most you have to pay personally for covered services over the course of a year. All the money you pay for your deductible, coinsurance, and copays (but not premiums) goes toward your out-of-pocket maximum. Once you reach this limit, your insurance plan pays 100 percent for all covered medical services. Understanding how all potential out-of-pocket costs work together can be a little complicated, so here’s an example:

  • Suppose you are in a serious accident and have acquired $30,000 in medical expenses. Your health insurance plan offers a $2,000 deductible, 20 percent coinsurance, and a $5,000 out-of-pocket maximum for the year.
  • You would first be responsible for paying your deductible ($2,000).
  • After paying your deductible, you are responsible for your 20 percent coinsurance on the remaining $28,000 until you reach your out-of-pocket maximum.
  • Since 20 percent of $28,000 is $5,600, you would only be responsible for paying an additional $3,000 since your out-of-pocket maximum is $5,000. Your insurance plan would then pay 100 percent for all covered medical services thereafter.   

Be on the lookout for new resources from the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) to help consumers choose and get the most out of their health insurance benefits.

Five commonly asked consumer health insurance questions – National Consumers League

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doctor_patient_crop.jpgWith the Affordable Care Act (ACA) becoming law in 2010, more Americans now have access to health care coverage than ever before. However, many consumers are still puzzled about how to select a plan, what services are covered, or why they need health insurance altogether. If health insurance talk leaves you disillusioned or just plain confused, don’t give up. Below, we answer five of the most commonly asked consumer questions about health insurance. 

Why do I need health insurance?

It is in your best interest to have some form of health insurance. Why, you ask?

  • To protect your health
    While you may seem perfectly healthy now, sudden injuries or illnesses can occur in an instant. Without health insurance, you could be faced with thousands of dollars in medical costs, which could pose a significant financial burden well into the future. With health insurance, you also have access to preventive services such as physicals, immunizations, and other screenings that can help prevent diseases and identify problems earlier when they are easier to treat.
  • It’s required by law  
    Under the ACA, individuals are required to have health insurance (unless you qualify for an exemption). If you choose not to enroll, you will have to pay a tax penalty. 

How do I know what type of insurance plan is right for me and my family?

When shopping for a health insurance plan, here are some things to take into consideration:

  • Premiums: Each health insurance plan has a monthly premium that you must pay to maintain your coverage.  
  • Coverage/access to providers: Every plan has a different set of services, prescription drugs, and doctors that it agrees to cover. Every plan also uses a specific network of hospitals and health care providers to facilitate your care. Before choosing a plan, check that the services and prescription drugs you need are covered, and ensure that your current providers are within your plan’s network to avoid incurring additional costs down the line. 
  • Out-of-pocket costs: Out-of-pocket costs are health care expenses  you must pay yourself and that are not reimbursed by your insurance plan.

 Copayment, deductibles, coinsurance … What’s the difference?

  • A copayment or “copay” is a fixed amount ($10, for example) that you pay each time you visit a health care provider or fill a prescription.
  • A deductible is the amount you are responsible for paying for covered medical services before your health insurance plan starts to pay for covered medical expenses.
  • Coinsurance is usually a percentage of a total bill that you are responsible for paying after you’ve paid your deductible (for example, you pay 20 percent and your plan pays 80 percent). 

What is a health savings account, and what can I use those funds for?                                                                         

Health savings accounts (HSA) allow you to deposit pre-tax funds to pay for qualified medical expenses. They are typically combined with qualifying high-deductible health plans (HDHP). While HSA funds cannot be used to pay for monthly premiums, HSA-eligible HDHPs are attractive to many consumers because the premiums are generally lower. HSA funds can be used as needed to pay for prescription drug costs and fees such as copays, deductibles, and coinsurance. Learn more about health savings accounts here.

If my insurance company denies coverage for a service, is there anything I can do? 

If your insurance company does not authorize payment for a medical service, you have the right to appeal that decision. Before sending an appeal, carefully review your health coverage and the correspondence from your insurance company. Have copies of your medical records, letters from your providers, and any other pertinent information that supports your appeal. If your plan still denies payment of your claim after your initial appeal, you may opt for an external review conducted by an independent third party.

