Millions of Americans now can shop for and buy health insurance in online “marketplaces,” which were established as part of the 2010 Patient Protection and Affordable Care Act (ACA) and opened Oct. 1. People also can learn if they qualify for help paying their premiums – the monthly cost of insurance coverage – or for Medicaid, a government program that provides health care insurance to low-income people. Medicaid has been expanded to cover more people in 26 states. 

To help people with arthritis better navigate the marketplaces, the Arthritis Foundation has created a toolkit.  

The ACA aims to provide insurance coverage for a large portion of the approximately 48 million Americans who don’t have insurance – including those who haven’t been able to get insurance due to a pre-existing condition, such as arthritis – and provide additional options for the 15 million Americans who buy their own insurance. 

“This is an opportunity to put insurance within reach of low-income people with arthritis, many of whom have lots of medical expenses, including drugs, surgery and physical and occupational therapy,” says Patience White, MD, vice president of public health for the Arthritis Foundation.

Under the ACA, most Americans will be required to have health insurance by March 31, 2014, or pay a fine. (In 2014 the fine will be $95 per adult or 1 percent of family income, whichever is higher.) People who are insured through the federal government – such as the military, Medicare and Medicaid – will continue receiving coverage. Many employers will also continue to provide coverage for their employees.

Each state has its own marketplace (some of which are being operated by the federal government) in which private insurers such as Blue Cross Blue Shield companies and Kaiser Permanente offer a variety of plans. The plans vary significantly, but all must cover 10 essential benefits, including emergency care and hospitalization, doctor visits, prescriptions, rehabilitative services and chronic disease management.

The cost of individual policies will vary, too, depending on the level of coverage. For instance, lower-priced “bronze” plans cover 60 percent of health care costs and come with hefty deductibles. At the other end of the spectrum, top-of-the-line “platinum” plans cover 90 percent of costs but have the highest premiums.

Monthly premiums, copays and high deductibles can be financial obstacles, but certain people qualify for government subsidies to reduce costs. Adults earning less than about $46,000 a year and households of four with an annual income less than $92,000 may be eligible for a tax credit that cuts monthly premiums.

The ACA also limits the amount of money paid out of pocket each year for medical and prescription drug costs. In 2014, the cap will be $6,350 for individuals and $12,700 for families.

Across-the-board benefits

Other key provisions of the ACA apply to all Americans, whether they get insurance through an employer or buy it themselves. Those benefits include:

  • Health plans can’t deny coverage or charge more for pre-existing conditions. Until now, insurance companies could choose not to cover someone with an existing health problem. They also could charge higher premiums to people with pre-existing conditions or refuse to cover certain costs associated with them. Starting next year, these practices won’t be allowed. (Existing, “grandfathered” individual plans don’t have to cover a pre-existing condition.)