The Affordable Care Act: What To Expect Next2 min read

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As of  mid-July, we are currently sitting in health insurance “limbo.”  The initial roll out of the Affordable Care Act, also known as Obamacare, is over. The 2015 open enrollment is a few months away and all is quiet on the insurance home front.   During this intermission, I thought it might be a good time to discuss what one might expect as it will eventually heat up again before we know it.  This first installment will discuss the current and upcoming situation for those who do not have access to employer provided coverage.  This includes many self-employed, as well as many employees at small businesses that do not provide health benefits.
For Individuals Not Covered by a Company Health Plan:
Obamacare is now the law of the land.  You may or may not realize that having a qualified health plan is now required, and if you do not, you may owe quite a sizeable penalty tax.  In 2014, if you did not have health insurance with minimum essential coverage, the “shared responsibility payment” is $95 per adult in the family/$47.50 per child, OR 1% of income, whichever is greater.  Beginning in 2015, that penalty jumps to $325 per adult/$162.50 per child or 2% of income, whichever is greater.
Open enrollment for individuals begins on November 15 this year, and ends on February 15, 2015.
After this time period, most consumers go into what is called a “lock-out” period, which means they will not be able to get effective coverage under a qualified health plan until the next open enrollment.
I suggest that you shop your plan options via the exchange, or utilize a quality health insurance agent to help you.  It does not cost you any more for the expertise, and small details in a plan can make the difference in your satisfaction.
One of the biggest issues that I have run into this year has to do with networks.  We have all been somewhat spoiled in the past with open networks, and just about every hospital participating.  Now, with individual plans, networks are a huge factor in the decision as many health carriers have moved to what are called “narrow networks.”  Some of the major hospitals and many affiliated doctors in our state are excluded from some plans, and there may be no out of network benefits.  While cost is important when considering a plan that best suits you, finding a plan with accessibility to your preferred provider is equally as important in the decision making process.  Several additional options are going to be available for 2015, and with recent news about rate increases on current plans, shopping for the right plan will be essential.
A significant number of individuals with their own plan took advantage of early renewal last year, and renewed their plan with a 12/1/14 effective date.
This change means that the first renewal having to comply with the new laws is coming up at the end of this year.  The early renewal was done in order to delay having to change to the new compliant plans, which have a significant higher cost than what they have had previously.  My advice to you is to be proactive.   I have had clients that did not accept the early renewal and are now being automatically changed to the new plans.
The cost of the new plans can be as high as twice the cost of the old plans.  Insurance companies will “map” you to a plan that is close to what you have, but I suggest looking at all the plans with a new perspective.  Major cost savings may hang in the balance.
One more note on individual plans:  some confusion exists on what are, and what are not “Obamacare” polices.  The short answer is… going forward all policies are under Obamacare.
We all live under the new law, and every new qualified health plan now has to have “minimum essential benefits” that complies with the law.  The verbiage gets confusing because of plans being “On” and “Off” the exchange.  Plans “On” the health exchange are eligible for government tax subsidies.  An application must be made to Healthcare.gov, household information must be provided, as well as income information, and other demographic information.  Plans that are “Off” exchange are done through insurance companies, do not qualify for subsidies, and much less information is given in order to apply.  The “Off” exchange plans are usually referred to as private plans.
Stay tuned for the next installment which will cover what to expect in regards to the Affordable Care Act for small groups, and the upcoming renewals for 2015!
Written By: Jim Newett, President of Employee Benefits Group, LLC.  www.ebgindy.com 317-865-9151
 
 

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