Affordable Care Act will NOT be affordable!

It appears that Obama’s Affordable Care Act (ACA) is not going to be affordable for a great number of people.  Last week I attended agent meetings for both Optima and Anthem BCBS.  Though there are a great number of things to be finalized before Oct.1, 2013, the message I received was loud and clear.

My clients, and pretty much everyone else who now has an existing individual health insurance plan, will see significant rate increases for the “new and compliant plans” that will go into effect Jan. 1, 2014 and after. In fact, a lot of insurance companies are recommending that their clients renew their policies early.  This is a special consideration given to existing clients so that they may lock in their premiums until December of 2014.  This will postpone the sticker shock.  I highly encourage everyone affected to sign and return their early renewal paperwork as soon as possible.  If by some chance, a new plan is better because of coverage or premium, the insured still retains the right to buy the new policy.

The insurance companies desperately want their customers to know that they have to respond to the new laws and regulations. Thus in order to remain in business, they have to pass the costs onto the consumer and raise premiums.  For example, every person will pick up the cost of maternity coverage, whether you want it or not.  It is mandated that every qualified health plan (QHP) pay for maternity. In addition, infertility treatments and prosthesis’s are also covered in the mandated law.  No one can be turned down for insurance because of a pre-existing condition.  Therefore, the insurance companies are looking to have to pay claims for those who have cancer, diabetes, and serious heart disease for clients they never sold to before.

If you are my client, you will be receiving a call from me.  If you have another health agent, I suggest that you contact them soon. This is a troubling and confusing time for everyone.



Free Preventative Health Screenings (Before you have to meet your health insurance deductible)

I have a wonderful family doctor and she just ordered a bunch of preventative tests for me.  I asked if they would be covered before my deductible (its high) and she said she  really did not know.  I called my insurance carrier and they said I should ask my doctor. Does anyone know what is on the list of services that went into effect with the Affordable Care Act?  I did some research, and here is a partial list. I am not including children and pregnant women because their list is a lot longer.  There are a lot of screening tests including:

Abdominal Aortic Aneurysmone-time screening for men of specified ages who have ever smoked

Alcohol Misuse: Screening and counseling

Aspirin: Talk with your doctor about taking aspirin every day (depends on age)

Blood Pressure: Get your blood pressure checked

Cholesterol:  Have a cholesterol check if you are an adult of a certain age or at higher risk

Colorectal Cancer:  Screening for adults over age 50.  Does include periodic colonoscopies

Depression:  Talk with your doctor about depression

Diabetes, Type 2: Screening for adults with high blood pressure, and counseling on how to prevent

Diet: Counseling for adults at higher risk for chronic diseases

HIV: Screening for adults at high risk

Immunizations: vaccines for adults (doses, recommended ages, and recommendation populations vary):

  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster (shingles)
  • Human Papillomavirus (HPV)
  • Influenza (flu)
  • Measles, Mumps, Rubella (MMR)
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella (chickenpox)

Obesity: screening and counseling for all adults

Sexually Transmitted Infections (STI): prevention counseling

Syphilis: screening for adults at high risk

Tobacco Use: screening for all adults and help quitting (cessation interventions) for tobacco users

Well Women Visits: you should not have to pay for your appointment to get the following ordered/done:

  • Breast Cancer Mammography: screening every 1 to 2 years for women over age 40
  • Cervical Cancer:  Exam and PAP smears for sexually active women
  • Chlamydia Infection: Screening for younger women and other women at higher risk
  • Contraception: FDA – Approved contraceptive methods, sterilization procedures, patient education and counseling
  • Gonorrhea: Screening for all women at high risk
  • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older
  • Osteoporosis: Screening for women over age 60 depending on risk factors

A few notes and disclaimers:

  1. These are preventative screening tests.  Once you have been diagnosed with something, a follow-up test does not mean free.
  2. They are only screening tests.  If something is found, the test my no longer be “free.”
  3. Your insurance carrier will decide what you have to pay for.  If you disagree, you may always file an appeal.
  4. The above list is not comprehensive and there may be exceptions and fine print.






No Health insurance? – Deadline is Approaching

By January 1, 2014, every American who is not covered under a government plan, will have three options for health insurance.

