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Understanding ObamaCare

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Here is some information to help you navigate Obamacare.

1 – Does your current health insurance plan need to change?

If you have a grandfathered plan your going to be able to keep your plan (as long as the health insurance company you have your grandfathered plan with allows you to do so).

If you have what they call a “transitional plan” you’ll be able to keep that plan until your renewal date in 2014.  Once your renewal date hits in 2014, you will then be required to buy a plan that meets all of the essential health benefits.

If you buy a plan with an effective date of January 1, 2014, that plan will meet requirements.

2 – How will you pay for your health insurance in 2014?

Depending on your household income, you may be able to qualify for payment assistance that make insurance more affordable.  The only way you can obtain assistance, is if you purchase your plan from either the state or federal exchange.  If you buy a plan “off exchange” you will not received payment assistance or special discounts.

3 – What is the difference between on and off exchange plans?

In my opinion, the only reason you would go to either the state or federal marketplace (the government prefers this word, but it’s the fancy word for exchange) is if you qualify for payment assistance.  If your income is over the assistance limit, then going off exchange is the way to go.  I say this because you won’t have to prove your income, and answer all of the questions that the state and federal government require from you.

For example, here in Kentucky, Humana offers some plans that aren’t available on the state exchange.  These plans have a more comprehensive network, then the current on exchange plans have.

4 – What type of plans are available?

Networks, co-payments, deductibles, and out of pockets differ between all the carriers.  You must decide for yourself what is most important to you, and then work with an agent or broker (Zinser Benefit Service, Inc. would be one) who should be able to guide you to the right plan.

5 – When can you buy coverage?

The new open enrollment period for a January 1, 2014 effective date started in Oct 2013 and ends on December 23rd 2013.  Once this date passes, you’ll have dates similar all the way up through March of 2014.  If you miss during this time, you will have to have a qualifying event in order to enroll in a plan during 2014.  A qualifying event would be any of the following:

  • Loss of essential health coverage
  • Change of family structure – gain or become a dependent because of a marriage, death, birth, or adoption of a child
  • Change of citizenship status
  • Government error
  • Change in subsidy eligibility – so if you make more money or lose some of your income, this could trigger a qualifying event
  • Move to a new coverage area – state, county, etc.

This is just a brief overview.  I hope it helps!

Modified Community Rating

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This week’s Business First of Louisville had an article about Modified Community Rating.  Director of Government Relations Lawrence Ford is quoted throughout the article.

Here’s the link:

http://www.bizjournals.com/louisville/print-edition/2013/05/24/modified-community-rating-system-is.html

Mr. Ford does a good job of explaining how this will impact Kentuckians rates.  He highlights two issues.  The first is younger people subsidizing the older population.  Insurance companies aren’t going to bring down older folks rates, they’re going to push the young population up to help offset the older population claims.  He also talks about the lack of a substantial penalty for those who don’t enroll.

Still something needs to be done about letting individuals buy whenever they get ill.  The way it’s currently set up that is what could happen.  I know there are talks about it, but we need something done soon before Jan 1, 2014.

PPACA Rollout

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On Friday President Obama held an event to tout the benefits of ACA, specifically to a large group of women.   The New York Times is also reporting that the administration confirmed that Kathleen Sebelius, the head of the health and human services, has been trying to raise money from the private sector to promote an education and outreach program raising the awareness of the benefits of PPACA.  Congress has repeatedly refused to fund this outreach program, and that’s why Ms. Sebelius is going to the private sector.

http://www.nytimes.com/2013/05/11/us/politics/obama-to-makes-new-pitch-on-health-care-law.html?ref=us

Speaking just for Kentuckians, I’m really skeptical that we’re going to see a decrease in premiums.  Just taking into account what the new policies are going to have to cover, that in and of itself will cause an increase in premiums.  For instance, maternity.  All policies (even men) will have maternity coverage. Right now, that costs about $100/mo more than a policy that doesn’t cover it.

The second factor that’s going to cause premiums to rise is the guaranteed issue aspect of the law.  When underwriting is taken away from the insurance companies, healthy individuals are going to be penalized even more than they are today because insurance companies can’t offset the amount on the older and/or sicker population.  So the older individuals more than likely have their premiums staying roughly the same, it’s the younger generation that’s going to see an increase.  The same young people that the President is targeting to enroll in this law.

I will give the President this, the individuals and families that receive a subsidy, may see a decrease in what they pay.  However, I think the insurance will still cost more.

We’re going to just have to wait and see in October when the premiums are made public just how much it will cost.

 

 

 

Follow Up Post to The Cost of Health Care

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As a Board Member of our Professional Association (Greater Louisville Association of Health Underwriters, or GLAHU) I’m currently Co-Chair of our Media Relations.  I try to submit something monthly, and especially when there is a major story on health care or health insurance.  I think I’ve had at least three in the paper over the course of my time (since 2008).   I had one get published on a Sunday (that’s the one that I received the most comments about, I think three people said something to me, all over the age of 60! Go figure…Ha Ha).

So, the process is when I see something, I send it to our National Association, and I ask them to put something together, or I work with them, but usually Kathryn at NAHU always gives me something great.

This morning I submitted the below editorial to the Courier-Journal.  I’ve had good luck in the past getting in, so let’s hope we get another one!

Dear Editor,

A recent article reported that hospitals across the country are charging “wildly varying amounts for common major medical care” (“Costs for same medical procedures vary widely at Louisville hospitals,” May 9). Even the director of the Center for Medicare and Medicaid Services, Jonathan Blum, questions the validity of the practice.

 

The healthcare law’s efforts to improve access to insurance are admirable, but the problem isn’t limited to the cost of health insurance. If we continue to ignore this “cost shifting” in hospitals as well as other pricing issues with pharmaceutical companies, healthcare equipment providers, medical malpractice suites and other causational factors, coverage will remain unaffordable. Addressing the system’s cost drivers is crucial to preventing that unfortunate outcome.

M. Zachary Zinser

Media Relations Co-Chair

Greater Louisville Association of Health Underwriters

 

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