Obamacare: It’s Crazy

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Are you buying health insurance? Premiums increasing? As President Clinton said about Obamacare (ACA) (it’s) “the craziest thing in the world”. So, why are heath insurance premiums up so much? Also, why are insurance companies terminating current plans and choosing not to offer new plans. Companies state they are losing money – big money. Blue cross stated they lost $300 million in 2014 and $700 million in 2015. United Health Care discontinued all individual ACA plans as they lost $1 billion in 2015. These types of loses are one of the reasons we are now seeing the biggest changes in health insurance. There is a process to see if you are buying the best plans meeting your needs. So, if you are under age 65 and need to buy or maintain individual health insurance, what can you do?

First, review any mail received regarding your present plan. Confirm that it is not being discontinued. Review you present plan and its network of providers. Confirm that your providers are covered. Make sure your medications are still covered. Many medications have changed tiers (coverage level) or, in some case cases dropped as a covered drug. Review your “out of network” coverage. This is the coverage for providers outside of your plans network. Out of network coverage may have also been cut back.

Many of the limited plans that remain are moving to an HMO chassis to better manage care and costs. In these the HMO plan, you must stay in network.

The Open Enrollment Period (OEP) is the only time most people can change their health insurance coverage under ACA. The OEP started on 11/1 and will end on 1/31/2016. Some of the exceptions are for people experiencing an income change, loss of creditable health insurance, marriage, divorce and birth of a child.

All of the aforementioned factors make it more important than ever to secure the advice of an accredited ACA insurance professional. Importantly, the value of your health insurance is the ability to receive the quality healthcare and protect your financial wellbeing. It is this writer’s opinion, navigators and people working for the healthcare exchange place too much emphasis on just premium. In addition, they are not to provide insurance advice, only help people navigate the system.

Should you keep your present plan? Even though premiums are rising, and if your plan is not changed; perhaps it is best the keep your present plan; although, it must be affordable. The reasons premiums are rising are too complicated to address in this article. However, for your financial security and the ability to obtain healthcare, it is important to have substantial health insurance coverage.

Options: so what type of plan is best for you? Perhaps catastrophic coverage if you are age 26 to 30. The importance of coverage for the more minor expenses may be diminishing for people not eligible for a tax credit. Tax credits, also called subsidies, are immediate (or delayed) credits to assist you in playing premiums. These tax credits are base on income of the people on your tax return. This subject is too complicated to summarize in a paragraph or two, but again is a major reason you should see an ACA insurance agent.

Every person/family’s situation is different; one important consideration moving forward is your plan’s out of pocket maximum. How much would you pay if you had a $100,000 expense due to a car accident? In-network, you may have $2,500 out of pocket, or $7,150 depending upon your plan. This year, out of network expenses could be more than 50% of the cost in PPO plans for non-emergency expenses.

Hopefully, The President Elect will present workable solutions for the future, but don’t wait. In summary, you have options. Options are good, but can be confusing. If you do not have an ACA agent, find one. Do not limit your options by only talking with the insurance company’s main office. As always, feel free to contact our office if you have questions at 309-693-1060.

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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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