The Affordable Care Act (ACA), also known as Obamacare, is intended to lower health care costs, provide more health care choices, and improve the quality of health care. Major provisions include:
- Coverage for seniors who hit the Medicare Prescription Drug coverage gap, or “donut hole”
- Expanded coverage for young adults, allowing them to stay on their parents’ plan until age 26
- Access to insurance for people with pre-existing conditions
- The end of annual and lifetime dollar limits on coverage
- Small business tax credits to help companies provide insurance coverage to their workers
When and How to Enroll
The Open Enrollment period begins on November 1, 2015 and ends on January 31, 2016. You can enroll year round if you have certain life changes — like getting married, having a baby, losing other coverage, or moving — or if you qualify for Medicaid or CHIP.
Apply for health insurance coverage through the ACA Marketplace:
- Create an account and apply online at HealthCare.gov
- Apply by phone at 1-800-318-2596 or TTY at 1-855-889-4325
- Find a local center to apply in person
- Download an application form to apply by mail
Get more information about common ACA questions.
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The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides continuation of group health coverage that otherwise mightbe terminated. COBRA contains provisions giving certain former employees, retirees, spouses, former spouses, and dependentchildren the right to temporary continuation of health coverage at group rates. Qualified individuals may be required to pay theentire premium for coverage up to 102 percent of the cost to the plan.
For more COBRA information, view An Employee’s Guide to Health Benefits under COBRA (PDF, Download Adobe Reader).
Get More Information or Help
If you have questions or complaints about your COBRA coverage, contact your plan administrator or the Employee Benefits SecurityAdministration (EBSA).
Note: In some cases, you can change from COBRA coverage to Marketplace health insurance coverage.
Health insurance helps you pay for medical services and sometimes prescription drugs. Once you purchase insurance coverage, you and your health insurer each agree to pay a part of your medical expenses. These amounts are usually a certain dollar amount or percentage of the expense.
You can have health care coverage through:
- a group coverage plan at your job or your spouse/partner’s job
- your parents’ insurance plan, if you are under 26 years old
- government programs such as Medicare, Medicaid, or Children’s Health Insurance Program (CHIP)
- the Veteran’s Administration or TRICARE for military personnel
- your state, if it provides a health insurance plan
- a plan you purchase on your own directly from a health insurance company or through the Health Insurance Marketplace
- Continuing Employer coverage from your former employer, on a temporary basis under the Consolidated Omnibus Budget Reconciliation Act (COBRA)
Types of Health Insurance Plans
When purchasing health insurance, your choices typically fall into one of three categories:
- Traditional fee-for-service health insurance plans are usually the most expensive choice, but they offer you the most flexibility in choosing health care providers.
- Health maintenance organizations (HMOs) offer lower co-payments and cover the costs of more preventive care, but your choice of health care providers is limited.
- Preferred provider organizations (PPOs) offer lower co-payments like HMOs but give you more flexibility in selecting a provider.
Choosing a Health Insurance Plan
When choosing among different health care plans, you will need to read the fine print and ask a lot of questions, such as:
- Do I have the right to go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists, covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? Are there any co-payments? Deductibles are the amount you must pay before your insurance company will pay a claim. These differ from co-payments, which are the amount of money you pay when you receive medical services or a prescription.
- What is the most I will have to pay out of my own pocket to cover expenses?
- If there is a dispute about a bill or service, how is it handled?
Long-Term Care Resources
Long-Term Care (LTC) is a variety of services that include medical and non-medical care for people who have chronic illnesses or disabilities.
If you are thinking about long-term care needs for you or your loved one, check out the following resources:
- Find local long-term care services
- Assess the cost of care
- Learn about legal issues to consider
Long-Term Care Insurance
Most health insurance plans and Medicare severely limit or exclude long-term care. Read the Guide to Long-term Care Insurance. You should consider these costs as you plan for retirement.
Here are some questions to ask when considering a separate long-term care insurance policy.
- What qualifies you for benefits? Some insurers say you must be unable to perform a specific number of the following activities of daily living: eating, walking, getting from bed to a chair, dressing, bathing, using a toilet and remaining continent.
- What type of care is covered? Does the policy cover nursing home care? What about coverage for assisted living facilities that provide less client care than a nursing home? If you want to stay in your home, will it pay for care provided by visiting nurses and therapists? What about help with food preparation and housecleaning?
- What will the benefit amount be? Most plans are written to provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing-home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
- What is the benefit period? It is possible to get a policy with lifetime benefits but this can be very expensive. Other options for coverage are from one to six years. The average nursing home stay is about 2.5 years.
- Is the benefit adjusted for inflation? If you buy a policy prior to age 60, you face the risk that a fixed daily benefit will not be enough by the time you need it.
- Is there a waiting period before benefits begin? A 20 to 100 day period is not unusual.
Complaints about Long-Term Care
To report an emergency where there is immediate danger, call 911 or contact your local authorities.
If you have a complaint about a long term-care facility, read about the long-term care ombudsman (PDF, Download Adobe Reader) program, which investigates complaints.
If you have an elder abuse complaint, contact your long-term ombudsman or local elder abuse resources.
There are many resources available to help people with disabilities with their medical and health needs:
- Visit the Health section of Disability.gov for information and links to various health resources for people with disabilities.
- Explore the Disability and Health section of CDC.gov for articles, programs, tips for healthy living and more for people with disabilities.
- Learn more about assistance and benefits for people with disabilites from the Social Security Administration.
- Contact your local city or county government to determine what assistance is available in your area to help people with disabilities with their medical and health needs.
- Contact your state social service agency for help finding programs that are available to assist people with disabilities with their medical and health needs.