  1. Get coverage through an employer, if available.  (More employers will have to offer coverage or may be fined. – It depends on their number of employees.)
  2. Buy a health plan through an “Exchange” (you may qualify for a subsidy) or buy directly from an insurance company “off exchange.”
  3. Go uninsured – but you will incur a tax penalty unless you qualify for an individual exemption. In 2014 that penalty will be the 1% the taxable household income.   So, if your family makes $25,000 per year, your penalty will be $250.00.  If your family makes less than $9500 per year it will still be $95.00.

The good news is: no one will be denied coverage even though they have pre-existing medical conditions.  The bad news is: Even with financial assistance for those making less than 400% of the Federal Poverty level (as of 2012, $44,680 for an individual and $ 92,200 for a family of four) it will still be a significant premium bill that most will not have the budget for.  In addition, even with a plan, there will be fairly large copayments and deductibles.  It will not be free as many people now falsely think it will be!

March 23,2010 – Why is this Date Significant to Those Who Have an Individual Health Insurance Plan?

 It is the date that President Obama stated that if you like your current health insurance, you can keep it.  It is the date that your individual health plan can be “grandfathered”, according to the new Affordable Care Act.  If you purchased your plan before this date (and it hasn’t been through certain changes since then), you can keep it.  Or you can change it if you can find something better or less expensive.  It is up to you to decide whether to keep your grandfathered plan.  The following are reasons to help you decide.

Three Reasons to stay grandfathered:

  • Your current plan will not have to include some of the benefits that the Affordable Care Act (ACA) now requires of the new plan.  For example, you will not be paying for maternity coverage if you do not need it.  This could help control costs over time, but it does not guarantee that rates will be lower now or in the future.
  • Your current plan will not be limited to certain “categories, also known as the metal plans” that will take place in 2014.  For example, if you currently have a plan with rich benefits, you may not be able to buy one that is as good.
  • Many health care reform provisions will not apply, so you would not be affected by the changes that could change your deductible or share of cost.

Four Reasons NOT to stay grandfathered:

  • A new plan would include all of the additional benefits the new law requires, including expanded preventative care.
  • You would have more flexibility to manage your premiums by choosing different benefits or increasing your deductible.
  • By staying in the old plan, you would be part of a “closed” plan that is no longer sold to new applicants.  That means you could see higher premiums or costs which typically happens when new and healthy applicants are not being added to the “closed pool” of members.
  • In order to receive a subsidy (based on income and family size) for your premium, a new plan has to be purchased through the Marketplace Exchange.

If your individual health plan was effective after March 23, 2010, you may stay in your current plan until its policy anniversary date unless you choose “metal plan” before that time.

How will the Affordable Care Act (ACA) affect Me?

How Will the Affordable Care Act (ACA) affect Me?

I am often asked about the Affordable Care Act (also known as Obamacare) and how it will impact my clients with Medicare.  Good question, and we probably won’t know until it is fully implemented and has been in effect for a while.  However, this is what we do know:

  • It started to be implemented in 2010 and should be fully implemented by 2014.  Most changes involving Medicare are already being implemented.
  • It is the ACA that will eventually eliminate the “donut hole.”   It started with a $250 rebate check to those who hit the coverage gap in 2010.  In 2011, brand name drugs were subsidized 50 % and generic prescriptions saved 7%.  Each year, the gap will close further so that in 2020, the donut hole will disappear.  (This does not mean that prescription drugs will be free – you still will pay approximately 25% of the cost.)
  • The ACA requires that insurance policies, including Medicare Parts A & B, cover preventative care for adults with no co-pays or deductibles (2011).
  • Under the Affordable Care Act, your existing Medicare-covered benefits will not be reduced or taken away.
  • You still should be able to choose your own doctor.

It is this last point that concerns me for a couple of reasons:

  1. In 2014, there will be a lot more insured people in this country.  The ACA will make it possible for many people, who could not previously afford or qualify for coverage, to obtain insurance.  Of course, they will want to see the doctors too.  Will it be harder to get an appointment?
  2. Medicare providers are already limited by law to collect in full for their services.  We already have a shortage of physicians who will see Medicare patients due to reimbursement issues. The Affordable Care Act is scheduled to further reduce their compensation.  Will even more doctors stop seeing Medicare clients?
  3. Reimbursement for Medicare Advantage Plans have been cut every year since its implementation in 2006.  If Medicare Advantage plans continue, they will probably be set up as HMO’s, the most cost-effective model.  These plans generally require that you see a doctor that is “in network”, again, limiting your ability to choose your own doctor.

Most important of all, is that the Affordable Care Act is supposed to make Medicare more secure and control rising costs.  Time will tell.