A New Year – Frustration, New Options and Decisions to Make

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Affordable Health Care Act (ACA)

Healthcare Reform (Affordable Health Care Act or ACA) is now covering people not before covered by insurance. At least, that is the promise and appears to be the case as of December 7 when this column was written.

A New Year – First, 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.

Frustration – healthcare.gov was almost impossible to work with in October and November. It worked much better in December, but still had glitches. People called ACA’s 800# and the ACA staff would take verbal information and enter it into the same site with the same result of lock ups. Other people, if not entitled to subsidies, were surprised by the “sticker shock” of the premiums. Some employers changed employee hours and some say layoffs were a result of their higher premiums.

New Options – people with pre-existing conditions are blended in with the entire population and now covered for these conditions they had prior to securing ACA. While Illinoisans had ICHIP to do much the same in the past, it was fairly expensive and subsidies were not available. Many people, especially with health conditions, simply could not afford ICHIP. Clearly coverage for pre-existing conditions will help many people.

Decisions – When direction is unclear or changed on the fly, it is difficult to plan. Unless an individual or a business is able to plan: the way to reach objectives and goals becomes very murky. ACA is a gigantic change in the US economy and healthcare industry affecting at least one sixth of the US economy.

So what happens now? If you have employee healthcare, review your plan for benefits, who in your family is offered coverage and at what premium. If you have current individual permanent health insurance coverage, you may be grandfathered (purchased policy and no substantial changes since 3/23/2010). If your plan was purchased or substantially changed after 3/23/2010, you may be able to keep your current coverage through 2014 and possibly longer. If you are eligible for subsidies, create an account on the exchange. Then do your homework and apply for any subsidies available. Then decide if you want to apply for coverage now or wait until you must give up your current plan… Higher earners or low earners with assets need to research their options. This writer recommends that you contact a certified insurance agent for assistance.

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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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