Arc: Act will help those with disabilities

Published 3:22 pm Saturday, October 5, 2013

Currently, many adults with disabilities and chronic health conditions cannot afford to purchase private health insurance, or find the plans available to them exclude or limit coverage for services they need. Beginning in 2014, this will change thanks to key provisions in the ACA creating a new health insurance marketplace.

1. Eliminates pre-existing condition exclusions: Health insurance companies are not allowed to deny enrollment or specific benefits based on pre-existing conditions. A pre-existing condition is one that existed before the date of enrollment for health insurance coverage and can include common conditions such as diabetes, seizures, asthma, and others.

2. Medical underwriting no longer allowed: Beginning in 2014, health insurance companies will only be able to base premium amounts on age, smoking, size of family and geographic location. Insurers will no long be able to take into account health status when setting premiums. Premiums are the amount people pay to purchase insurance.

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3. Affordability provisions: Tax credits and cost-sharing reductions will make private health insurance more affordable for low and moderate income individuals (up to 400 percent of poverty or $45,960 for an individual and $94,200 for a family of 4 in 2013.)

4. Health plans sold in the marketplace must cover key services: the law requires that plans sold to individuals, small employers and Medicaid Alternative Benefit Plans must cover 10 categories of services. Key categories include rehabilitative and habilitative services and devices, mental health and substance abuse disorder services including behavioral health treatment, preventative and wellness services, chromic disease management and other important health care services.

5. Allows states to expand Medicaid coverage: States can now expand Medicaid coverage to adults with incomes up to 133 percent of the federal poverty level and receive a generous federal match — 100 percent for the first three years and gradually declining to 90 percent in 2020.

To learn more about this program, visit

Jamey Helgeson is the Program Director at The Arc Mower County and can be reached at or by calling 507-433-8994, Extension 102. You can also visit our website ( and follow us on Facebook (