I have a pre-existing condition. Does the health care reform law make it easier or harder for me to get coverage?

As of January 1, 2014, insurers are prohibited from discriminating against individuals with pre-existing conditions.

What does it mean if my health plan is “grandfathered” under the new health care reform law?

Your health plan will have a "grandfathered" status if the it was purchased before March 23, 2010. "Grandfathered" plans do not have to follow the rules and regulations of the new health care reform law. "Grandfathered" plans also do not have to offer the same benefits, rights and protections of plans under the new health care reform law which means that on many old plans, individuals can still face situations such as be dropping from coverage for reasons other than fraud, being denied treatment for preexisting conditions and facing annual and lifetime dollar limits.

If my health insurance company denies my claim, does the health care reform law make it easier to fight that decision?

Yes. With the health care reform law, individuals have the right to appeal a health insurance company's claim denial. The first step in appealing a claim denial is to make an "internal appeal" through your health insurance company. An "internal appeal" is a formal request for your health insurance company to perform a full review of its original decision. Should your health insurance company maintain its claim denial even after the "internal appeal," the health care reform law allows you to initiate an "external review," in which you can have an independent third party either confirm or overturn your insurers' decision.

Will the new health care reform law force me to buy health insurance? What if I can’t afford it?

Under the new health care law reform, individuals who do not buy health insurance will be subject to a tax "penalty." However, there are a number of exemptions from this tax penalty that many Americans can qualify for. If you cannot afford insurance, there are three types of cost assistance available: Premium Tax Credits, Cost Sharing Reduction subsidies, Medicaid and CHIP.

What are the minimum requirements for health plans under the new health care reform law?

All private health insurance plans are required to offer "essential health benefits," which are services that all plans must cover (in all categories of plans –bronze, gold, and platinum). These essential health benefits include the following items and services:

  • Emergency services
  • Ambulatory patient services
  • Mental health and substance use disorder services (including counseling and psychotherapy)
  • Laboratory services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Pediatric services
  • Preventative and wellness services and chronic disease management


While all plans must cover essential health benefits, plans may offer additional coverage such as:

  • Birth control benefits
  • Breastfeeding benefits
  • Dental coverage

How can I get health care enrollment help with no additional costs?

You should never have to pay an extra fee to get help in purchasing coverage. Licensed agents appointed to sell on Healthcare.gov or your state exchange are the most qualified group to answer questions for you. You can also call the insurance carriers direct, the federal Obamacare website or your state exchange or use a navigator. Only licensed and appointed insurance agents/brokers are allowed to recommend and compare plan benefits of private insurance carriers, with or without a subsidy.

If you are low income and qualified only for Medicaid, you can enroll directly with that agency in your state or through the federal website.

When you register on the government's www.healthcare.gov federal website, it is crucial that you use an email address you will always have access to. Should you lose access to that account, you will not be able to reset the password or setup a new account. Unless you enroll in a new plan, you would have to make any changes via telephone with hc.gov.