Thursday, 26 September 2013
For Younger TGB Readers: Obamacare Enrollment Begins
If you are 64 or younger, today's post is for you.
At last. Whether Senator Ted Cruz likes it or not, on 1 January 2014, Obamacare (the Affordable Care Act or ACA) goes into effect. So that eligible people can be covered by day one, next Tuesday, 1 October 2013, open enrollment begins.
So today's post is a sort of cheat sheet for you - information on how to sign up for Obamacare and even if the government shuts down temporarily next Tuesday, sign-up will go forward:
”...cutting off funds for non-essential government programs in a shutdown wouldn’t stop funding for implementing his health care law, health policy experts said.”
Bloomberg has more information on that.
Obamacare is deeply complicated. I can't even pretend to cover it in any detail and I'm certainly not going to get into the politics of it. Just know that whatever some Republicans say, Obamacare is the law of the land and you are entitled to use it to purchase health coverage.
Mostly, I want to give you an overview of the basics, then provide links to the best, most succinct information available.
10 ESSENTIAL SERVICES
These 10 essential services of Obamacare are required to be included in all coverage plans, no exceptions. They are:
• Emergency services
• Laboratory services
• Maternity care
• Mental health and substance abuse treatment
• Outpatient, or ambulatory care
• Pediatric care
• Prescription drugs
• Preventive care
• Rehabilitative services
• Vision and dental care for children
BENEFITS AND PROHIBITIONS
Here are some of the new benefits and prohibitions.
• Your policy cannot be canceled if you get sick or for honest errors in your application
• No lifetime limit on benefits
• Few annual dollar limits
• Free annual checkups and preventive care
• Coverage cannot be denied for pre-existing conditions nor can you be charged a higher premium for them
You've undoubtedly heard about the new healthcare marketplaces – also called exchanges - where coverage is sold. They are individual to each of the 50 states. Some are operated by the states; others by the federal government.
They are where you go to find health coverage, learn if you qualify for lower costs based on your income, compare different kinds of coverage and enroll – all online. Or, there are “navigators” who can, via telephone, help you find what works best for your circumstances.
Healthcare.gov is the place to start for everyone – individuals and families. The website is extensive, crammed with the information you need along with answers to questions you probably haven't thought of yet.
I assume you know that Obamacare makes purchasing health coverage mandatory and that there is a penalty if you don't buy it. But there are also subsidies for low-income individuals and families.
At healthcare.gov, there is a calculator to help determine if you are eligible for that financial aid. I tried it out using my state, Oregon, with $25,000 estimated income for 2014 for a 60-year-old individual. Here is the result:
Total monthly premium: $848
My percentage: 17%
Percentage paid by federal tax credits 83%
My monthly premium: $144
When I tried again using $50,000 estimated 2014 income, I received a notice that I am not eligible for financial assistance.
As I was writing this post on Tuesday, an email arrived from Maggie Mahar, the respected health and health policy journalist who writes the Health Beat blog. Ms. Mahar points out that Obamacare coverage premiums are coming in much lower than originally anticipated. There are four reasons, she says:
- In the exchanges, insurers are forced to compete on price
- Some state regulators have flexed their muscles
- The vast majority of exchange shoppers will be eligible for government subsidies
- Insurers have brought down premiums by refusing to include health care providers who over-charge (even for simple procedures) in their networks
Yesterday, officials released a state-by-state chart of premiums under the new health care law. They vary dramatically from state to state but are mostly quite reasonable. You can see the chart here.
ONE MORE THING
Obamacare is far from perfect. It is a huge, unwieldy health program and many things will go wrong. They can be fixed. Don't be impatient. Remember, Medicare seemed to be a disaster when it began but one by one, the glitches have been and continue to be addressed and it's pretty hard now to find any elder who would want to live without it.
Whatever we might have wished for – universal healthcare, Medicare for all - Obamacare is what we have. It's a big step in the right direction so give it a chance, let the process of correction go on.
While that happens, remember that now, tens of millions more people than before along with their families and children will finally be able to see a physician. This is a good thing.
At The Elder Storytelling Place today, Arlene Corwin: Lovely Age