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We are here to help people with CF get the insurance coverage they need. Hear how the Foundation helped the Cox family.

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Frequently Asked Questions 

How Will the Affordable Care Act Affect Me? 

Navigating health insurance can be confusing and sometimes complicated, but the Cystic Fibrosis Foundation is here to help.

Below you will find answers to frequently asked questions about the Patient Protection and Affordable Care Act (ACA) and how the changing health care landscape may affect you.

If you have specific questions or concerns about your health coverage, please contact the Cystic Fibrosis Foundation’s Patient Assistance Resource Center at 1-888-315-4154 or parc@cff.org.

In this Section


Coverage 

I already have insurance. How will the Affordable Care Act affect me?

If you are satisfied with your health insurance coverage and your plan meets the law’s requirements, you should be able to keep your plan. The ACA may offer you more protections, such as the elimination of annual and lifetime benefit limits. If you decide to look for a different plan in the future, there will be other/new options available to choose from.

What are grandfathered plans?

Grandfathered plans are those that were issued before March 23, 2010. To find out whether your plan is considered a grandfathered plan, call your insurance company.

How will the ACA help people with pre-existing conditions like cystic fibrosis?

Beginning on January 1, 2014, insurers will no longer be able to refuse coverage or increase costs due to a pre-existing condition like cystic fibrosis.

The only exception to this rule is if you are covered by a “grandfathered” individual health plan that has restrictions on pre-existing conditions. Grandfathered plans are those that were issued before March 23, 2010, prior to the passage of the ACA.

The exception applies only to plans purchased individually, not plans purchased through an employer. To find out whether your plan is considered a grandfathered plan, call your insurance company.

How long can I stay on my parent's plan?

You can stay on your parent’s health plan until age 26 unless you are offered affordable coverage by an employer.

What will happen with federal and state assistance programs like Temporary Assistance for Needy Families or CHIP? Will I still qualify?

The new health insurance marketplace aims to streamline the application process and determines whether you are eligible for public coverage and assistance programs like Medicaid or the Children’s Health Insurance Program (CHIP).

Each state has different eligibility requirements for state-based programs.

How does Medicaid expansion apply to my state?

States are able to choose whether or not to expand their Medicaid program to include more low-income adults. Many states have chosen to expand Medicaid, while others have chosen not to expand or are still deciding.

For more information about how Medicaid expansion applies to you and whether your state is participating, visit HealthCare.gov.

If my state doesn’t expand Medicaid but my income is below 100 percent of the poverty line, will I be eligible for financial assistance through the health insurance marketplace?

At this time, people whose incomes fall below the federal poverty level (100% FPL) will be able to purchase coverage through the marketplace, but will not be eligible for assistance to pay their insurance premium.

In states that do not expand Medicaid coverage, anyone with an income between the state’s current Medicaid limit and 100% FPL will have very limited coverage choices. Coverage options for this population will vary in each non-expansion state.

If you need assistance determining your coverage and assistance options, please contact the CF Foundation's Patient Assistance Resource Center at 1-888-315-4154 or parc@cff.org.

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Health Insurance Marketplace 

What is a health insurance marketplace?

A health insurance marketplace, sometimes called an “exchange,” is a state or federally based online resource where individuals may compare and purchase health insurance coverage. The protections put in place by the ACA apply to all plans sold in the marketplace; none are considered grandfathered.

Is the marketplace only for individuals?

No. The health insurance marketplace will allow individuals, families and small businesses to purchase insurance. The marketplace will provide an online hub for individuals and families to compare plans and purchase insurance.
 
Do I have to buy a policy from the health insurance marketplace?

No, you do not need to buy a policy from the health insurance marketplace. However, to avoid the penalty for not having health insurance, you must have some form of health care coverage.

How will the marketplace work?

The marketplace is an online tool that allows individuals, families and small businesses to compare plans, determine eligibility for financial assistance and purchase health insurance coverage. Each state will have its own marketplace or will take part in one run by the federal government.

Through each state's program, you will be able to compare the coverage offered in each plan and make informed decisions about which plan best meets your health care and financial needs.

If the health insurance marketplace doesn’t begin until 2014, how can I get coverage now? 

