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Big changes in Kentucky healthcare: A summary of how the Affordable Care Act will affect individuals with disabilities

Published: March 3, 2015

The Patient Protection and Affordable Care Act (ACA) was signed by President Obama on March 23, 2010 to provide better, more affordable healthcare to Americans. The law means that many more Americans will have health insurance, and that, for the first time, those with pre-existing conditions cannot be denied insurance or have an annual limit or lifetime cap on their benefit coverage. Additional reforms include legal mandates that 80% of a health insurance company’s premium dollars go toward health care costs and not the company’s administrative expenses. Community living is also supported as opposed to institutional care, as the Act creates new financial incentives for states to redirect more Medicaid funds into paying for home and community based services.

Money Follows the Person grants, including the Home Modifications Project coordinated through the Human Development Institute, should also receive extended funding to assist as people transition from institutions to home and community based living. The ACA created health insurance exchanges or “marketplaces” where individuals can compare benefit plans and costs, and where the application for benefits also universally screens individuals and families for Medicaid and Children’s Health Insurance eligibility. Individuals without health insurance and who do not have extreme financial hardship, must purchase at least a “bronze” level plan from a healthcare exchange to avoid a financial penalty assessed in their tax filing in spring, 2014.

Some of the provisions of the ACA that benefit people with disabilities include:

  • Children under 19 can no longer be denied coverage based on preexisting conditions. A pre-existing condition is one that existed before the date you enrolled in health insurance coverage and can include common conditions such as diabetes, seizures, asthma, and others.
  • Effective in 2014, adults can no longer be denied coverage on the basis of a pre-existing condition as well.
  • Insurance companies cannot drop your coverage or charge you more on the basis of your disability or other health condition.
  • Insurance companies cannot impose lifetime dollar limits on essential benefits.
  • You can appeal coverage determinations.
  • All new health plans must cover certain preventative services without charging deductibles.
  • Coverage is extended so young adults can stay on their parents’ plan until they are 26 (and the coverage for a dependent son or daughter with a disability should be extended beyond the age of 26 after the January 2014 enactments).

Kentucky decided to establish a state-run healthcare connection, called “Kynect” (http://kynect.ky.gov). Also, Kentucky opted to expand Medicaid in the state, to include 399,000 additional Kentuckians under this entitlement program. As part of the ACA, young adults and individuals with limited incomes should be able to afford health care insurance, through discounts or tax credits, or approval of Medicaid coverage, even though they may not have a dependent child. Open enrollment started October 1st and closes March 31, though there may be an extension to this initial enrollment period, as delays have resulted from computer and systems’ difficulties in responding to the high demand of many thousands of individuals trying to enroll at the start.

Kynect is available for people who buy insurance on their own and for people who do not have any health insurance. If you are paying for your own health insurance and the premiums cost more than 9.5% of your income or if the insurance covers less than 60% of your medical expenses, you can still shop for a more affordable and better benefit plan at Kynect. You may also qualify for federal tax credits to help you pay for your new premiums.

Tax Credits are only available on health insurance plans purchased through Kynect. If you are single and you make less than about $46,000, or if you are a family of four and you make less than about $94,000, you may get a tax credit from the government to help pay your premium.

The Affordable Care Act says that most Americans must purchase insurance or pay a penalty. These penalties will be in the form of “fines” when you file your taxes in 2014 and the fines will go up in 2015.

 

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