Day 13: Today's Important Thing to know about Health Care Reform

Today’s thing to know is about grandfathered plans.  By now, most of you should know whether your health insurance coverage through you employer is going to continue into 2014 and what it will cover.  Plans offered by your employer are considered creditable plans but may not cover the ten standardized categories mandated by the Affordable Care Act.  The reason they don’t have to cover those items is because they are grandfathered plans or plans that were in place when the law was enacted in March of 2010.  As long as the plan is not changed, it may remain as it is.  The only thing that can change is the premium.  Now, you may also be a person who has purchased their own private health insurance.  If you haven’t already, you will be receiving from your insurance carrier a letter outlining your options to continue or change your coverage for 2014.  If you need help decide what your best option may be, contact me.

Day 12: Today's Important Thing to know about Health Care Reform

Today’s important thing to know is that health care reform primarily affects health insurance for people over the age of 65.  Yes, in 2014 every American must have creditable coverage or pay a fine or tax but people over the age of 65 are generally covered by traditional Medicare or a Medicare Advantage plan.  Those plans are deemed to be creditable coverage by the Federal government so there is no reason for concern if you are covered by Medicare.  If you are a senior or know a senior, please know that all the confusion surrounding health care reform should not be a concern.  Traditional Medicare and Medicare Advantage plans are alive and well as we head toward their open enrollment period in October as well.

Day 11: Today's Important Thing to know about Health Care Reform

Today’s important thing to know is about premiums on the new ACA-compatible plans.  In previous videos, we have already covered the rich benefits that will be covered by the Affordable Care Act policies.  Some of the benefits, such as maternity and dental for children, have been benefits that were added on at an extra charge if the policyholder needed them and were willing to pay for them.  Now, those benefits are included in everyone’s premium.  Another benefit driving up premiums is the MOOP that we discussed yesterday.  Putting a cap of what you as the policyholder potentially has to pay out of pocket increases what the insurance company will have to pay.  But probably the biggest premium driver is the elimination of the pre-existing condition clause.  More claims costs mean higher premiums for everyone.  Lastly, though younger people will see a sizeable increase in premiums, perhaps as much as 30%, older Americans will be paying the same or less.  Currently health insurance companies can charge as much as five times as much for coverage of a 60 year old as a 20 year old.  The ACA limits the upcharge for age at three times.  Of course, ACA only applies to people under 65.  Don’t think the insurance companies are going to be getting rich anytime soon though.  The Affordable Care Act also capped their overall profits at 20%.  Anything over that must be refunded to their policyholders.  If you have a question you would like for me to answer, send it to me as a comment or via the contact box and I will include it in an upcoming video.

Day 10: Today's Important Thing to know about Health Care Reform

Today’s thing to know is about MOOP which stands for maximum out of pocket.  If you haven’t noticed already, the government has an acronym for everything.  I wanted to talk about MOOPs today because the first thing I heard on the news this morning was that they had been postponed for a year.  Well, the truth is, only the MOOP on a few small group plans has been postponed.  This is an example of how difficult it is to get real information about the Affordable Care Act and, I hope, is the reason you are watching this.  Anyway, back to MOOPs.  MOOPs are a very important part of the new ACA-compatible plans because they limit how much money you spend each year on your deductibles, co-pays and co-insurance.  The individual MOOP for 2014 is $6,350.  The family MOOP is $12,700.  The importance of the MOOPs is huge.  There are many people today who have a deductible higher than next year’s MOOP.  In a perfect world, you would have an emergency fund equal to the MOOP.  Imagine never having to organize a fundraising event for a friend undergoing cancer treatment and about to lose their home.  If you are one of those smart folks with an HSA account, you may already be set to cover your MOOP.  Remember to check back here tomorrow for factual up-to-the-minute information and share this with your friends.

Day 9: Today's Important Thing to know about Health Care Reform

Today’s thing to know is that the Affordable Care Act made it illegal to deny an individual health insurance based on health conditions.  That means that people with pre-existing health conditions such as diabetes, heart conditions, cancer, etc. cannot be turned down for coverage starting in 2014.  Applications for ACA-compliant health insurance policies will not include any health questions.  In the insurance world, we call this “guaranteed issue” since you cannot be denied coverage.  This provision of the Affordable Care Act will be a great benefit to many people.  Being denied due to pre-existing conditions has prevented many people from purchasing health insurance.  Getting the coverage that they need is definitely a positive.  Now, for the negative.  Covering folks with pre-existing conditions raises the dollars paid out in claims.  This will necessitate increases in insurance premiums to everyone.  Most hard hit will be younger individuals who will have to help share the burden of higher claims costs.  If you are young and make a decent income, you may want to purchase coverage prior to the implementation of ACA-compliant policies to take advantage of lower premiums. 

Day 8: Today's Important Thing to know about Health Care Reform

 

Today’s important thing to know is when will the marketplace open?  Gee, I would like an answer to that one myself.  Open enrollment is supposed to begin October 1 – just six weeks from now.  Unfortunately, there are still many questions about the government’s systems and whether they will be secure and able to handle the amount of traffic they will surely have once they are open.  The insurance companies are so nervous about the actual start date that they have postponed advertising the exchanges at this point.  So, all I can tell you is what the law says and what HHS (Health & Human Services) and CMS (Centers for Medicare & Medicaid Services) are saying.  Federally facilitated exchanges or marketplaces are supposed to open on October 1^st of 2013.  Anyone enrolling October 1 through December 31 will have a policy with an effective date of January 1, 2014.  The exchanges are scheduled to remain open until March 31^st of 2014.  Any policy purchased in January will be effective February 1 and so on.  If you do not enroll during the initial six month enrollment period, you will be locked out until open enrollment next year which will be six weeks starting on October 15^th and running until December 7^th which mirrors Medicare open enrollment.  To stay up to date, check my Facebook page at Holt Health Insurance.  Tomorrow we will talk about how you cannot be turned down for insurance.

