What Health Advocates Need to Know about the Affordable Care Act

It’s official and it’s not going away.

The Patient Protection and Affordable Care Act, also known as healthcare reform, or the ACA, is changing the face of healthcare for every American. The first changes became effective shortly after its passage in 2010. New parts of the law will continue to be implemented until January 1, 2014 when the biggest part of the law, the individual mandate, will ensure (almost) every American has some form of insurance or government coverage to pay for the care they need.

Are you, as an independent health advocate, prepared for those changes? Even further, are you prepared to help your clients and potential clients understand them?

Here’s why it’s important you become familiar with the new ACA law – not just for yourself, but for your practice, too:

1. You will be affected. If you don’t already have coverage for yourself, you will be required, through the individual mandate, to purchase it.

2. Your clients will be affected if they don’t already have coverage in just the same ways you will.

3. As if there isn’t already enough confusion about what the ACA will mean to people, confusion is going to grow. And what does confusion about the healthcare law mean to American private professional patient advocates? Yes! it means opportunity!

Here are some of the opportunities you may find in this new law:

  • If you can explain the individual mandate to purchase health insurance to those who don’t currently have coverage, helping them understand the resources for purchasing individual insurance, then you can actually market yourself as someone who can help them make their best choice. Beginning in mid-2013 (if not sooner), expect to be overwhelmed with advertising from health insurers who want to capture their corner of that untapped market… everyone of whom will talk about their own plans and no one else’s. But YOU can be the voice of objectivity! Here’s an overview of the individual mandate to purchase health insurance.
  • One of the biggest questions will become whether or not it makes sense for any individual to purchase a high-deductible plan (also called catastrophic health plan). Do you know when that makes sense? Could you advise someone to do so – or to avoid doing so? Here’s more information about whether choosing a high-deductible health plan is advisable.
  • Seniors are finding shifts in their own coverage based on the changes in the donut hole (prescription purchases and co-pays – Medicare Part D) – so ramp up on the ways the new law affects the donut hole as well as the Medicare Advantage plans they may purchase – then speak to seniors groups about these changes. (Here’s what you need to know about the ACA’s affect on the donut hole.) They will see you as a trusted expert – who will be called when they need further medical-navigational help, too.
  • Patients (potential clients) with pre-existing conditions will find some open doors they have never had before once the ACA is fully implemented. But even now, there is an interim solution called the PCIP (Pre-Existing Condition Insurance Plan) offered by the government (through private insurers) to help them get insurance which, to many, is an enormous gift. There may be thousands of people in your area who want to know more but don’t know where to turn. Why not run some seminars for people with pre-existing conditions who, because they’ll trust you once they meet you, will later hire you to help them? Here are the ACA basics for patients with pre-existing conditions.
  • Did you know there are now 100+ screening tests that patients can get for free? There’s a great list of tests, but of course, most patients have no idea what most of them are for, or how they can be helped by being screened. But you can help them! You can make sure they don’t get billed if they have these tests, you can suggest they be tested when appropriate – just your knowledge of the possibilities is important. Here’s more about these preventive tests and a link to the master list.

… and this is just a start. Behind every new element of the law is an opportunity for private, independent advocates to learn, share, and garner trust – and new clients.

Get started!

Here’s a brief overview of the new law, which will help you understand all you need to know about the basics of the Affordable Care Act. (Sort of ACA 101.)

From that article you’ll find links to further explanations of the most important components – plus the important mention of grandfathered plans – in which all bets are off.

As a private health advocate, it’s your role, and your potential for growth, which make it important for you to learn what you can. It’s time to ramp up and get yourself out there…. people are waiting for someone they can trust to help them understand what they need to know, to allay the confusion they have today – and that should be you.

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