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| Shown above, Sen. Walsh speaks on the Senate floor in the 2013 legislative session, during which she was a staunch advocate for increasing Missourians' access to health care through the expansion of Medicaid, a key provision of the Affordable Care Act. |
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Over the course of health care reform, I have heard the stories of hundreds of Missourians who have shared their health care needs with me. I have heard from all corners of North St. Louis County, from those with health insurance and from those without; from men and women who have struggled to pay premiums for their families; from small business owners who were fighting to cover their employees; and from people who couldn’t get coverage at all due to a pre-existing condition.
Ensuring that everyone can have access to quality, affordable health care is one of the most critical challenges facing our nation. For three years, Missourians have benefited from better access and a health care system that is working for them and not just for those who can afford it. I will continue to work with my colleagues in the Missouri Senate to improve health care quality and coverage for all Missouri citizens.
Since its passage on March 23, 2010, the Affordable Care Act has allowed Missouri families and small business owners the ability to benefit from better access, more choices, and a health care system that no longer works only for those who can afford it.
Some of these benefits include:
Creating Affordable Health Insurance Marketplaces
The Affordable Care Act will expand health insurance coverage by establishing a Health Insurance Marketplace in every state and increasing access to the Medicaid program. The Marketplace is a new way to shop for health insurance that fits your budget and needs. By filling out one application, you can see a variety of different options and enroll in the plan that is best for you. By using the Marketplace, you can also find out if you qualify for financial assistance to help you pay for health insurance premiums and co-pays.
Starting this fall, individuals in Missouri will be able to shop for health insurance and compare plans through the Marketplace. The Marketplace is designed to help you find health insurance that fits your budget, with less hassle. Every health insurance plan in the new Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on price, benefits, quality, and other features that may be important to you, in plain language that makes sense.
Enroll Missouri
Beginning on Oct. 1, 2013, Missourians will be able to find, compare, and enroll in affordable health insurance plans through Enroll Missouri.
Through Enroll Missouri, you will be able to:
- Compare health insurance plans side by side to find the one that is best for you. You can sort plans by cost, coverage, provider, or other factors to help you choose the right plan.
- Find financial help to pay for co-pays and premiums. Enroll Missouri can determine if you are eligible for financial assistance to pay for co-pays and premiums based on your age, annual income, and household size.
- Select and enroll in a health insurance plan. You can browse and learn more about the different plans that are available, then enter basic information to begin the application process.
Enroll Missouri will be ready for open enrollment on Oct. 1, 2013.
HealthCare.gov
You can visit HealthCare.gov to prepare for the Marketplace before open enrollment begins on Oct. 1, 2013. HealthCare.gov was launched to help individuals have more control over their health care as informed and empowered consumers. This new site and 24-hour call center will help you understand your choices, prepare for open enrollment, and sign up for the health insurance coverage that best suits your needs. You can access educational information and learn what you can do to begin to get ready for open enrollment this fall.
HealthCare.gov will help you get ready to enroll in the Marketplace:
You can also obtain information and assistance through the Marketplace Call Center at (800) 318-2596. The 24-hour call center provides assistance in English, Spanish, and more than 150 additional languages. Hearing impaired individuals using TTY/TDD technology can dial (855) 889-4325 for assistance.
Assistance for Small Businesses
The Affordable Care Act provides employers who have small businesses with fewer than 25 employees and provide health insurance to their employees the ability to qualify for a tax credit of up to 35 percent (up to 25 percent for non-profits) to offset the cost of insurance. This credit will increase in 2014 to 50 percent (35 percent for non-profits).
Expanding Coverage Options for Young Adults
Health plans are now required to allow parents to keep their children under age 26 without job-based coverage on their family’s coverage. Thanks to this provision, thousands of young adults in Missouri have already gained insurance coverage as a result of the health care law.
Making Prescription Drugs Affordable for Seniors
In 2010, Medicare beneficiaries who hit the coverage gap or “donut hole” in the Medicare prescription drug benefit received a one-time $250 rebate. In 2011, Medicare beneficiaries began receiving a 50 percent discount on covered brand name drugs and coverage for 7 percent of the cost of generic drugs in the coverage gap. In 2013, Part D covers 21 percent of the cost of generic drugs in the coverage gap. Coverage for both brand name and generic drugs in the gap will continue to increase over time until 2020, when the coverage gap will be closed.
- Learn more about Medicare prescription drug coverage.
- If you have any questions regarding potential discounts and rebates, you should call Medicare's toll-free number at (800) MEDICARE (633-4227) or TTY (877) 486-2048.
Covering Preventive Services with No Deductible or Co-pay
Insurance companies are now required to provide certain preventive services without requiring a co-payment, co-insurance, or deductible to receive recommended preventive health services.
Removing Lifetime Limits on Health Benefits
The law bans insurance companies from imposing lifetime dollar limits on essential health benefits. Starting in 2014, yearly dollar limits on coverage will also be banned.
Creating New Coverage Options for Individuals with Pre-existing Conditions
Starting in 2014, many individuals with pre-existing conditions will no longer be refused coverage or charged more for their coverage, even if they have been refused coverage due to a pre-existing condition in the past.
Providing Better Value for Your Premium Dollar
Insurance companies must spend generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they do not, they must provide consumers a rebate or reduce premiums.
Scrutinizing Unreasonable Premium Increases
Insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more.
Preventing Illness and Promoting Health
The Prevention and Public Health Fund was created to support effective policies in Missouri, its communities, and nationwide so that all Americans can lead longer, more productive lives. Since 2010, Missouri has received more than $11 million in grants from the Prevention and Public Health Fund.
Increasing Support for Community Health Centers
The law increases funding for community health centers in all 50 states, including the hundreds of existing community health centers in Missouri. If you cannot afford a health insurance plan, you can get free or low-cost health and dental care at a community health center.
Links to Full Health Care Reform Law
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