ACA Plans — Not Like Mom & Dad’s Health Coverage

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ACA Health Insurance Plans

Wow, health insurance has changed. Even getting the amount of premium you will pay has become a complex process. Also, the volume of people who will need to move to an ACA Plan has been a problem in October. Nearly 46% of all people with individual health insurance plans will need to enroll in an ACA Plan during open enrollment for 1/1/2014 effective date; or in some cases prior to their annual renewal date. Does this mean you?. Please substitute green highlight for red type and yellow highlight. Hope this is better. In addition, about nearly half of Americans with individual plans will need to be enrolled in a new plan prior to 1/1/2014 or not be covered. If you do not have Medicare or employer sponsored (group plans) plans, this probably means you. Open enrollment continues until 3/31/14. For those who enroll after 12/15/13 may go about 30 – 45 days without coverage.

First, there is much truth and much mis-information in the news and from people about Healthcare Reform (ACA). First, know that Insurance agents who have passed ACA certification MAY enroll people in ACA plans. In addition, certified Insurance agents CAN help you obtain appropriate subsidies in which you may be entitled. It has been said only facilitators can help people enroll in ACA plans – this is not true.

The true statement is that if you qualify for Medicaid, a state medical card, you will need to speak with DHS, the public aid office. All other people, not on Medicare, can see or talk with an ACA certified insurance agent. The question becomes why:

Certified Insurance Agents have spent hours being educated about insurance contracts and recently hours of training on all aspects of ACA. They have experience with provider networks and which companies may work best for you. They have experience with insurance companies’ stability and service. They can help you navigate through this system as your advocate. In addition, you do not pay a cent for their help.

The government rules and regulations of ACA are constantly changing. You need to know, as of early October; if you had make or make a snap decision and enroll in an ACA plan, you will not be able to move to a different plan or company until 1/1/2015 unless you have a qualifying event. CMS and insurance companies are fixing technical problems on the fly. Glitches will be, hopefully, mostly resolved prior to you reading this column. Most ACA insurance agents have sorted through the plans, benefits, and which plans are best in your situation.

Remember:

  • ACA Plans become effective 1/1/2014 (not earlier):
  • You need to enroll prior to 12/16/2013 for a 1/1/2014 effective date.
  • The deadline for open enrollment is 3/31/2014, but most people should enroll prior to 12/16/2013.
  • Wise advice – Do not wait until December. The site again may again close due to numbers of people attempting to access the CMS site.

If you are on Medicare, remember: your (annual) open enrollment is from 10/15 to 12/7. During this time you can change Medicare Advantage and/or Medicare Prescription Drug Part D plans.

In summary: there can be great value using a trusted professional to guide you ahead. Gather your information, but also contact your insurance agent to see if he or she can guide you. If not, perhaps they can suggest an ACA certified insurance agent. Using an agent will not cast you a penny.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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