An FYI on the Patient Protection and Affordable Care Act; individual policies, employer plans, and the expansion of Medicaid (essentially because I’m sick of bullshit, misinformation posts, which are not helping anyone).
This is not a political rant; it is purely informational. Except for the occasional digress on informing yourself about how new laws will have an effect you.
If you purchased your plan directly from an insurance company (self-employed, not offered by employer), and that plan does not meet new minimum standards (i.e., has a pre-existing clause or doesn’t have a well care benefit, etc.), it is likely being cancelled. And, your insurance company has probably sent you a letter offering a much more expensive replacement policy. These plans were given a grandfathered status, as long as the insurance company didn’t change any provisions after March 2010. This was a major point of contention with conservative politicians quoting Health and Human Services’ estimates of more than 60 percent of individual policy cancellations due to the law’s minimum requirements, in 2010. Three years ago.
Did insurance providers make changes to those plans?
Insurance is a for-profit business. Providers stand to make more money with plans that meet minimum care standard provisions in the law. Premiums are higher for these plans than previous individual plans because they cover more and have fewer out-of-pocket dollars now. The same/comparable plans can be found at a lesser rate on healthcare exchanges (state or federal). Even Fox News has reported the plans on the exchanges are cheaper and provide the same coverage. The California exchange offers the same Blue Shield plan I get through my employer, as an option, at nearly the same premium rate. There was also another PPO and an HMO plan offered for my age, location, and income level. Can you still decide to stick with the “replacement” plan. Yup. However, if you fall into this group, you are a big portion of the people aimed for with the implementation of the exchanges. It’s an attempt to create a more competitive market atmosphere for the benefit of the consumer. Through the exchange you may also receive tax breaks that are intended to offset the lack of an employer contribution.
If you have a plan through your employer:
It only has to change, by law, if it does not meet the minimum care or grandfather status requirements. Will it change otherwise? Health plans offered by employers are negotiated with the insurance companies of their choice. Your employer decides what type of plan to offer you, and whether or not (and how much) they contribute to the premium. Plans through employers are pre-tax exemptions. This is no different than it’s ever been for employer based coverage. What has changed is your employer can opt to pay a $2000 fine rather than offering a plan to full-time employees, if they are not exempt based on other conditions. Plus, businesses now have another year to put it off no matter. You are not likely to use the exchange if your employer offers a qualifying plan.
For those in a lower income bracket:
An expansion to Medicaid programs was included in the law for those working, but unable to qualify for assistance, or unable to afford the additional cost of carrying health insurance. If your state chooses to participate. You will qualify for a government run healthcare plan if your income is less than 138 percent of the poverty level. This calculates to less than $16,000 annually for an individual, and scales up to $32,500 for a family of four. This coverage works similarly to an HMO plan. You can see your primary care physician for any illness, copay rate is based on sliding income scale, at anytime of your choosing. All other services, excluding well care, must be authorized through the plan provider. You will qualify for additional tax breaks if you fall into the bracket of income up to 400 percent of the poverty level. You have to go through the exchanges to get these benefits.
There is a gray area in the law. A group of people who ended up left out by the supreme court rulings. Those people, who are making too much for Medicaid, in states opting not to expand, and not enough to get coverage through the federal exchange, are exempt and will not be fined. The ruling allowed states to decide whether or not to expand Medicaid and to run an insurance exchange. Some of the poorest states have decided against it (25), two are on the fence, and 23, plus the District of Columbia, have opted in. Exempt individuals can still purchase catastrophic coverage through the exchange.
Affordable Healthcare Coverage:
According to federal government standards affordable coverage is no more than 8 percent of annual household income. You can get a rough idea of what that means for you by multiplying last year’s taxable income by .08. The plan must meet the minimum levels of coverage and pay at least 60 percent of medical costs for the group it insures. Keep in mind this applies only to the insured’s cost for a medical plan. It does not include dental, vision, or the cost of insuring dependents.
Wrapping it up:
All of this information is public, and widely “out there” for people to find. I found it by exploring searches on google related to healthcare and having a PDF copy of the act on my phone for reference when reading news articles and opinion pieces by experts. I checked to see if my employer plan met the standards enacted by the law.
The access we have to information negates any excuse for being less than a fully informed public. You may inherently disagree with the law, but to not know, at the very least, it’s major provisions, outside media sound-byte interpretations, is nothing to blame on politicians, and likely willful ignorance based on ideological standings.
Percent of Americans covered through employer plans: 55.1
Percent of Americans with preexisting condition: est. 16-41
Medicare users are largely unaffected by the healthcare law.
Number of Americans who will still be without coverage: 1 in 10
Average annual cost for an employer to provide healthcare: $4266.00
The following list of links provided the information I summarized in the above diatribe, not to mention the number of articles I’ve read over the last three-plus years. I’m, admittedly, a news-junkie. I also have worked in the healthcare industry for ten years. However, several of these sources are easy to find, and view from your smart phone. This entire article was researched and composed on my own hand-held device.