PPACA Will Affect You

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Affordable Healthcare and You

Your life will be affected by Healthcare Reform named The Patient Protection and Affordable Care Act (PPACA), and the many unknowns yet in the next 3 years (and beyond). Putting politics aside, the question becomes: how can you best prepare to have favorable outcomes due to these changes?

So, this is what this writer is seeing today. Insurance premiums are rising. PPACA had only a couple cost controls. PPACA did not address closing the US borders (to people who are receiving tax paid healthcare), and did not address limitations on malpractice lawsuits. However, PPACA did mandate certain benefits be included in all plans, e.g. the elimination of maximum benefits and the elimination of rescissions. The effect of these mandates will be good for a few consumers, but also remove choices for all consumers. For example, one insurance company had a substantial individual plan that did not cover mental health. This plan’s premium was about 20% less than other plans this company sold, and some people were willing to take this risk for the premium savings. PPACA mandates that all plans must cover mental health; therefore this company can NO longer sell this plan. At least three major insurance companies in Illinois have discontinued lower cost plans due to these mandates.

Likewise other mandates have cause insurance premiums to rise fairly substantially. An analogy would be for someone buying a car. A new car dealer could not sell a car which had all options included, such as ‘view view camera” for the same price that they would sell a car without any options. Insurance is the same – simply, premiums must be higher to cover these mandates.

All people will be mandated to have healthcare coverage (with a few exceptions). PPACA is modeled after a healthcare reform plan put in place in Massachusetts in April 2006. Massachusetts also requires most all people have healthcare coverage. Today, 4% of their residents are without coverage; the lowest in the US. Since 2006, emergency rooms and other medical providers in Massachusetts have been overloaded with patients. The average wait to see a provider after one’s initial call to set an appointment is 43 days. People are now going to neighboring states for more prompt healthcare. That’s just part of the problem.

Since 2006, the cost of Massachusetts’s insurance program has increased by 42 percent, or almost $600 million, according to an analysis by the Rand Corporation. Meanwhile, the cost of insurance premiums in the state is the highest in the nation, and double-digit rate hikes are expected again in 2010. The worry, shared across the political spectrum, is that the Massachusetts’s health-care spending will overwhelm the state’s budget. Already, it has forced service cuts that have irked those on both sides of the aisle.

Concerning PPACA and people across the country and assuming larger insurance premium increases, employers may choose to drop employee health insurance in these economic times. In 2014, when employers with 50 + employees are required to provide healthcare coverage or be fined, even large corporations may find it “cheaper” to pay the fine opposed to providing coverage.

Seniors are also affected: The PPACA does cut payments to Medicare Advantage plans (MAs), which could result in carriers pulling out of more areas. MAs are not guaranteed renewable, and carriers may pull out of a market at the end of any calendar year, forcing enrollees to change carriers or return to Original Medicare. The people who have chosen an MA to reduce their premium may not have a low cost option available. In addition, PPACA will be adding cost-sharing requirements to Medicare Supplement plans C and F that are sold after Jan. 1, 2015.

So, what can you do? Much of PPACA is based on direction, interpretation and implementation by the Secretary of Health & Human Services. So, the question of what you can do has no answer yet, other than to maintain insurance coverage now, gather information, and talk with or write your congressmen. Even though insurance plans issued prior to 3/23/10 are “grandfathered” it may behoove you to gather information from an agent or the new national web porthole www.healthcare.gov (established last month) on healthcare coverage options available to you. Word of caution: always work with a professional when dealing with complex financial matters such as insurance products.

Ironically, many people have come from Canada and in fact, all over the world to the US for their healthcare; but now people in the US are considering options in countries like Costa Rica for their future healthcare. Due to PPACA you may beginning hearing more about healthcare shopping or what is becoming known as “healthcare voyeurism”. Some creative ideas are available now for many people who would consider medical voyeurism. Contact the office below for details and availability.

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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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