FAQ: Health Care Reform | Crohn’s & Colitis Foundation

FAQ: Health Care Reform

Obtaining health insurance or financial assistance to cover all health costs can be challenging for those who need it most.  In 2010, The Patient Protection and Affordable Care Act was signed into law to ensure all Americans have access to affordable health care.  As a result of this law, the “Health Insurance Marketplace” was created to help uninsured people find health coverage. Below are some questions and answers to help you understand the Marketplace as well as your health insurance options.


 What is the Health Insurance Marketplace?

The Health Insurance Marketplace is a new way to find quality health coverage in one place. Within the Marketplace you can learn about your health insurance options, compare insurance plans and submit an application.  This will be helpful if you do not have coverage or would like to explore more cost-effective options.  Further, all plans are considered “Qualified Health Plans,” meaning that they must cover certain essentials, including but not limited to: ambulatory patient services, emergency services, hospital coverage, behavioral health, prescription drugs, lab services, and chronic disease management. For more information about the Marketplace or to apply for coverage, visit: www.healthcare.gov

When can I begin to enroll in the Marketplace to see my options?

Open enrollment began on November 1, 2015 and will remain open until January 31st, 2016.

Will my pre-existing condition be covered under the Marketplace?

Yes.  Health insurance plans within the Marketplace cannot deny you coverage or charge you more due to a pre-existing health condition.  Coverage for your pre-existing condition(s) begins as soon as the insurance plan is in effect.  This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past.


Will coverage be lower cost within the Marketplace?

Depending on income and family size, you may have the opportunity to save money within the Marketplace in three ways:

1.     You may qualify for lower out-of-pocket costs for co-pays and deductibles.

2.     You may be able to lower costs on monthly premiums when you enroll in one of these plans.

3.     You may be eligible for Medicaid as some states have expanded Medicaid as of 2014. Check qualifications of your state.

Below are two additional links which can help you estimate your costs for coverage within the Marketplace, as well as offer information about your eligibility to save on monthly premiums:

Subsidy Calculator

Monthly Premium Savings


How do I know if I qualify for Medicaid or if my child qualifies for Children’s Health Insurance Program (CHIP)?  What if I was previously denied?

You qualify for Medicaid based on family size and income.  If you are eligible, you get free or low-cost healthcare and will not need to purchase a Marketplace plan.  When you complete an application within the Marketplace, it will let you know if you are eligible for Medicaid/CHIPS, and the Medicaid agency will be notified so your coverage can begin.


If you have previously applied and were denied, you may qualify for the 2014 year if your state is participating in Medicaid expansion.  To see if your state is participating in Medicaid expansion and to find more information about your specific state, please visit: https://www.healthcare.gov/do-i-qualify-for-medicaid/


How do I get help enrolling in the Marketplace?

The Marketplace offers several ways to help you choose a plan that meets your specific needs, including:

·         Visiting www.healthcare.gov to review online questions and answers.

·         Using the www.healthcare.gov website’s “live chat” feature

·         Calling their toll free call center at: 1-800-318-2596

·         RECOMMENDED:  Finding local help by visiting https://localhelp.healthcare.gov/  to get personalized assistance from a Marketplace navigator in your area.


Additional Helpful Resources for Consumers:

For further information, call Crohn's & Colitis Foundation's IBD Help Center: 888.MY.GUT.PAIN (888.694.8872).

The Crohn's & Colitis Foundation provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization's resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.

About this resource

Published: November 1, 2015

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