Day 7: Today's Important Thing to know about Health Care Reform

Today’s important thing to know is about tax subsidies.  Tax subsidies or credits that will be available from the federal government to low-income individuals and families to help them pay their health insurance premiums.  The Affordable Care Act capped the percentage of income an individual can spend on health insurance at 9.5%.  To be deemed affordable, your health insurance must be no more than 9.5% of your annual income or your modified adjusted gross income from your tax return.  This cap is just for an individual.  Family coverage may, and probably will, cost more than 9.5% of your income.  Individuals and families between 100% and 400% of the federal poverty level (or approximately $45,000 for individuals and $90,000 for a family of four) will receive a federal tax subsidy or tax credit each month paid directly to their insurance company thus lower their insurance premium to the affordable level.  Calculating the tax subsidy is fairly complicated so if you have specific questions, email me via the contact box here.  Tomorrow we will talk about when the marketplace and tax subsidies begin.

Day 6: Today's Important Thing to know about Health Care Reform

Today’s thing to know is how to purchase creditable health insurance.  For people fortunate enough to have health insurance provided through an employer, not much will change except perhaps the premiums.  Most employer plans will be grandfathered for at least some period of time.  Grandfathered plans will not be required to provide the standardized benefits that we discussed yesterday.  If you provide your own health insurance or currently have no health insurance, you can purchase the new health insurance through the federally facilitated marketplace or through a public marketplace.  Tennessee opted out of having its own marketplace.  Through the federally facilitated marketplace you can purchase health insurance and, if you qualify, you can receive tax subsidies from the government to pay a portion of your premiums.  You can access these marketplaces online or via your local, FFM-certified insurance broker, like me.  Tomorrow we will discuss the tax subsidies and how you qualify.

Day 5: Today's Important Thing to know about Health Care Reform

One of the important things that the Affordable Care Act legislated was standardized benefits.  All policies sold going forward will have to include these benefits in order for them to be creditable. The standardized benefits are:

               Ambulatory patient services

               Emergency Services
               Maternity & newborn care
               Pediatric services including dental & vision
               Rehabilitative/habilitative services & devices
               Mental health & substance use disorder services, including behavioral health treatment
               Preventive & wellness services & chronic disease management
               Hospitalization
               Prescription Drugs
               Laboratory Services

You will notice that these standardized benefits include maternity, newborn care and pediatric services.  That means EVERYONE gets maternity benefits whether you are a 28 year old man or a 60 year old woman.  Of course, the premiums will also reflect that coverage.  One benefit of standardized benefits is that it makes it extremely easy to compare policies from different insurance carriers.  Now, you know today’s important thing about health care reform – standardized benefits.  Stay tuned for tomorrow’s important thing to know – the federally facilitated marketplace.

Day 4: Today's Important Thing to Know about Health Care Reform

 

Yesterday I mentioned “creditable” health insurance.  Today’s important thing to know is that there is no such thing as “Obamacare.”  The Affordable Care Act is a law that requires health insurance companies to comply with certain requirements in order to offer to you creditable health insurance.  These policies are offered through private insurance companies not the federal government.  The Affordable Care Act is a law not a program like Medicare.  New ACA compliant or creditable policies will offer a standardized set of benefits.  In order to make these benefit rich policies affordable, low income individuals and families will receive a tax subsidy from the federal government.  Tomorrow we will look at what the standardized benefits are.

Day 3: Today's Important Thing to Know about Health Care Reform

Today we are going to talk about “Play or Pay.”  One of the most controversial parts of the Affordable Care Act is the individual mandate which means that come 2014 if you don’t have health insurance you will have to pay a fine.  The Supreme Court ruled it constitutional because it is actually a tax.  Thus, “Play or Pay,” you either play by buying health insurance or you pay the fine. The fine or tax will be assessed on your 2014 tax return due in April of 2015.  The tax will amount to $95 or 1% of your 2014 income, whichever is greater.  We hear a great deal of the news about the $95 but most people who don't purchase health insurance will pay 1% of their 2014 income.  Tomorrow we will talk about how you can purchase this creditable health insurance so you are not assessed a fine.

Day 2: Today's Important Thing to Know about Health Care Reform

Today’s important thing to know about health care reform is. . . Health Care Reform is here to stay.  We cannot ignore it just because we don’t understand the law or are overwhelmed by it.   Today, I want to give you enough information so that you are not like the 42% who were recently polled and said they didn’t even know that health care reform was the law.  You will hear a great deal about health care reform on the news but most of it is either not accurate or not helpful.  Implementation of many of the main features of health care reform is still scheduled to be effective on January 1 of 2014.  Tomorrow we will discuss “Play or Pay,” the individual mandate.

Day 1: Today's important thing you need to know about health care reform

1.      The Patient Protection and Affordable Care Act, commonly known as Obamacare, was officially signed into law in March of 2010 and upheld by the Supreme Court.  Some parts of the law have already gone into effect like covering children up to the age of 26 and preventative exams provided at 100% on all health insurance.  A major shift occurs with the PPACA.  The primary responsibility of having health insurance shifts to the individual.  So, over the next few days, let’s keep things simple.  Each day I will give you one piece of important you need to know about Health Care Reform.