Healthcare

WHAT YOU NEED TO KNOW ABOUT YOUR HEALTHCARE RIGHTS IN THE U.S.

1. Health insurance

Do I have a right to health insurance?

Patient

As long as you are not already covered by your employer, you have a right to purchase health insurance from Healthcare.gov (established by the Affordable Care Act aka “Obamacare”). You have this right even if you have a preexisting condition.1Affordable Care Act

Am I required to have health insurance?

Generally, yes you are required to have or purchase health insurance (with exceptions listed here), or you will receive a fine of $695 per person ($347.50 per child) or 2.5% of your household income, whichever is higher, which is collected as part of calculating and filing your tax return every year.2Affordable Care Act

Can I get free or reduced cost health insurance?

If you qualify based on your income (generally less than $50K per year) and certain other factors, you may receive “subsidies” to help pay for your health insurance premiums. See Healthcare.gov for more.

Also if your income is at or below 138% of the federal poverty line (generally about $15K or less per year for an individual), you may be eligible for free or very low cost health insurance (called Medicaid, but some states use a different name, such as “MediCal” in California). Although the Affordable Care Act intended this provision to apply to all states, only about half the states decided to implement it. The states that did not implement the Medicaid expansion each have their own eligibility for free or low cost health care, which is generally harder to qualify for than the 138% poverty line threshold. See Healthcare.gov for more.

If you are legally determined as permanently disabled, or you are at least 65 years old, you likely qualify for low cost health insurance, called Medicare.

Is my health insurance required to cover certain things?

Yes. Under the Affordable Care Act, plans offered on the individual or small group market must cover the following 10 categories of “essential health benefits“:

  1. ambulatory patient services (outpatient care, such as doctor’s visits)
  2. emergency services
  3. hospitalization
  4. maternity and newborn care
  5. mental health and substance use disorder services including behavioral health treatment
  6. prescription drugs
  7. rehabilitative and habilitative services and devices (rehabilitative = regaining lost skills or functions; habilitative = maintaining, learning, or improving skills or functions)
  8. laboratory services
  9. preventive and wellness services and chronic disease management
  10. pediatric (healthcare for children) services, including oral and vision care.

2. Medical records

Do my health care providers or other professionals have the right to share my medical information with others without my permission?

Generally, no. They must protect the privacy of your medical records.3U.S. Code of Federal Regulations, Title 45, Sec. 164.508 The relevant law is called the Health Insurance Portability and Accountability Act, and here is a fun example of a violation.

Do I have the right to obtain my medical records?

Yes.4U.S. Code of Federal Regulations, Title 45, Sec. 164.524 Under federal law, you have the right to obtain a copy of your medical records from your health care provider within 30 days of requesting it.

Exceptions include:

  • Psychotherapy records
  • Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding

Do I have the right to correct mistakes in my records?

Not exactly. You can request that the healthcare provider which created the information amends it, and the provider must do so if he/she agrees that the information is inaccurate or incomplete.  However, if the provider does not agree to your request, they may not need to amend the record. That said, you have the right to submit a statement of disagreement that the provider must add to your record.5U.S. Code of Fed Regs, Title 45, Sec. 164.526; Health Insurance Portability and Accountability Act of 1996

3. Medical Aid in Dying

In 5 states, you have the right to request medical assistance in ending your life if you have a terminal illness. These states are: California, Oregon, Washington, Vermont, and Montana. The laws are sometimes referred to as “death with dignity.” To follow this issue, go to TheBrittanyFund.org.

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