Obamacare is coming! Obamacare is coming! Do you know what to do?

healthcare reform pic

Yes, it’s true. Despite Congress’ copious & failed attempts to repeal the new Affordable Care Act—I think the count is up to 37 tries now —some of the acts’ most monumental provisions are upon us. So instead of angrily stomping your feet on the House Floor or planning to move to Canada in protest—they have universal healthcare too, btw—maybe it’s time to learn what the ACA means for you.

The Patient Protection and Affordable Care Act, more commonly known as the ACA or Obamacare, was passed in 2010. This bill was set in place to help every American find affordable access to comprehensive health insurance coverage, regulate the health insurance industry, improve healthcare services and keep healthcare costs down. The jury is still out on whether or not this law will be successful in its goals, however like it or not: change is coming. First things first: the insurance mandate.

You may have heard about the ACA’s insurance mandate in the news lately. Provisions of this law required all large employers to offer health insurance to full time employees, and required all individuals to have health coverage—or pay a penalty. The employer mandate section of the ACA instructed employers with over 50 full time employees offer health insurance or pay a penalty. The Federal Government recently postponed the employer-mandate to 2015 to allow employers more time to weigh options and make decisions. The rest of the law, and individual mandate, however is still set to take effect in 2014. So what do you have to do to prepare for the ACA? For those of you with employer supplied health insurance: nothing. However, for others who don’t have access to health insurance through your employer, you’ll have to get health insurance coverage, or face a fine. However, there are new options available to you:

  • If you work full time (over 30 hours) for a large company, come 2015 they’ll have to offer your credible health insurance that meets federal and state standards for coverage, or pay a fine
  • If you work for a small company (less than 50 employees) your company will be incentivized to offer you affordable coverage. However, these smaller companies do not face penalty if they can’t afford or do not offer health insurance
  • If you’re an individual who wishes to buy his or her own plan—you’ll now be able to do so with pre-tax dollars. Health Insurance Exchanges. State regulated market places will help you find the best plan for you and your family. These marketplaces evaluate every plan, and spell out the options in simple and clear language. Plans are divided into categories (bronze-platinum) for your convenience and comparison. Search tools such as monthly premium price, deductible amount and coverage type are available to help you narrow down your choices. If this is too complicated or intimidating for you, there are health insurance brokers than can help you evaluate and choose your own plan. This may be a better option for a first-time buyer or small business.
  • Individuals who purchase their own plans can only do so 1 time a year, unless there are specific circumstances (job loss, COBRA benefits run out, etc.). This is called Open Enrollment; this year’s Open Enrollment is available from July 1st-August 15th, a second 2013 Open Enrollment is available from October 1st through December 7th.
  • For individuals who cannot afford insurance, the federal government and state may be able to provide you with a plan via their Medicaid program. Each state has their own qualifications, so visit your State website to see if you qualify.
  • If you don’t qualify, and still can’t afford your own health insurance via your state health insurance marketplace, let the state/federal government know. You may qualify for a penalty exemption.

Now if you live in Massachusetts, not much will change—as the Commonwealth has had its own version of healthcare reform since 2006. Most individuals already have coverage from their employer, Medicaid or individual coverage plan. If you don’t however, pay attention, as you may have to make some changes.

Another provision requires insurance companies to make changes as well. Health insurers are no longer allowed to discriminate against people for bad health histories. Result: employers with sick employees no longer have ballooned premiums due to increased medical usage. The same would go for individuals. Insurers are no longer allowed to charge female customers more than their male counterparts or older customers more than the younger generation. This is great news for some—however younger individuals will pay more. Leading to the next provision in the law—young adults are allowed to stay on their parents insurance until they’re 26. This mandate was made to help ease the financial burden health insurance can be to young professionals just starting out.

The last provision I’ll mention today—and one that will impact every American regardless of insurance status—is that preventative care services will now be free. That means your annual checkup with your primary care physician, immunizations, mammograms, colonoscopies and more are now available to every person without charge.

Now that every American is closer to affordable health coverage—you should take a look at your plan. Do you need health insurance coverage? Are you ineligible for your state’s Medicaid plan? Your state doesn’t have an expanded Medicaid program? Could you be spending less on health insurance? Are you unhappy with the amount of coverage you receive? If your answer was “yes” to any of these questions, log onto your local state’s health insurance exchange (in MA it’s the Health Connector, and they’re great) and see if you could save on a new plan. If choosing your own coverage is intimidating, you might want to also check out a health insurance broker to help navigate the field and your options!

Don’t know much about your health insurance plan? Getting unexpected bills from previous medical visits? Check out our blog article on Health Insurance 101 or call your insurance agency for more info on your plan!

Still want to know about health reform? Is your state not expanding Medicaid services? Check out this short video by Mary Pat Whaley, a healthcare expert, for a clear overview of the ACA.


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