Last week I attended a public meeting with a consultant from AON Hewitt sharing ‘Just the Facts’ about the ACA or Health Care Reform. There was no time to discuss ideology or politics (which was good, as we got to cover a lot of ground that way). Some things I thought would be helpful from the presentation are below.
Remember that the ACA (Obamacare) is in Addition to today’s coverage options. Today we have government sponsored or related plans (Medicare, Medicaid and TriCare/VA), plus Individual Plans and Employer Based Coverage – includes active employees, retirees and COBRA). In 2014, we will have all of those, PLUS the marketplace (exchanges) and expanded coverage.
Think you can’t afford health coverage-even under the ACA? There are two ways that you can avoid the “shared responsibility payment”, also known informally as the penalty, or fee. Here is a sampling of the conditions that might yield a waiver or an exemption.
- The lowest-priced coverage available to you would cost more than 8% of your household income.
- You’re incarcerated, and not awaiting the disposition of charges against you.
- You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
- You had medical expenses you couldn’t pay in the last 24 months.
Among the new essential health benefits with no annual or lifetime dollar limit are behavioral health treatment (includes counseling and psychotherapy), plus depression screening for adults. New preventive care benefits are offered at no cost (aka free). And yes, if you are over 50 your colorectal screening is free when offered by a network provider on a plan purchased in the exchange (aka marketplace).
Cost sharing limits have changed and will be indexed according to the ‘premium adjustment percentage’ after 2014. In 2014, the out-of-pocket maximum cannot exceed $6,350 for self-only coverage and $12,700 for family coverage.
Reviewing health insurance/coverage takes a lot of time each fall now, from open enrollment at work, or checking out the latest Medicare Advantage plans. Now we have an ACA marketplace vs. alternatives analysis. You could do it yourself or use an insurance broker. In Washington State, you can contact the Washington Health Foundation for help.
My Personal Conclusion
Yes, it could be more complicated and yet possibly simpler at the same time. There will be fewer questions about your health insurance past due to the elimination of the pre-existing condition policy. As with anything new, it will take time to learn about all the features. In the meantime, I know several families that will be now able to get insurance for 2014.