The
Basics on the Affordable Care Act (ACA)
In 2010, the
federal government enacted the Patient
Protection and Affordable Care Act, which aims
to increase the number of Americans with
insurance and cut the overall costs of health
care.
A few important
changes we've seen in the past few years are:
-
Children
covered under their parents to age 26
-
No life time
caps on coverage
-
100%
preventative care coverage
-
Maternity on
all plans
The new law
created a number of ways to help reduce the cost
of insurance and encourage uninsured people to
get covered. The federal law is important to
Californians because it provides financial
assistance to help individuals and small
business pay for health insurance. The law also
requires that most people over the age of 18
have health insurance or pay a penalty starting
in 2014. If you already have affordable health
insurance, you don’t need to take any action,
unless your health coverage status changes.
The big changes
are:
-
No more
underwriting for health history.
(yeah!)
-
Financial
assistance for about half of us to help pay
for our new plans.
-
Increased
access to Health Care and Consumer
Protections.
To help those
without health insurance get covered, the
Affordable Care Act also requires that the
states either set up their own marketplace to
offer health insurance or have one set up by the
federal government. These marketplaces will
provide an accessible place where you can
compare health plans and buy health insurance
that works best for you, your family and your
budget. California chose to set up its own
marketplace also know as the California Health
Exchange and
Pacific Health Brokers will be offering
those plans.
Starting in
November,
Pacific Health Brokers will begin
enrolling eligible Californians for health
coverage that will begin January 2016. Legal
residents of the state of California who do not
have health insurance from their employer or
another government program can purchase health
insurance through the California Exchange or the
open market place. We will be able to
advise you on the best place to purchase your
coverage. Basically, it will come down to
your income. If you qualify for the
subsidy, you will want to purchase coverage
through the exchange. If you do not
qualify for the subsidy and/or prefer larger
provider networks, you will most likely go to
the open market place. We can give you
clear and concise proposals to outline your
options and also lend our advise based on your
needs.
Health Care Reform intends
to change the face of health insurance coverage
in the United States. With tens of millions
across the nation currently uninsured, the
current health care market was in vital need of
change. As a result, the new law was designed
and implemented with the intent that anyone who
wants and/or needs health insurance would be
able to acquire it. Prior to the Affordable Care
Act (ACA), individuals with pre-existing
conditions would not be approved for a health
plan in the individual market. Unless they were
offered employer sponsored coverage of qualified
for a public assistance program, these
individuals were left out in the cold. In the
event of a catastrophic illness or injury, many
would face financial devastation.
The Affordable Care Act
clearly outlines the implementation of
guaranteed coverage for all regardless of their
health status beginning as early as January 1,
2014. At this point in time medical underwriting
would cease to exist, and instead qualified
individuals would be required to only complete a
short medical survey, along with a financial
questionnaire form to determine eligibility for
premium assistance. Rates are still based on
where the individual lives, as medical care
varies greatly from county to county and state
to state.
-
Goals of Health Care
Reform:
-
Help the millions of
uninsured obtain coverage
-
Expand Medi-Cal and
Medicaid programs to qualified individual
-
Encourage more
employers to offer coverage to their
employers (via tax credits and penalties)
-
Help simplify the
process of shopping for and obtaining health
coverage
-
Inspire more people to
utilize preventive services by offering a
multitude of no cost or low cost services
Health
Care Reform Timeline:
Health Reform touches all
areas of health insurance plans, including the
individual market, large group, and small
businesses alike. While all face slightly
different requirements, the goal across the
board remains the same – offer health insurance
coverage to every eligible resident. Let Health
Exchange Quote Insurance Agency agents answer
your questions about health care reform and how
it affects you. Call us today!
Essential
Health Benefits (core benefits)
Newly sold
health plans must
cover services that
fall into these 10
categories of Essential
Health Benefits:
-
Ambulatory
patient care
-
Emergency
service
-
Hospitalization
-
Maternity and
newborn care
-
Mental health
and substance abuse disorder treatment
-
Prescription
drugs
-
Rehabilitation and habilitation
-
services and
devices
-
Lab services
-
Preventive
and wellness services and chronic disease
support
-
Pediatric
services, including dental and vision care
New Standardized Plans: Platinum,
Gold, Silver and Bronze.
Covered California
insurance plans will be
grouped by cost and value, using
standardized
information so you can
make
apples-to-apples comparisons
among plans,
see your expected costs
more easily
and get the coverage
you need.
There will be
four basic levels of
coverage: platinum, gold, silver and
bronze. As the coverage goes up, so
does the monthly
premium payment but
your cost when you receive medical care
is usually lower. You can choose to pay
a higher monthly cost so that when you
need medical care, you pay less. Or you
can choose to pay a lower monthly cost
so that when you need medical care, you
pay more. You have the choice.
These changes to health insurance are
designed to give consumers protections
and help them stay healthy.
Each carrier will
offer 4 core metallic health plans (Platinum,
Gold, Silver, and Bronze) plus one more lower
priced option for younger people. This is true
for both individual or group health insurance
which has traditionally offered very different
benefits and corresponding rates. The exchange
plans available through
Pacific Health Brokers (we
will include all in your proposal) will
be slightly different from carrier to carrier as
each California carrier will modify benefits to
meet the main requirements of what makes up a
metallic plan. Pricing should be similar as
well and we expect the Silver plan to be the
most popular Exchange plan.
Qualifying for the Subsidy
The Silver plan is the only Exchange plan that will allow a
subsidy based on income. If you make between 150% and 400% of the national poverty
level in 2014
(when the Exchange rolls out), you will likely be eligible for a subsidy.
400% of the poverty level is about $46,000 for a
single individual, $62,000 for a couple and
$94,000 for a family of four. So, about
half of us will qualify for some portion of the
subsidy.
We'll be
able to help you maximize your subsidy through our proposal system with plans on
and off the Exchange. This Subsidy can be sizeable depending on your income level so it's
important to get the maximum allowable amount and that's what we can do for
you!
Should
you purchase outside the Exchange?
Are there
reasons to purchase plans not available in the Exchange? We think so.
The California Health Plans outside the exchange
will most likely appeal more to your Doctors and
Hospitals. Therefore we expect to see
larger provider networks off the exchange.
We expect adverse selection and other factors in
the Exchange will influence the difference
between the two markets. There may
be other smaller benefits but doctor selection
and ultimately cost (due to adverse selection)
are going to drive a marketplace outside the
Exchange. If you don't make less than 400% of
the national
poverty level or want the larger provider network, the
non-Exchange plans may be the best option.
We can't say for sure, but we should have some
idea by the middle of 2014 on how it's going to
look.
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