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With open enrollment in the new health insurance marketplaces set to begin October 1st, we wanted to answer your most frequently asked questions about the new law and how it could impact blood cancer patients. 


What is the health insurance marketplace and how do I know if I am eligible for coverage?

The health insurance exchange, also called a health insurance marketplace is a new way that consumers who do not have health insurance can shop from a range of health insurance options.  Beginning in 2014, under the new Affordable Care Act, Americans are required to have health insurance or they  will face penalties and fines when filing their taxes. 


Anyone under 65 who does not currently have health insurance is eligible to purchase coverage through the health exchange.  However, many people will also qualify for a federal subsidy to purchase this coverage.  In order to find out if you are eligible for a subsidy, visit www.healthcare.gov.


How do I enroll in coverage?

Whether you are in a state that is operating its own health exchange, or whether you are in a state with a federally facilitated exchange, the best starting place to get information is www.healthcare.gov. This is the website of the Federal Department of Health and Human Services, and is the best source of information regarding healthcare reform. This website serves as the entry point for all consumers who need to purchase health insurance coverage through their state’s exchange.  If you live in a state with its own exchange you will be transferred to that state specific exchange for more information. When you visit this website, it will calculate for you based on your income whether you qualify for a subsidy to purchase coverage, or whether you may qualify for Medicaid benefits.


When is open enrollment?

Open enrollment is available from October 1, 2013 to March 31, 2014.


Can I be denied coverage based upon my cancer diagnosis?

No, under the provisions of the Affordable Care Act, you cannot be denied coverage for any pre-existing condition, including cancer.


How many insurance choices will I have?

This will vary widely depending upon what state you live in.  In some states, there may be dozens of insurance companies offering hundreds of different plan selections.  In other states, there may only be one or two companies offering a handful of plan choices. The choices will be broken down into four tiers:  bronze, silver, gold and platinum coverage.  Bronze plans will offer “bare bones” coverage, with platinum coverage representing the most robust coverage.  Premiums will reflect the level of coverage, so when purchasing coverage it is very important to weigh the cost of premiums, the level of coverage, and the patient cost-sharing and co-pays you will pay to receive your care.  If you receive subsidies to purchase your insurance through the exchange, the law requires that you purchase at least the Silver level coverage. 


What is patient cost-sharing?

Patient cost-sharing is any cost paid by a patient in order to get access to their care that does not include the monthly premium.  Patient cost-sharing includes copays, coinsurances, and deductibles. Copays are flat dollar amounts that a patient pays in order to go to the doctor or pick up a prescription.  Coinsurances are different than copays because they require the patient to pay a percentage of the cost of the product or service they receive.  Since coinsurances mean significantly higher out of pocket costs, it is an important consideration for blood cancer patients, especially those who depend on high cost oral medications. Before enrolling, these patients need to consider whether a plan has coinsurance rather than flat copayments and understand the costs they will be expected to pay. 


What can I do if mid-coverage year I decide my coverage isn’t adequate for my healthcare needs?

The open enrollment period is the only time during the year when you can switch coverage.  If you decide during the year your coverage isn’t adequate, your first opportunity to switch to a higher level plan will be October 1, 2014. So it’s very important to consider the healthcare needs of you and your family members very carefully before you enroll.


How can I find out if the particular medications I take to treat my disease are covered and what the cost of these medications will be?

Most health exchanges will not be ready to easily share this information with consumers during the first year of enrollment and coverage in the new exchanges. This means that you will need to contact the insurance plans you are considering directly and ask specific questions regarding drug coverage and costs for the medicines you take.  

As additional information becomes public regarding drug coverage, we will bring you the most updated information available.


How do I know if I qualify for a federal subsidy?

By providing information during the enrollment process regarding your household income, the website will automatically let you know if you qualify for a subsidy to purchase coverage.  If you do qualify for a subsidy, the law requires you to purchase at least Silver level coverage.


If I receive co-pay assistance from LLS today can I also continue to receive it if I purchase coverage in the exchange?

If you still need assistance with your copayments or insurance premiums based upon your new coverage, and you still qualify under the conditions of the LLS copay program, yes, you may still receive this form of assistance.


We welcome your questions, and look forward to a continued dialogue with our patients and their families on questions you have about navigating the new health insurance exchanges.


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