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.

Health care reform was created to:

• Help more people get health care.
• Slow the growth in health care costs.
• Improve people’s health.

• 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.

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 health plan.
• All adults. Adults can receive more preventive screenings and immunizations at no charge, including:
  • Blood pressure screenings.
  • Cholesterol screenings.
  • Colonoscopies.
  • Flu shots.
  • HIV screening and counseling.
• Wahine. Women can receive certain health care services at no charge, including:
  • Well-woman exams.
  • Mammograms.
  • 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.

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 health insurance:

• 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.

By 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:
  1. Ambulance service.
  2. Emergency care.
  3. Hospitalization.
  4. Laboratory services.
  5. Maternity and newborn care.
  6. Mental health and substance use services.
  7. Pediatric oral and vision services.
  8. Prescription drugs.
  9. Rehabilitation.
  10. Services for preventive care, wellness, and chronic disease management.