We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next eight years. Texas physicians have carefully studied the law to help you understand what the changes mean to your health care.

1. If You Are Uninsured Because
Your
Here are a few answers to many of the questions
Q. Is it true that every Texan must now have health Texas patients have asked their doctors.
insurance? What will happen if I don’t get health
Doctor
insurance?
A. The new law requires most Texans and legal
immigrants to have health coverage by 2014. The Big Questions
Cares
If you don’t, you will pay a tax penalty. For adults, the Q. Will I still be able to see my current doctor?
penalties are these:
A: Generally, yes. However, your doctor may or may
ü 2014: $95 or 1 percent of income
not continue to participate in your health plan or in
ü 2015: $325 or 2 percent of income
government health plans, such as Medicare or Medicaid.
ü 2016: $695 or 2.5 percent of income
Talk to your doctor.
ü After 2016: The dollar amount increases with
inflation.
ü For children, the dollar amount of the penalty is Your Doctor Cares About Q. Will I still be able to get the care I need?
half the numbers above.
ü For a family, the penalty will be no more than
You and Your Health A: There is no simple answer. Much of what is in health
reform has never been tried before. We pledge our best
$2,085, which is 2.5 percent of income or three to do what we can to make sure our patients get the care
During the health care debate, doctors worked to make
times the penalty for one adult in 2016. they need.
sure nothing would come between you and your doctor.
Now that the Supreme Court has upheld most of the law,
In those states where Medicaid is not expanded, some Q. How much will this cost me?
that is still our biggest priority.
people who can’t afford to purchase health insurance
A: Again, there’s no simple answer. People who choose
won’t have to pay the tax penalty.
The goal of health reform was to lower health care costs not to buy health insurance will be taxed. The law also
and cover millions of Americans with insurance. Your may shift costs from older, sicker people to younger,
Q. How does the new law help me now? doctors are working to make sure that doesn’t mean you healthier ones. How much you pay for health care will
A. A new insurance pool, called the Pre-Existing get lower-quality care or less care. depend on the type of health plan you have, amount of
Condition Insurance Plan (PCIP), allows uninsured the deductible and copay, and whether you qualify for a
people to buy coverage, even if they have a preexisting We know health reform is big and confusing. Some parts of subsidy, Medicare, or Medicaid.
condition. Uninsured Texans — even cancer survivors the law started in 2010. Other parts are rolling out over the
or those with illnesses like diabetes or high blood next eight years. Texas physicians have carefully studied the The good news is preventive services, like vaccines and
pressure — can get the coverage they need. For more law to help you understand what the changes mean to your screening tests, will be fully covered. People on Medicare
information, visit www.pcip.gov. health care. will find more of their prescription costs covered, too.
Don’t see your question here? What You Need to Know What You Need to Know About Health Reform
About Health Care Reform
Go to MeAndMyDoctor.com and ask your question.
➚ ü Most people must have health insurance beginning in 2014 or face a tax penalty.
ü People who cannot get affordable health coverage from their employer can buy it through a federal or state
health insurance exchange. Starting in 2014, some people can get tax credits to reduce the cost of their
premiums, copays, and deductibles.
ü Small businesses also can buy health coverage through an exchange.
ü Large employers (50-plus employees) who don’t offer health coverage to their employees must pay a penalty for
each employee who receives a tax credit to buy their health insurance through an exchange.
ü Health insurance companies must provide coverage to anyone, regardless of health status or a preexisting
condition. People will not pay more because of their health status or sex.
ü There will be no lifetime or annual dollar limits on health insurance coverage.
ü Texas has an option to use federal funding to expand the Medicaid program to cover more low-income adults.

2. What If I’m on Medicare? Q. How do I know if my children or I qualify for
If You Have Commercial Health Insurance Medicaid?
Q. Will it be easier for seniors to find a doctor? A. Currently, low-income people may qualify for Texas
Beginning in 2014: Medicaid if they fit into certain eligibility categories and
A. No. In fact, the new law did nothing to fix a 10-year-old have low enough incomes. The chart below shows the
ü Health plans can no longer exclude adults with
problem in Medicare. That problem is forcing doctors to rules based on the federal poverty level (FPL) for 2012,
preexisting conditions from coverage nor charge them
limit the number of Medicare patients we see or even to with income examples for a family of three:
more based on their health status.
quit taking Medicare patients. Your doctors are petitioning
ü Federal subsidies (money) will be available to eligible
Congress to fix the problem so we can continue to care for
people who purchase a health plan through a state or
our patients. Texas Medicaid Eligibility
federal exchange.
