Health Care Reform
Your guide to health care changes.
Health care is changing and HMSA is here to help you. Learn how health care reform
affects you and what you need to do.
The federal government’s health care reform law is complex and it's more than 900 pages long.
No one expects you to read all of it, but the law’s important and affects us all.
We explain how health care reform affects your health and wallet. Here are important
things you need to know.
What is health care reform?
Health care reform is a federal law that changes how you receive health care. It
was signed into law in March 2010 by President Barack Obama.
Why was it created?
Health care reform was created to:
- Help more people get health care.
- Slow the growth in health care costs.
- Improve people’s health.
Who is affected?
- Uninsured. Nearly 50 million Americans don’t have health insurance.
They can’t afford it or can't get coverage because they have serious ongoing health
problems, such as diabetes, cancer, heart disease, or asthma. In Hawaii, nearly
100,000 people are uninsured. Hawaii’s uninsured rate is lower than the national
average because of the state’s Prepaid Health Care Act, which requires private employers to
provide health insurance for their employees who work 20 hours or more a week for
four weeks in a row.
- Underinsured. Millions more don’t have enough money to pay for
comprehensive health insurance.
- Insured. Health care reform provides more coverage at no charge
for people with health insurance.
What has changed?
Health care reform affects everyone – from keiki to kupuna. Here are some changes
that are already in effect:
- Keiki. Children cannot be turned down for health care coverage
even if they have certain medical problems, such as asthma.
- Young adults. People up to age 26 can be covered under their parent’s
- All adults. Adults can receive more preventive screenings and immunizations
at no charge, including:
- Blood pressure screenings.
- Cholesterol screenings.
- Flu shots.
- HIV screening and counseling.
- Wahine. Women can receive certain health care services at no charge,
- Well-woman exams.
- Breast-feeding support and counseling.
- Kane. Men who smoke can be tested for an aneurysm at no charge.
- Kupuna. Seniors on Medicare can receive preventive care at no charge.
See a complete list of screenings and immunizations that HMSA covers: Health Care Reform Coverage for Preventive Health Benefits.
Some exceptions may apply. Call HMSA or check with your doctor for details.
What will change soon?
Coming in October 2013:
The health care reform law requires each state to set up an exchange, or online
marketplace, by October 1, 2013. People can shop, compare plans, and buy health insurance
on the exchange. Hawaii’s exchange will be called the Hawaii Health Connector.
Here’s what you need to know about the exchange. To get started, answer this question:
How do you get health care insurance?
I have a health plan through work:
- I work at a large company: Large businesses with more than 50
employees may not have to use the exchange. The state will decide whether to allow
large companies in the exchange starting in 2017. In the meantime, you can continue
your health care coverage through your employer.
- I work at a small company: Small businesses with up to 50 employees
can decide to:
- Allow you to buy a health plan in the exchange, or
- Continue your existing health plan.
Things to consider:
- Certain changes may not apply to you or your company. Check with your employer.
- Some small businesses may qualify for a tax credit to help lower the cost of health
insurance. These businesses should check with their tax advisor.
I get health care coverage on my own:
If you have an individual health plan, the health care reform law requires that
your coverage ends on December 31, 2013. That’s because health plan benefits will
change starting next year. New health plans that comply with the health care reform
law will be available starting January 1, 2014. You will have two options to buy
- Directly from HMSA. If you’re already an HMSA member, we can help you choose
a health plan that will suit your individual health and financial needs.
- In the state exchange starting October 1.
I don’t have health care coverage:
Health care reform requires most people to buy health insurance by January 1, 2014,
or risk paying a fine to the Internal Revenue Service. You will have two options
to buy health insurance:
- Directly from HMSA.
- In the state exchange starting October 1.
What will change in 2014?
- Almost all Americans must have health insurance or risk paying a fine.
- People with serious health problems cannot be denied coverage.
- Health plan rates will change:
- Rates will be based on age rather than health status.
- Smokers will pay more than nonsmokers.
- If you get coverage on your own through an individual plan or through work at a
small business, your health plan must cover:
- Ambulance service.
- Emergency care.
- Laboratory services.
- Maternity and newborn care.
- Mental health and substance use services.
- Pediatric oral and vision services.
- Prescription drugs.
- Services for preventive care, wellness, and chronic disease management.
More to come!
Details of the exchange and ways you can buy health insurance are still being worked
out. We’ll have more information as it becomes available. Check back with us in
the months ahead.
Questions? We’re here to help. Give us a call:
- For individuals: Call (808) 948-5555, option 2, on Oahu or
1 (800) 620-4672, option 2, toll-free on the Neighbor Islands.
- For businesses: Contact your HMSA representative or call (808) 948-5555,
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Stay informed. For more details on health care reform, visit the
U.S. Department of Health and Human Services’ website at www.healthcare.gov.
This information is based on HMSA’s review of the Affordable Care Act (ACA). This
overview is intended for educational purposes only and should not be used as tax,
legal, or compliance advice.