Healthcare Reform and Your Practice

  • Many Alaskans have healthcare coverage through new individual and small group plans created to comply with the federal healthcare reform (also known as the Affordable Care Act or ACA). Healthcare reform makes federal subsidies available to qualified individuals and families to help them pay for their coverage.

    These changes may have an effect on your patients. It’s important that you and your staff understand the benefits and requirements of these new plans.

    The ACA’s new rules will primarily affect people who:

    • Haven’t had coverage in the past
    • Buy their plan without going through an employer
    • Receive their coverage through a small employer

    The Exchange marketplace is one of the key components of the Affordable Care Act and opened to the public on Oct. 1, 2013. Here are some frequently asked questions about Healthcare Reform and Exchanges.

    Extension of Non-Grandfathered Plans 

    On Nov. 14, 2013, President Obama announced a proposal to allow non-grandfathered members in the individual and small group markets to keep their current plans. States could choose to implement the change or not. Alaska’s Department of Insurance (DOI) decided to allow these changes, so we are extending our current individual plans until the end of 2014 at their current rates. We are also offering an option to our small group customers in Alaska to allow them to keep their current plans until the end of 2014, but we are still finalizing the details with the DOI.

    Here are some frequently asked questions about Healthcare Reform and Exchanges.

    Frequently Asked Questions

  • Exchanges are places where patients can go to compare and purchase health plans. You'll be able to shop for plans online, over the phone or even in person. The Exchange is also the place where members can find out if they qualify for a federal subsidy to help pay for their health plan. There are state-run Exchanges, state and federal partnership Exchanges and federally facilitated Exchanges. Alaska has elected not to operate their own Exchange. They will provide a federal Exchange. Healthcare.gov

    Grandfathered plans are health insurance plans that existed before March 23, 2010 (the day the Affordable Care Act became law). They may be exempt from following certain provisions present in the Affordable Care Act.

    Grandfathered plans: Preventive Screenings list

    Many preventive services received in-network are covered with no member cost share.

    Non-grandfathered plans: Preventive Care Services

    Grandfathered plans: Preventive Screenings List

    The new law requires that some preventive services must be covered without copayments or co-insurance to meet deductibles when delivered by a network provider. This applies to all individual and small group plans that are non-grandfathered. For a list of covered preventive services under the law, please visit HealthCare.gov. 

    All individual, small-group, and non-grandfathered plans (existed after March 23, 2010) including those offered through the Exchange, must cover the following 10 essential health benefit categories:

    1. Ambulatory patient services
    2. Emergency services
    3. Hospitalization
    4. Maternity and newborn care
    5. Prescription drugs
    6. Rehabilitative and habilitative services and devices
    7. Laboratory services
    8. Preventive and wellness services and chronic disease management
    9. Pediatric services including oral and vision care, to age 19
    10. Mental health and substance use disorder services, including behavioral health treatment