Healthcare Reform – Going Well?

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Affordable Healthcare Act (ACA)

Healthcare Reform (ACA) is now covering people not before covered by insurance. The healthcare.gov website is working reasonably well for what people see. The backside is a different matter. People below 138% of the Federal Poverty Level can now be covered by Medicaid. That is a real blessing to many, perhaps a curse to others.

In review, it is important to understand that the ACA is not a US governmental plan like Original Medicare. It is where the government establishes minimum essential benefits; and private insurance companies offer products under the criteria set by the government. There are about 20 new taxes associated with healthcare to take effect during the next several years to help cover the additional expenses due to ACA. Beginning 2014, ACA imposes a new 2.3% premium tax on insurance companies. See www.ahip.org for further additional tax information. These tax increases will be passed on to consumer in the form of increase insurance premiums and increased medical costs.

How is it working for you and the people you speak with? This author would like to let you know what I am seeing:

Many people are not seeking professional help and have enrolled in plans that do not include their doctors not in the network. Others have asked what is an HMO; and found that they enrolled in plans only providing coverage for only network providers. Several people have enrolled in plans and have found that sound advice and a different plan through the exchange could save them thousands of dollars and provide better coverage with subsidies and cost sharing. Many have been directed toward Medicaid which may or may not be their best option.

Can you keep your plan for the year or not – what will that plan’s premium be? These are questions being asked.

After enrollment, payment has been difficult at best. Some people do not know how, where or when to pay. Others have called their new insurance plans only to find themselves on hold for over an hour. Attempting to access benefits has often been a challenge. The “backside” workings of the exchange website appear not to have linked well with insurance companies.

Some people have multiple policy #s, others have been lost in the system and appear to never have applied.

Did we talk about premiums and deductibles yet? Premiums may be better for older people, but rough on young males. A deductible of $5,000 to $6,000 is becoming the new norm.

So what happens now? People who do not have health coverage need to apply before 3/31/2014 or be locked out until this fall’s open enrollment period. People without coverage will face a fine when filing their 2014 tax return.

If your current plan is not an ACA plan and not made effective before 3/23/2010, you will need to change to an ACA plan at the end of this year or soon thereafter. My advice: get professional help from a certified ACA insurance agent.

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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