Health Care Reform Includes Richer Benefits
The health insurance plans are very, very rich in benefits. More rich, than a number of Mainer’s have had for benefits. The richer the plan, the higher the cost – If today, you own a $10,000 or $15,000 deductible plan; prepare yourself for rate shock. Those high deductible plans go away in 2014; replaced with smaller deductibles, out-of-pocket caps, and more benefits. It is estimated that some may see premium hikes to be three times their current premium.
In these cases, it is very possible that the premium tax credit that you are eligible for does not off-set the now required, more robust insurance. Thus –your insurance will cost more. And, for those who aren’t eligible for a premium tax credit and don’t have any health issues, the Affordable Care Act requires you to buy a plan that is more robust than you need and want to pay for.
This puts some in a precarious situation: To have insurance or to go without? What happens if you decide to go without health insurance? The “individual mandate” requires everyone purchase insurance or pay a fee. In 2014, the tax is 1% of income or $95/adult person (whichever is higher); $47.50/child, with a cap/family of $285. Each year it increases. By 2016 it will be 2.5% of income ($695/adult). In short: Risky business.
There are some forgiving circumstances that exempt you from paying a fee, such as: being uninsured for less than three months; having very low income and coverage isn’t affordable; you don’t file a tax return because your income is too low; being a member of a federally recognized Indian tribe; religious reasons such as participating in a health share ministry; being a member of a recognized religious sect; or religious objections to health insurance.
No doubt, health care reform now has your head spinning. Everyone has their own set of circumstances. And many are trying to find the most affordable way to get the coverage they need. This idea that everyone has insurance or pays a fee, begs the question: what is considered real health insurance? Will any old supplemental/indemnity type protection foot the bill? The answer: No!
To be considered insured, you have to have a Qualified Health Plan. These plans can be purchased in the Federally Funded Marketplace; or can be purchased privately. Either way, health care reform assures the plans have to offer the same set of essential benefits, co-pay levels, and co-insurance maximums.
Some will feel frustrated and left out. Beyond qualified health plans, there are a variety of resources to tap into, that many people may not be aware of. Hospitals throughout the state offer free and discounted care to people who income qualify. There are a variety of discounted prescription drug plans that help people struggling to pay for prescriptions. The Affordable Care Act has funded navigators to help people; a visit to the local DHHS office can help; or simply find a good health insurance agent who cares. There is no charge for any assisted provided by these resources.
Still feeling perplexed, bewildered, dazed or confused abut health care reform? A local health insurance agent will happily assist you in not only making the choice that best suits your needs, but servicing you throughout the year.
Karen Vachon is a freelance writer and licensed health insurance agent in Scarborough. She can answer health care reform questions. Follow her on www.facebook.com/karenvachonhealth