To answer questions like these, the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) are teaming up to provide consumers with even more helpful information about how to choose and use health insurance benefits.

 

 

From patient To consumer: Reimagining health care from a consumer perspective – National Consumers League

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family-on-bikes.jpgThe following Huffington Post op-ed was published August 18, co-authored by NCL’s Sally Greenberg and Marilyn Tavenner, the President and CEO of America’s Health Insurance Plans.

Navigating our health care system is no easy task. For decades, consumers have been forced to contend with a fragmented health system that makes decision making an all-consuming challenge. Whether it’s choosing a provider, knowing where to get information about cost or quality of doctors, or understanding a dictionary of complex health care terms, many consumers often feel left to fend for themselves in a system that is working against them.

For many individuals, it’s hard to know where to start. A recent state analysis by Rice University in Texas found that 42 percent of consumers who bought their own insurance felt like they lacked a clear understanding of their health insurance plans. Nearly a quarter of those surveyed who had employer-sponsored coverage still struggled with understanding their benefits.

We need to find a way to change this. While we all recognize the seismic shift underway as the age of consumerism in health care finally takes hold, we have to ask ourselves if we are truly practicing what we preach. We all have a responsibility to provide consumers with the transparent, actionable information they need to make smart choices about their care.

The good news is that online and mobile apps are making it increasingly easy for consumers to access information on their own time and with relative simplicity. Health plans have rolled out provider cost and quality calculators, and websites like FAIR Health make it possible for patients to see what a typical doctor’s visit or MRI will cost before they even walk into a provider’s office.

But even with this push towards more available data, we know that individuals and families still struggle when it comes to understanding and using their insurance benefits. Commonly searched online terms around insurance include, “what are deductibles?”, “finding a doctor,” and “how much will I pay in premiums?” Consumers are clearly telegraphing the need for simple, easy-to-understand information about their coverage.

Recently, our two organizations came together to compare notes on how we could collaborate to improve consumers’ health care experience. As a first step, we agreed that while there is a wealth of information in the market available for consumers, it is often poorly organized, out-of-date, or like the health care system itself, requires consumers to search multiple places for the information they need. Our first joint project will bring critical information together and present it in ways that are useful for consumers. We will rely on AHIP’s considerable knowledge of health insurance and NCL’s more than 100 years of consumer education to make information accessible, understandable, and actionable.

Our work builds upon what we have learned over the past several years on the frontlines of this health care transformation. A recent report from McKinsey found that although consumers are beginning to research their health plan choices, many of them are not yet aware of key factors they should consider before selecting coverage, such as the type of health plan and provider network, level of coverage, premiums, cost-sharing, covered services, drug formularies and tiers, and health status and anticipated utilization. Even once they have their insurance plan, many consumers may not be aware of all the benefits that are included, including free preventive services, disease management programs, fitness plans – and equally important, the tools they have available to get the best value for their health care dollars.

As consumers prepare for the upcoming open enrollment periods for Medicare and the Exchanges, AHIP and NCL will share new consumer resources and information answering some of the important questions about insurance coverage and health care ranging from how to choose a health plan to how to choose a doctor, as well as consumers’ rights if they feel they’ve been inappropriately denied a product or service that should be covered by their plan.

We know that health care isn’t always simple, but if we are to be successful in moving towards a patient-centered health system, we have to start by making health care information more accessible and usable for consumers. While this partnership is a first step, our hope is that our combined efforts will encourage and support the important work underway to improve consumers’ experience with the health system and the wellbeing of the country as a whole.

This article originally appeared in the Huffington Post.

Chipotle’s misdirected food safety efforts – National Consumers League

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92_chipotle_stock_photo.jpgBy Ali Schklair, Linda Golodner Food Safety & Nutrition Fellow 

Back in August, Chipotle launched its ‘G-M-Over it’ campaign. In the name of food safety, it pledged to eliminate all genetically modified ingredients from its food supply. But the hype didn’t last long. By September, Chipotle was facing a class-action lawsuit challenging the validity of their GMO ban. Plaintiffs argued that the meat and dairy products served at the chain come from animals that feed on GMO corn and soy, not to mention the corn syrup used in Chipotle’s juices and soft drinks.

