Health Care Act - Oregon Consumer Guide

Health insurance changes are coming down the pipeline, and the new plans under the Health Care Act (aka "Obamacare") will be unveiled October 2013 and will go into effect January 2014.  I find this is causing concern for some, and that the biggest concerns are about cost and a general sense that people don't know what is going to change.  

The Oregon Insurance Division has put out a great brochure reviewing the basics of what is included in all new plans and how rate review (regulation) works in Oregon specifically.  Click the button below to download or be linked to the brochure in PDF format.

Its actually very exciting, and most consumers are going to benefit from the new plans.  If you are insured through a large employer it is highly unlikely anything is going to change aside from a few new plan inclusions.  Small business employees and privately insured individuals will see the biggest changes in the realm of covered services and rates, but there is much more rate regulation and review in place so the rate changes should be minimal and generally beneficial to the consumer - especially to older Americans.

If you don't want to read the brochure, here are some of the more notable points listed:

• Everyone is eligible for health insurance, regardless of current or past health status, meaning NO PRE-EXISTING CONDITION DENIALS FOR COVERAGE though there may still be exclusionary periods where a pre-existing condition isn't covered for a certain period of time when you sign up for a new plan.  That is yet to be seen.
• Health plans for individuals and small employers must contain basic (essential) benefits and will be easier to compare. 
  
• Cover Oregon, the state’s health insurance exchange, will offer one-stop health insurance shopping and link eligible Oregonians to financial assistance programs for premiums and out-of-pocket costs.
  
• All health plans in the individual and small group markets will offer comprehensive coverage known as essential health benefits. The exact benefits differ by state and reflect services offered in a typical employer plan. However, all plans must offer essential health benefits in these 10 categories: 

1. Emergency benefits 
   
2. Hospitalizations
   
3. Laboratory services 
4. Maternity care 
5. Mental health and substance abuse treatment 
6. Outpatient, or ambulatory, care 
7. Pediatric care 
8. Prescription drugs 
9. Preventive care 
10. Rehabilitative and habilitative (helping maintain daily functioning) service

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The Rehabilitative and Preventative care are the bigger areas of change, though "preventative" means wellness exams by your PCP, not alternative medicine (3,000 years of history and clinical evidence for preventative medicine here on the Chinese Medicine side of things....helloooo) fyi.  

Most plans in Oregon will have a Complementary and Alternative Medicine (acupuncture, naturopathic, chiropractic, maybe massage) "rider," or supplemental plan,  that you can include for an additional premium, but CAM services are not part of the Oregon essential benefits list.  They ARE part of the Washington State essential benefits list, so ALL PLANS ORIGINATING IN WASHING STATE WILL INCLUDE COVERAGE FOR ACUPUNCTURE starting January 1st 2014!

I am ridiculously excited about this, if you can't tell, but it is quite amazing that Washington has included CAM services in their essential benefits list and hopefully, as our focus in the US shifts from treating disease to treating "dis-ease" and heading problems off at the curve through preventative medicine and a wellness focus, this will become the norm that all states incorporate.  Ah, an acupuncturist can dream...

If you want to review the full Oregon Insurance Division brochure, please click the button below.  There is also a button for the Cover Oregon health exchange site where you can learn more about how the health exchange works, enter your household information to calculate if you are likely to be eligible for a subsidy (i.e. tax refund to help pay the cost of your insurance premium starting in 2014) and sign up for alerts to stay in the know about health care exchange happenings.

So click on, read up, and stay tuned here as well - I will be trying to disseminate information about health care act related changes, sign up dates and more through my blog as best I can.  I also send out information via my eZine, so if you haven't signed up yet - its time!!

Until my next inspiration and installment,
~Rebecca

Download Brochure

Cover Oregon Website