Elizabeth, NJ- At the beginning of the month, provisions in the new health care law went into effect nationwide. The Garden State one of the densest and most multicultural landscapes in the country– also plays home to some of the largest health care providers in the nation.
We took a closer look into the health care changes and how it might affect residents from Elizabeth and beyond, and got some help understanding it from experts, who just happen to be right here in town.
“New Jersey Citizen Action” , which is a watchdog organization that deals with social justice and health care, is very supportive of the Affordable Care Act, because it provides more security, cost sharing, quality of care, and preventive care for women,” said Jeff Brown, Policy and Communications Coordinator for New Jersey Citizen Action. “We are national advocates of health care reform and added to the health care debate.”
Before analyzing the current health care reform, it’s important to understand health insurance and its various sub-categories. The four major types of health insurance include basic, major medical expense, dental and eye, and dread disease and accident.
- Basic-This is health insurance at its most basic. It covers hospitalization in the event of illness or injury, physician’s fees, surgery, and prescriptions.
- Major Medical Expense-It covers the costs in excess of basic insurance, usually requiring a co-pay and deductible. A co-payment is the amount paid by you when you visit a doctor’s office or have surgery. The insurance company pays the remaining balance of the medical cost. A deductible is the amount paid in full before receiving any benefits from an insurance company.
- Dental and Eye-Often this insurance only covers a portion of dental work and eye care, requiring you to pay the rest.
- Dread Disease and Accident-A set dollar amount that is available for reimbursement from certain diseases and accidents.
The three major types of plans are private, non-group, and government-sponsored plans. HMOs, PPOs, POS, and EPOs fall under private plans. Non-group coverage plans insure individuals independently if insurance is not offered by their employer or they are self-employed. Medicare, Medicaid, Medigap, and Worker’s Compensation are the four types of government-sponsored plans.
- Medicare covers the elderly and disabled who are covered by Social Security.
- Medigap covers additional costs not included in Medicare.
- Medicaid covers low-income, needy families with dependent children, or those who are blind or aged.
- Workers Comp. covers employees who suffered work-related injuries, accidents, or illnesses.
For more information, visit http://www.horizon-bcbsnj.com.
Next, we’ve come up with three groups that the majority of Americans fit into. Here, we break down the new changes and the most important factors of the Affordable Care Act (ACA) into the simplest terms possible.
1) You already have health insurance.
According to Pres. Obama, you will keep your already-existing insurance, but it will become more affordable and secure. On August 1, 2012, women’s preventive care (check-ups, mammograms, birth control, etc.) became free with no co-pays.
That day, New Jersey Citizen Action held an event called “Countdown to Coverage” to educate the public and help women and families understand the new law. The organization had already been working with the state since earlier this year.
“Contraception for new and renewed plans will now be free as well as covering well-women exams,” said Brown. “The theme of the event was the reform and we talked about what already went into effect on Wednesday.”
“We want to raise women’s voices,” said Brown. “Anytime we can get the word out, it’s a good thing.”
New Jersey for Health care is a coalition to organize around the state and their long-term goal is to get affordable and high-quality health care. New Jersey Citizen Action also coordinated and co-sponsored events with Planned Parenthood Affiliates of New Jersey, which is headquartered in Elizabeth.
“As the leading provider of women’s health care, Planned Parenthood knows firsthand how critical this benefit is for women and families. We see the need for affordable health care every day,” said Michele Jaker, spokesperson for the Planned Parenthood Affiliates of New Jersey.
“Women who come into our health centers often struggle to decide whether to pay for birth control or pay for textbooks, groceries, or gas for the car,” said Jaker. “This new benefit will help make critical health care services affordable and accessible.”
Along with these changes, other major aspects of the law will be put into place in the near future. Insurance companies can no longer put lifetime limits on the care that a person receives. Children with pre-existing conditions cannot be discriminated against. Seniors will receive discounted prescription medications and preventive care. Health insurance companies will issue rebates and small businesses and middle-class families will receive tax credits.
2) You don’t have health insurance.
The individual mandate requires nearly all Americans who can afford basic health insurance to purchase it by 2014 or pay a fee to offset costs. Consumers who don’t have coverage through work can use Affordable Insurance Exchanges. The law expands Medicaid to allow more low-income families to become eligible to receive care.
3) You’re a young adult who is under the age of 26.
Under the new law, if your parent’s plan covers children, you can now stay on your parent’s health insurance policy until you turn 26.
New Jersey Citizen Action and Planned Parenthood have already held events at Highlands Park and in Montclair to explain benefits for families on health reform. They are planning more events in the near future.
For more information, visit http://www.whitehouse.gov/healthreform, or http://www.health care.gov/law/timeline/index.html.