Fast-forward to December, and Chipotle was being linked to numerous foodborne illness outbreaks. Over a six-month period, 500 people were sickened and 20 were hospitalized from norovirus, salmonella, or one of two different strains of E. coli. 2016 isn’t looking much better for Chipotle. A federal grand jury has served the company with a subpoena asking for documents relating to the norovirus outbreak at a Simi Valley, CA location. At this point, it is safe to say that Chipotle has greatly misdirected its food safety efforts.

Outbreaks at restaurants are serious. In 1993 an E. Coli outbreak at the fast food restaurant Jack In The Box infected 732 people. The bacterium originated from undercooked beef patties in hamburgers. The outbreak involved 73 Jack In The Box restaurants in California, Idaho, Washington, and Nevada and has been described as “far and away the most infamous food poison outbreak in contemporary history.” Four children died, and 178 other victims were left with permanent injury, including kidney and brain damage. The FDA implemented new guidelines and regulations after the Jack In The Box tragedy, including setting temperatures for cooking beef to destroy pathogens.

The Centers for Disease Control (CDC) estimates that approximately 48 million Americans are infected by foodborne diseases each year. Consumers are twice as likely to get sick from food prepared at a restaurant. Since pathogens can grow and spread anywhere throughout the supply chain, it’s often hard to track the source of an outbreak. When restaurants have multiple supply sources, as does Chipotle, it is even harder to identify the origin. As discussed in a recent New Yorker article, “while Chipotle has said that it is introducing more stringent testing and reassessing its food-handling practices, its reliance on local suppliers means that the task of insuring the integrity of its supply chain will be harder.” Not only will Chipotle have to revamp its food safety protocols, but it may also need to reconsider its entire local sourcing model—something that is a draw for many devoted Chipotle customers.

Where does that leave consumers who eat out? The CDC suggests taking these four precautionary steps when picking a restaurant or dining out:

  1. Check inspection scores. Search online to see how the restaurant scored on their state health department health inspection.
  2. Make sure the restaurant is clean. Look around to see how used plates and utensils are handled. If you can see it, notice how food is being prepared and how cooking spaces are cleaned.
  3. Check that your food is cooked properly. Look at your meat to determine whether it is cooked thoroughly, and send it back if it appears too pink or raw in texture.
  4. Handle your leftovers properly. Refrigerate leftovers no more than an hour after leaving the restaurant. Eat leftovers within 3 to 4 days, and discard if you see signs of deterioration – like mold or a bad smell or texture – on leftovers.

The CDC and Food Safety News offer plenty more helpful information about avoiding food borne illness.

So Simple, So Hard tackles adherence challenges in CA – National Consumers League

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“So Simple, So Hard” was the theme of the medication adherence conference the National Consumers League (NCL) held on September 15 in Sacramento, California. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), the speakers and attendees explored the challenges and barriers to medication adherence – why it is so hard – and highlighted the tools and strategies to make it simpler and to improve adherence and health outcomes, especially among underserved populations.

NCL gathered more than 80 stakeholders in Sacramento, including health care professionals, community health workers, advocates, industry representatives, policymakers, and researchers. Throughout the day, conference participants heard from researchers and experts on adherence, and engaged with each other about possible collaborations and solutions.

The meeting kicked off with presentations on adherence research and health disparities, and continued with a variety of strategies and tools to improve adherence that could be utilized in health care practices or organizations. Takeaways from the presentations included the following:

  • One size does not fit all – adherence intervention work best when tailored for the patient
  • Quality of communication and a sense of collaboration between patients and health care professionals impact adherence, especially among people of color   
  • Adherence rates are unique to each medication a patient takes 
  • Cultural considerations are vital to understanding barriers to adherence
  • Always consider the health literacy of the patient
  • Determining the reasons for poor adherence is essential to developing effective interventions   

Specific strategies and solutions:

  • Medication synchronization
  • Comprehensive medication review
  • Tools for translating medication labels into the patient’s native language
  • Best practices and tools for more culturally competent clinical care

The conference provided a forum for participants to interact, connect, and lay the groundwork to develop partnerships for collaborative initiatives. We will be following up with all conference participants to determine the benefits of the conference and learn of any connections and /or collaborations developed.  

