Health Insurance Exchange: A Good Fit for You?

September 2, 2013

October 1 marks the open enrollment date for Texas’ Health Insurance Exchange.  What is a Health Insurance Exchange?  It’s a key component of the nation’s Affordable Care Act and it’s rolling into action next month.  Family caregivers, aging parents, and other family members are reviewing their healthcare plans in order to determine if the Health Insurance Exchange fits their family’s needs.

Is your family ready?

Families and caregivers are researching their options on upcoming Healthcare Exchange enrollment

Families and caregivers are researching their options on upcoming Healthcare Insurance Exchange enrollment


What is a Health Insurance Exchange?

A Health Insurance Exchange is an online marketplace where home caregivers, seniors and other consumers can go to learn about possible insurance options and, if they desire, to choose a plan that best suits their specific needs.  The Exchanges are intended to be operated on a state level; some states have opted not to participate at this time and their marketplaces will be federally organized. Get more information on Texas’ Health Insurance Exchange here.

You do not have to buy insurance through an Exchange. Many people who are covered through an employer-provided insurance plan will continue to use that plan rather than purchase insurance through an Exchange.  Do be aware, however, that the new healthcare law does mandate that all Americans must have health insurance; if you do not, you will face a tax penalty.

For those who face financial difficulties in obtaining health insurance but do not qualify for federal insurance (such as Medicare or Medicaid), there is financial assistance available to help lessen the burden of purchasing insurance. In addition, Medicaid limits will be expanded so that more people will qualify for that program.  Learn more  from Health Insurance 101.

Plans will include essential services

Starting in 2014, most plans will be required to include coverage of the following:

  • Emergency services
  • Prescriptions
  • Hospital stays
  • Rehabilitative services/devices
  • Maternity/newborn care
  • Lab services
  • Mental health/substance abuse
  • Preventive/wellness services
  • Chronic disease management

And note: most preventive services (like screenings for diabetes) should be fully covered by insurance.

Pre-existing conditions

Many home caregivers will be glad to know that in 2014, the new law states that pre-existing conditions cannot be used an excuse to deny coverage.  That means that if you change to a new plan and have an existing health condition, a plan can no longer refuse to cover you or cover costs associated with treating that condition.

Annual and lifetime caps

The new law is also designed to phase out annual limits on how much a company will spend on your care.  That means that if you have a condition that requires costly care, your plan will need to cover all the annual costs, not stop after you reach a certain limit.  The same goes for lifetime limits.  For many home caregivers, that will be welcome news.

Adult child age limit raised

Adult children up to the age of 26 can now continue to be covered under their parents’ insurance plans.  This is helpful for families whose grown children are just starting out and having a hard time finding work or obtaining employer-based insurance.

These are some of the big changes taking place under the new health care law.  The links below can help you find out more information.

Undoubtedly, there will be kinks to work out as the requirements of the new law are phased in.  Staying on top of what is happening and watching for new developments is crucial for home caregivers, seniors and others with an interest in how health coverage will change in the near future.


Affordable Care Act Basics

Be Covered Texas

Be Covered Texas: Helpful Materials about ACA

Be Covered Texas: Top 10 Questions

U.S. Department of Health & Human Services

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