Q. Will seniors get preventive services? Percent of FPL Income
Q. Will health insurers cover my children’s Family of 3 Amount
vaccinations and my mammogram? A. Medicare now covers the entire cost of checkups
and recommended screenings like colonoscopies and Child: 0-1 years 185% $35,316
A. Yes. Many preventive services, like vaccinations and
mammograms. Medicare patients will not have to pay any Child: 1-5 years 133% $25,390
cancer screenings, are covered. New private health plans
copay or deductible.
must cover preventive care and screenings recommended
Child: 6-19 years 100% $19,090
by the U.S. Preventive Services Task Force at no extra
Q. Does the new law affect the cost of prescriptions?
cost to you. This means you won’t have to pay a copay or Working parent 26% $4,963
deductible. A. The new law helps seniors on Medicare (Part D)
prescription-drug plans by reducing their out-of-pocket Pregnant woman 185% $35,316
Q. Can health insurance companies raise their costs for prescription drugs. The coverage gap, called “the
Adult with disability 77% $14,699
premiums under the new law? doughnut hole,” will be gradually reduced until it goes
away in 2020. If you think you are eligible and wish to enroll,
A. Yes. The Texas Department of Insurance (TDI) now has
more authority to review large rate increases to individuals you can find links to the application information
and employers. But if health care costs go up, premiums at www.healthcare.gov.
will too.
Q. What big changes can I expect?
What If I’m on Medicaid? Q. What decision did the Supreme Court leave up
Q. Will the reforms increase my health care to each state to decide regarding Medicaid?
A. Several big changes already are in effect: premiums? Q. How can I find a doctor who takes Medicaid?
The law told states that if they wanted federal Medicaid
ü There are no more lifetime dollar limits on what A. Health insurance premiums were rising prior to the A. Health reform did little to increase the number of money, they had to cover more people under age 65,
health insurance plans cover. law. No one knows for sure how the new law will affect doctors who take Medicaid. State budget cuts in the past including, for the first time, childless adults. Families of
ü Adult children younger than 26 can be added to premiums. However, the law gives states and the federal two years have forced out even more doctors. Beginning three earning up to $25,390 or 133 percent of the FPL
their parents’ health policies. government authority to scrutinize premium increases. in 2013, higher Medicaid payments to primary care doctors would qualify. However, the court ruled that states can
ü you get sick, health plans can no longer
If To help make insurance affordable, the federal law may help more participate in the program. Your doctors decide not to expand their Medicaid enrollment but still
retroactively drop your coverage because of honest requires every state to conduct a special review if a health are working to find a solution. keep their current level of federal Medicaid funding.
errors you made in your application. insurance company wants to raise premiums more than With the expansion, about 2 million more Texans would
ü Health plans must spend 80 to 85 percent of their 10 percent. This rate review by TDI will help protect small Q. Can undocumented immigrants get Medicaid or get Medicaid. Without it, most of these Texans will
premium dollars on actual patient care versus businesses and individuals who buy their own policies. CHIP? remain uninsured because people with incomes below
overhead and profit. Health plans who fail to meet TDI is supposed to announce whether the increase is 100 percent of poverty are not eligible for subsidies to
these benchmarks must give rebates to you and/or acceptable or unreasonable, although it can’t actually do A. The law has not changed. Medicaid coverage for get coverage in the new health care exchanges.
your employer. In fact, Texas recently received $167 anything to stop it. undocumented immigrants is limited to emergency
million in rebates for individuals who purchased services. Under the Children’s Health Insurance Program
their own coverage and employers who purchased The law also prevents health insurers from charging (CHIP), undocumented immigrant women can enroll in the
insurance for their employees. women higher premiums because of their gender or CHIP Perinatal Program to receive basic prenatal care so
ü Health plans must provide you simple, plain- charging small businesses more because of the occupation they have healthier babies.
language explanations about your coverage and or number of people employed. But this means the cost
how much you might have to pay. of premiums for men (who use fewer health care services)
and for people in low-risk occupations may be increased.
Your doctors are very concerned about the affordability of
health insurance. We plan to monitor this closely.