At NCL, we view poor adherence, with its devastating effect on health outcomes, as a public health problem. Since 2011, we have been leading Script Your Future – a public education campaign to increase awareness among patients, their family caregivers, and health care professionals of the importance of taking medication as directed.

As leaders of Script Your Future, NCL convened an AHRQ research dissemination conference to further explore possible solutions to this public health problem. The adherence issue is complex and taking medications is NOT so simple, especially for ethnic and racial minorities who often face health disparities. Collaboration among stakeholders who are dedicated to keeping the patient at the center of the discussion, is a critical first step toward developing and implementing effective medication adherence strategies to help people better self-manage their care.  

Conference participants and others are encouraged to distribute information from the conference to interested colleagues and through their networks. We look forward to hearing how others are sharing the information, tools, and resources from the conference, and the possible collaborations that will grow out of the meeting.   

* Funding for this conference was made possible in part by grant number 1R13HS023948-01A1 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government

Obesity doesn’t discriminate, but should preventive care be more personalized? – National Consumers League

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obesity.jpgBy Ali Schklair, Linda Golodner Food Safety & Nutrition Fellow 

It isn’t news that obesity is an urgent problem in our country. According to a recent study by the CDC, over one third of US adults are obese. Education and health professionals have presented numerous strategies to combat this growing epidemic. Still, in order to enact real change, there needs to be a greater focus on how overweight and obesity affects specific populations.

Growing up with a brother with disabilities, I was exposed to the many challenges my family faced trying to help him develop healthy habits. Nutrition and weight were always difficult issues to manage. As a kid, my brother was very skinny. He was taking a medication that sped up his metabolism and suppressed his appetite. My parents would beg him to eat anything, even if the food was mostly fat and sugar. But as he got older, changed medications, and moved out of the house, he began to gain weight. Traditional weight loss methods have not worked for him. My brother faces a unique set of challenges, but he certainly isn’t alone. 

Obesity rates for adults with disabilities are 58 percent higher than they are for adults without disabilities. Additionally, obesity rates for children with disabilities are 38 percent higher than they are for children without disabilities. These numbers put adults and children with disabilities at a much higher risk of developing weight-related diseases such as heart disease, stroke, type 2 diabetes, high blood pressure, and certain types of cancers.

So why are these rates so high? As is the case with my brother, many people with disabilities are prescribed medications that cause sluggishness or weight gain. Also, any physical disability affecting motor or balance issues, sight, or stamina can make getting enough exercise challenging. Many people with disabilities are sensitive to the taste, color, texture, and smell of certain foods, which can lead to limited food repertoires.

Along with physical or medical challenges, there are lifestyle differences that make weight loss for adults with disabilities especially difficult.  Adults with disabilities often rely on support staff, family members, job coaches, and nurses to help them through their day. Many adults with disabilities also have little control over their finances. This means food is often chosen and cooked for them, usually the quickest and easiest options.

The disability population faces a range of obstacles when it comes to addressing the obesity epidemic. But it is not just people with disabilities that face unique challenges. In its polling, the CDC has outlined how socioeconomic status, sex, and ethnicity can all contribute to the prevalence of obesity. Once we are better able to understand the barriers to eating healthy and getting adequate physical exercise, we can tailor strategies to address the unique needs of differing populations.

Cutting Costs for Contraceptives: Saving Money and Staying Healthy under the ACA – National Consumers League

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A recent study shows that since the Affordable Care Act (ACA) mandate for insurance plans to cover contraceptives, we’ve seen a large reduction in out-of-pocket spending. In 2013, women saved $1.4 billion! This is important for all American women because too many skip preventive care and other health services due to cost. It appears that free contraception is having a large effect on the rate of pregnancies and abortions in the U.S. But some women are still paying out-of-pocket.

