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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!

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

 

Kentucky Expands Medicaid

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Yesterday Governor Steve Beshear announced Kentucky’s decision to expand Medicaid.  A link to the article in the Courier-Journal is below:

http://www.courier-journal.com/article/20130509/PRIME07/305090046

Figures from the 2012 U.S. Census Bureau tells us that 308,000 Kentuckians will now be eligible for this coverage.  The next step is for these newly eligible citizens is to enroll.  The National Association of Health Underwriters (NAHU) have always touted that many uninsured citizens could obtain coverage if they were to sign up for it.  Some citizens don’t even know that they’re eligible for “free” coverage.  Hopefully this will change.

Another point to keep in mind with this expansion is that hopefully Employer Based premiums will be lowered because these premiums have a “tax” included that helps offset the bills for the uninsured.  Hopefully that will be removed.

Let’s also hope that these newly enrolled citizens will start using their insurance.  One problem that uninsured people encounter is that they wait to get their healthcare.  By waiting, they’re more likely to seek service in the Emergency Room, which is the most costly place to seek service.  Now that they have Medicaid, hopefully they will seek preventive care and stay out of the Emergency Room.  Opponents have said this will flood doctor’s offices.  I guess we’ll have to wait and see.

The last point I’d like to cover is what kind of impact will this have on Employers.  Under this Expansion, a single person making up to $15,856 annually, will be eligible for Medicaid.  This is just a tick above the minimum wage level (assuming a 40 hour work week).  Something that I’d like to know is how many Kentuckians with full-time employment (under the new law that’s over 30 hours per week) would qualify for Medicaid.  These newly eligible citizens maybe considered a  “Qualified Waivers” to an Employer Sponsored Plan.  A Qualified Waiver is someone that has coverage elsewhere under another insurance plan.  An example would be someone today being covered under their spouse’s plan.  The employer doesn’t have to cover that spouse, and the employer isn’t harmed in their participation percentage with their health insurance company because the employee is covered under a spouse’s plan.  I know, it’s confusing.  The point is (and I’m still waiting for insurance companies to verify this, although today this is accurate) that these newly Medicaid eligible recipients will now be considered a qualified waiver in an employer sponsored plan.  How many new Medicaid recipients make this amount of money and work 30+ hours for one employer?

 

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