Under the Affordable Care Act, who can make decisions about the care I need?

You can choose from a wide variety of private health plans, and decisions about your care will be made by you and your doctor. Your coverage for the care you receive will depend on the kind of health plan you choose. Your health plan will provide you with a detailed description of what is covered and what is not, along with a simplified Summary of Benefits and Coverage (SBC) that includes information on copays, coinsurance, and deductibles. The SBCs include examples of how much a member would typically pay in out-of-pocket costs for common medical scenarios. The Affordable Care Act guarantees your right to appeal a health plan decision. Private insurance plans have to tell you why a claim has been denied and they have to let you know how you can dispute their decision.

 


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