The ACA has strengthened women’s access to many different types of preventive care—including mammograms and all prescribed FDA-approved contraceptive services and supplies—without cost-sharing. However, as a Kaiser Family Foundation study found, not all plans are covering the cost of contraceptive services for consumers, despite the federal mandate to do so. The president of the American Congress of Obstetricians and Gynecologists, Dr. Mark S. DeFrancesco, stated, “Too often, medical management is used by some insurers as a barrier to access for patients.” The Department of Health and Human Services issued guidance for health insurers to clarify the ACA provision on contraceptive coverage without cost-sharing. With these clarifications, we can hope for full coverage of contraceptives without co-pays. 

U.S. Senator Kelly Ayotte (R-NH) has introduced the Allowing Greater Access to Safe and Effective Contraception Act to make birth control pills and other contraceptives available over-the-counter for people aged 18 and older. While the bill would make contraceptives easier to obtain, it may not keep these services free of cost-sharing. Insurance companies only cover contraceptive services that come with a doctor’s prescription. Dr. Mark S. DeFrancesco said, “Instead of improving access, this bill would actually make more women have to pay for their birth control, and for some women, the cost would be prohibitive…we cannot support a plan that creates one route to access at the expense of another, more helpful route.” The Allowing Greater Access to Safe and Effective Contraception Act also repeals parts of the ACA. Studies continually demonstrate improved health among the U.S. population due to the ACA. The Act is doing its job.

The age restriction that Senator Ayotte’s bill puts on over-the-counter birth control would also limit the population that benefits from access to contraceptive services. Medical experts should make these decisions about contraceptives, not politicians! While getting a prescription is a burden for many, the cost that comes with over-the-counter medication creates barriers for people who can’t afford it. Advocates say birth control and other contraceptives must be made both accessible and affordable to all those who are looking to access these services. The benefits of making contraceptives easy to access and inexpensive are clear and even favorable to conservative politicians: fewer unwanted pregnancies and abortions, and more women having the ability to make decisions about their health.  

A Big Win For California Patients And Consumers – “Refill Reminders” A “Go” – National Consumers League

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sg.jpgCalifornia’s Office of Health Information Integrity (CalOHII) just delivered a big victory for patients and consumers by expressly recognizing that sponsored medication adherence programs for a currently prescribed drug (commonly called “refill reminders”) do not require patient authorization in California. In publishing its long-awaited State Health Information Policy Manual, CalOHII takes a step to harmonize the state’s Confidentiality of Medical Information Act (CMIA) with the federal medical privacy laws and regulations (a.k.a., the HIPAA Privacy Rule).

For years now, due in part to privacy concerns, confusion has persisted within the healthcare community about the types of refill reminder programs that can legally run in California. In fact, California is the only state in the U.S. where pharmacies do not, to any meaningful degree, operate sponsored refill reminder programs. California consumers deserve the benefit of refill reminders that provide helpful information to patients about their prescription drugs. Patient access to this information is now guaranteed.

CalOHII’s publication of its Manual makes clear that California adopts the same approach that the U.S. Department of Health and Human Services (HHS) took in its 2013 final rulemaking and “Refill Reminder Guidance.” Under that HHS Guidance, pharmacies are able to provide their patients with sponsored refill reminders. NCL applauds CalOHII for clarifying that the CMIA should be interpreted consistently with the HIPAA Privacy Rule. With that clarification, NCL is hopeful that California pharmacies and their sponsors will jumpstart sponsored refill reminder programs. 

NCL is a longstanding supporter of refill reminder programs. NCL leads  “Script Your Future,” a public education campaign designed to raise awareness of the importance of taking medication as prescribed. Poor medication adherence is a major, and significantly under-appreciated, health problem. Studies establish that nearly three-out-of-four Americans do not take their medications as directed, which costs the healthcare system nearly $300 billion per year and results in almost 125,000 unnecessary deaths per year. To help combat this problem, most pharmacies, health plans, and doctors provide a broad range of patient-directed communications regarding prescription drug therapies, including communications that encourage patients to stay on prescribed therapy. The sponsored refill reminder programs endorsed by CalOHII in its Manual are a key part of these efforts in California.  

