Editor's note: We are proud to introduce a new contributor, Sarah O’Leary, who will write the “Insurance Essentials” blog covering health insurance and healthcare issues. O’Leary is CEO and founder of ExHale Health, which helps consumers across the country successfully manage their health insurance and healthcare provider relationships. The company’s mission is to save consumers time and money on their healthcare through policy/plan selection, claim filing and tracking, reimbursements, insurance-plan transitions and more. We know you’ll find this new blog interesting and helpful.
We’ve all heard a great deal about the Affordable Care Act (ACA) and how it will adversely affect Americans. As a company that represents consumers across the country, we encourage you to see how the ACA affects you and then decide how you feel about it. You deserve the best care possible at a fair price, and that’s all that should matter. Keep these five things in mind as you consider your options:
- Don’t fear needlessly! If you look back to the decades leading up to the passage of Medicare, you’ll see many of the same groups are engaged in the fight against this latest healthcare reform. People over the age of 64 can’t imagine life without Medicare. No system is perfect, but no system at all is dangerous. Many facets of the Affordable Care Act have already been enacted, and it’s already helping insure millions who would have gone without insurance otherwise. The federal web site, www.ACA.gov, is a good place to find information about the Affordable Care Act and how it may affect you. Millions of Americans who have insurance through their employer might not even notice a difference.
- Open enrollment for 2104 begins Oct. 1. The term “open enrollment” can be confusing for the average person who hasn’t purchased health insurance before. Essentially, it is a time period in which people can enroll into an insurance program or make changes to an existing insurance policy without risking a delay in their coverage or financial penalties. Individuals and small businesses owners who want to get health insurance through the Affordable Care Act can begin to enroll on-line through state (and potentially federal) insurance exchanges beginning Oct. 1. The open enrollment period continues through the first months of 2014. If you enroll by December 2013(barring any unforeseen processing issues by the insurance company you choose), you will be covered by Jan. 1,2014. Insurers can no longer refuse care based on their assessments of pre-existing conditions, so the enrollment process should be easier than in the past for individuals.
- Transparent pricing and competition is good for consumers. States such as California made health insurance companies bid on the opportunity to sell individual and small-business insurance policies through the ACA state exchange. This is a “cards on the table” approach to health insurance that can only help drive prices down for average consumers. The 13 insurers participating in Covered California, the name for the state’s exchange, will have to reveal their pricing-structures policy details up front, allowing consumers to shop around for the best policy. This means insurance companies will have to work harder to win an individual’s business. Many experts predict that the competition and transparency will mean that those who have been insured individually in the past may get better coverage for less than they pay now.
- Millions of consumers won’t be denied health insurance because of pre-existing medical conditions. This is an enormous change for individual/small business policy holders. Most Americans who have coverage through their employers (a group plan that isn’t based on an individual’s medical history) aren’t aware that small businesses and individuals have been subjected to higher insurance rates, insurance denial and termination of coverage based on how insurers judged their health. Prior to 2014, private insurers were allowed to decide what individuals they would approve or deny for insurance coverage based on pre-existing medical conditions. Each insurance company had its own – often somewhat arbitrary – list. A major PPO in Michigan, for example, counted acne and erectile dysfunction as potential reasons to deny coverage. Once you’ve been denied individual coverage, it is almost impossible to get it anywhere else. (Major insurers ask if you have been denied coverage by any other insurer because of a pre-existing condition on the application). If you could afford it and it was available, you could end up in your state’s high-risk insurance pool, potentially paying hundreds of dollars more a month than your neighbor for the coverage. The government is also requiring that insurers include an expanded number of tests, exams, procedures and life events (such as pregnancy) in their policies. Coverage of certain mental wellness services will also be made available to individuals under their insurance plans.
- Individuals and small businesses can receive tax credits for participating. Those who qualify can receive tax credits designed to offset the price of the insurance. If you do not get insurance before the deadline, you may be required to pay a nominal fine when you file your taxes. See IRS.gov for more information.
Insurance Essentials is written by Sarah O’Leary, CEO and Founder of ExHale Health. The opinions expressed here are exclusively those of the author. If you or someone you know needs help with health insurance questions or information, go to exhalehealth.com, facebook.com/exhalehealth or call 1-800.381.4741.