Sep. 30, 2013

New Health Insurance Marketplace

By Kimberly Cantor, Senior Director of Advocacy and Government Relations

Managing a chronic disease like lupus is complicated.  People living with lupus work hard to ensure they take the right medications, visit the right doctors and have the best health insurance coverage they can afford. Comprehensive health coverage is critical and necessary to managing the disease.  Yet many people with lupus find they do not have the coverage they need or they may need to leave their job and can no longer afford their COBRA premiums. Often they lose their health insurance all together because they have lupus.

Beginning October 1, there is a new way for all Americans to obtain health insurance via the Health Insurance Marketplace.  The new marketplace will operate in each state and provide individuals and families a choice among health insurance plans that may best meet their healthcare needs.  Coverage under marketplace plans begins on January 1, 2014.

Federal subsidies and tax credits are available to help individuals and families whose income was between $11,500 and $94,000 in 2012.  The amount and availability of subsidies and tax credits vary, based on income and family size.  Furthermore in some states, individuals and families may be eligible for enrollment in an expanded Medicaid program.

Marketplace health insurance plans must offer a standard set of benefits.  These essential health benefits and services include: ambulatory patient, laboratory, emergency, hospitalization, maternity and newborn, pediatric care, mental health, substance abuse, prescription drugs, prevention and wellness, rehabilitation and habilitation, and chronic disease management.

Educating yourself about the new marketplace and the changes to the existing health insurance system is crucial, especially if you do not currently have health insurance, are awaiting enrollment in Medicare after qualification under Social Security Disability, or are concerned that you may in fact need a new health insurance plan to cover your medical needs.

Understanding all these changes and navigating the new marketplace can be overwhelming.  To meet this need, each state marketplace has trained individuals and groups called navigators that are available to help people understand their options for health insurance coverage in 2014.

In addition, the Lupus Foundation of America has placed a number of tools on our website to help people with lupus better understand the new marketplace, and what it means to them.  One important document is a list of key questions that people with lupus should ask themselves and others when selecting a health insurance plan in the Marketplace.  For example, list all of your current medications and ask, does the plan you are looking at cover those drugs?  Is your rheumatologist covered under that plan?

Details and pricing on state-specific health insurance plans available under the marketplace will become public on October 1.  Take time now to learn more and ask questions about the marketplace so come October 1 you are ready to delve into the details.

For more information on the Marketplace operating in your state, visit

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