 As a founding member of the Best Privacy Practices Coalition, NCL is also a strong believer in the protection of medical privacy. However, medical privacy does not exist in a vacuum. NCL is pleased that CalOHII has arrived at a great middle ground that balances the need for information with privacy concerns of patients. This balance is a win for Californians.

Promoting health or products? A look into the Facts Up Front program

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factsupfront.pngDue to the work of the Facts Up Front campaign, today’s food products are marked with labels that advertise their nutrition facts. You have most likely seen them as the small snapshot of information on the front corners of products like cereal and bread. While this is a promising health campaign, consumers should be wary because these labels can often be misleading.

Facts Up Front was primarily developed by leaders in the food industry to help grocery shoppers like you and me easily identify nutritious food, when we may not have the time to read an entire Nutrition Facts panel.

Consumers seeking nutritional information should take a closer look at nutrition labels, as sometimes the food industry has been remiss in keeping honesty at the forefront of their labeling and marketing of products. Several years ago, one labeling campaign called “Smart Choices,” promoted sugar-laden, highly processed products as healthy options. Programs like Smart Choices, which had lenient criteria for what was considered “healthy,” lacked credibility and soon disappeared. Walter C. Willett, chairman of the nutrition department of the Harvard School of Public Health, said that the less healthy products that were given the Smart Choices’ seal of approval were in fact, “horrible choices.” As consumer advocates, we would like to see the food industry put the health of consumers at the heart of their new and improved labeling system.

Currently, Facts Up Front labels are only used by food companies that choose to display nutrition facts on the front of their packaging, which also raises some red flags. Michael Jacobson, the executive director of the Center for Science in the Public Interest, stated that Facts Up Front’s “voluntary nature means you may not see it on junk foods. And even if you did, it wouldn’t successfully highlight the food’s unhealthfulness.” There is no breakdown of the label information until you search online for Facts Up Front or a nutrition information website. The Facts Up Front labels show only the amount of calories, saturated fat, sodium, and sugar per serving on product packaging. The campaign may only display information about up to two nutrients or vitamins on front-of-packaging labels if the products meet FDA standards of a “good source,” which applies to foods that have 10 to 19 percent of the recommended daily value of a specific nutrient. The fact is, it is difficult for consumers to use these labels intuitively to make a “healthy decision,” which is what the campaign aims to accomplish.

The quick, simple informational element of this campaign requires more intensive public nutrition education, because it is clear that misleading nutrition marketing can, and does, occur. Facts Up Front can use the help of health marketing research, such as the Institute of Medicine’s 2011 study on front-of-package labels, and should continue to work with advocates to ensure labels provide the most honest, easy-to-use, and factual information to consumers. In the meantime, consumers should “trust, but verify” all nutrition labeling on food products.

King v. Burwell ruling will keep consumers insured (and healthy!)

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Health_Care_Law.jpgThe King v. Burwell ruling in favor of the Affordable Care Act (ACA) has allowed for approximately eight million consumers to keep their insurance coverage. In the King case, petitioners challenged the clause of the Affordable Care Act that stated subsidies are available to people who use an exchange “established by the State” to purchase insurance. 

Consumers living in the 34 states without state marketplaces are able to benefit from the subsidies because the Internal Revenue Service allowed people to receive assistance if they purchased a plan on the federally-run marketplace. The plaintiffs argued that subsidies by law are only given to people living in states with their own health insurance marketplaces. The ruling allows consumers in states where the marketplace is run by the federal government to keep their subsidy and insurance.

The National Consumers League (NCL) applauds the Supreme Court for upholding the ACA subsidies for consumers using the federal marketplace. The Supreme Court decision helps prevent a rise in premiums for all consumers using the health care exchange. The subsidies are a key provision of the law and they are an important part of keeping consumers insured and healthy. This decision provides hope that the ACA will face fewer political and legal obstacles in the future and can continue to provide health insurance to consumers. Despite the naysayers, the numbers speak volumes. Since the ACA’s enactment, more than 16 million Americans have been able to afford quality health insurance they did not have before.

If you do not already have health insurance, you can enroll in person, over the phone, by mail, online at Healthcare.gov, or on your state exchange’s site during the open enrollment period.