If you need coverage immediately, you may purchase individual insurance online or through an insurance agent. If you need assistance with exploring coverage options, please contact the CF Foundation's Patient Assistance Resource Center at 1-888-315-4154 or parc@cff.org.  

What plans will be offered through the health insurance marketplace? If I enroll in a marketplace plan and I don't like it, can I change my plan?

In every state, the health insurance marketplace offers private health insurance plans. Plans are divided into four categories: bronze, silver, gold and platinum. All four categories offer the same set of essential health benefits, but have different levels of out-of-pocket costs. Each plan will have its own rules for obtaining and changing coverage.  

Will long-term care, such as in-home or hospice care, be included?

No, long-term care is not an essential health benefit in marketplace plans.

If I can't afford coverage, what should I do?

Individuals who cannot afford coverage may be eligible for financial assistance, also known as a subsidy, to help with the cost of premiums. You can learn more about financial assistance for health coverage on HealthCare.gov.

For more information, contact the CF Foundation's Patient Assistance Resource Center at 1-888-315-4154 or parc@cff.org.

My state says it won't establish a marketplace. What do I do?

There will be a health insurance marketplace operating in all states. However, a number of states have chosen to allow the federal government to administer their marketplaces. If you live in a state where the federal government is operating the marketplace, you can still use HealthCare.gov to search for health insurance plans.

How can I learn more about the marketplace offered in my state?

More information about state marketplaces is available on HealthCare.gov, including information on how to apply for coverage and financial assistance.

To learn more about the marketplace, visit the CF Foundation's Patient Assistance Resource Library.

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Cost 

How much will health insurance marketplace plans cost?

The cost of marketplace plans varies by state, but every state categorizes its health plans into one of four categories: bronze, silver, gold and platinum. The average cost of a plan will depend on the plan category:

Plan Category Average Cost of
Benefits Paid by Plan
Average Cost of
Benefits Paid by Participant
Bronze  60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum  90% 10%

The cost of each plan to the participant will vary greatly depending on the benefits offered, co-pays, deductible, co-insurance and what services you choose to use. It is important to always find out these details for any plan you are considering.

How will the Patient Protection and Affordable Care Act (ACA) affect my out-of-pocket expenses?

Beginning in 2015, non-grandfathered plans and all plans offered in the health insurance marketplace will have limits on how much a plan may charge for out-of-pocket expenses each year. This limit is set at $6,350 for an individual and $12,700 for a family.

Will the ACA increase my premiums?

The ACA is designed to lower the cost of health care while expanding covered services. Through the health insurance marketplace, you will be able to compare premiums  and benefits of different plans.

Depending on if you choose a bronze, silver, gold or platinum health plan, you may have a higher monthly premium. You may qualify for subsidies to help pay for your premium if you purchase a plan through the health insurance marketplace. Subsidies are tax credits that are applied directly to your monthly premiums to immediately reduce the cost to you.

What if I cannot afford the plan I need?

If you cannot afford the plan you need, you may qualify for financial assistance or subsidies through the health insurance marketplace or you can explore alternative coverage options such as Medicaid, Children with Special Health Needs or coverage through a private insurance company.

To learn more about these options, please check out these web pages, National Programs and State Programs.

For more information, contact the CF Foundation's Patient Assistance Resource Center at 1-888-315-4154 or parc@cff.org.

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Care 

What are essential health benefits?

All non-grandfathered plans and all plans offered through the marketplace must offer essential health benefits, including: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, chronic disease management and pediatric services.

Will health care reform change my benefits? How will care change?

The ACA is designed to offer insurance coverage for more comprehensive care. In all non-grandfathered plans, pre-existing conditions — such as cystic fibrosis —  are covered and insurers must provide coverage for essential health benefits. 

What happens if I have a health insurance marketplace plan and move to a different state?

If you move to a different state, your insurance carrier may change. Contact your state’s marketplace program before moving to see how long your coverage will be active.

Where can I get more information on health care reform?

HealthCare.gov is the central online resource for up-to-date information on health care reform. Each state will have trained individuals, called navigators or certified counselors, to provide information about your coverage options.

People with CF, their families and health care providers who have questions may contact their CF care center or the CF Foundation's Patient Assistance Resource Center at 1-888-315-4154 or parc@cff.org.

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Updated 11/11/13

The Cystic Fibrosis Foundation is an accredited charity of the Better Business Bureau.