Images of Life: Then and Now
INTERESTING STUFF – 20 July 2013

When You're Not Old Enough Yet for Medicare

[EDITORIAL NOTE: I know a lot of people who read Time Goes By are younger than 65 and this post today is specifically for you. But 65-plus readers may want to pay attention for your children and grandchildren.]

At age 65, every American becomes eligible for Medicare and I haven't met anyone yet who doesn't like it. There is a reason some single-payer advocates shout “Medicare for All” and it's a damned good one: even with some omissions and some other relatively minor difficulties, Medicare works well.

It's those pesky years from 1 or 65 that health insurance is so difficult for many if not most Americans; it's hideously expensive and limited in its coverage. That is what the Affordable Care Act – known in shorthand as Obamacare – is supposed to remedy.

Republicans in Congress are still trying to kill Obamacare and if they can't destroy it entirely, they are doing their best to bite off chunks of it.

Even so, in less than three months, on 1 October, open enrollment in the Obamacare state-based health insurance exchanges begins. As the Kiplinger website explains:

”...it will give many older consumers their first opportunity to sign up for health insurance plans that guarantee comprehensive coverage regardless of health status, in many cases subsidized by tax credits.

“Coverage will begin January 1, 2014, when most people are required to have insurance or pay a penalty.”

This means that people are no longer tied to jobs they would rather leave due to health coverage and that the 20 percent of people age 50 to 64 who have no health insurance and therefore skip seeing physicians will be able to rest easier.

Those subsidies will be a boon for low income people plus, it was announced that in New York (and will probably be so in other states too), rates for individual coverage will drop under Obamacare by a whopping 50 percent. See a sample chart here.

As you may have noticed in the news, some states have opted out of participating in the state insurance exchanges. In those cases, the federal government will step in with a federally-operated exchange.

You can check where your state stands on exchanges in this list or map (as of 28 May 2013) from the Kaiser Family Foundation.

The Kiplinger website has done a good job of explaining the coming changes in simple language even I can understand. Here is a sampling:

Will I be required to switch plans?
If you’re covered by a plan that you purchased on the individual market, you may not have to change plans, but you may want to shop on the exchange anyway.

One big reason: premium tax credits are only available to people who enroll in plans through the exchange.

What types of plans will be available?
Plans offered on the exchange will be categorized as bronze, silver, gold or platinum, based on the percentage of health care costs that they cover for a standard population of policyholders.

A bronze plan should cover at least 60% of costs, on average; a silver plan, 70%; a gold plan, 80%; and a platinum plan, 90%.

How can I find the plan that’s best for me?
While the metal categories offer a quick gauge of a plan’s coverage, consumers shouldn’t read too much into these labels.

To get a better sense of the plan that’s best for you, consider your out-of-pocket costs and deductibles, as well as they types of services that require co-payments and co-insurance. And when comparing plans, pay attention to drug coverage and the choice of providers in the plan’s network.

You'll find more thorough answers at the Kiplinger website along with answers to other questions.

Right now, states are in the process of creating their exchange – or marketplace – websites. You can read how each is coming along by choosing your state at this page from the Kaiser Family Foundation where there are, in some cases, links to the exchange websites of the states.

You will continue to hear a lot from Republicans that Obamacare is an abomination. (They voted for the 40th time on Wednesday – unsuccessfully - to kill the program.) Ignore them.

Obamacare leaves a lot to be desired, but it is a good beginning. Three big, important changes are:

  • Denial of coverage for pre-existing conditions is gone
  • So are lifetime caps on coverage
  • Children up to the age of 26 can be kept on their parents' coverage which helps families enormously in this terrible economy for kids just out school

And here's a big ol' sheet of Obamacare facts worth knowing.

Keep in mind that when Medicare went into effect 48 years ago in 1965, it was far from perfect. Through the years there have been glitches, unintended consequences and errors that are tweaked as needed.

No program as big as Medicare nor a switch in coverage as massive this new Affordable Care Act can be as workable as originally intended by its creators without mistakes. The idea is to get it started and then make those fixes as the need becomes apparent.

Obamacare is a good thing and we should all be supportive of it. Who knows, maybe it will lead some day to a single payer system.


At The Elder Storytelling Place today, Marc Leavitt: Just One of the Guys


Comments

I don't know where I am in the system because I'm about to return to the USA after almost 7 years of being served by the NHS! I've got almost two more years before Medicaid. It'll be interesting, that's for sure. I do wonder why Repubs don't just give up on the voting-to-repeal thing. Of course there will be initial problems that require ironing out! That's only common sense. Once this program is really underway, Americans will not want to give it up. I am really going to miss the NHS, it's been wonderful! I can only hope to see the American program even approach the benefits, and hopefully, it will avoid some of the problems, if it ever gets that far.

Obamacare would be a good idea, even if the only thing it did were to separate access to health care from one's job.

Speaking as an American who has lived in Canada for many years, the opponents to Obamacare are frankly off their rockers.

These Republican politicians are doing nothing more than lobbying for their insurance company buddies, and they ought to have their behinds kicked to the curb for representing the almighty $ rather than the best interest of their constituents.

I think there's still a misconception among many under 65 that Medicare is free to seniors and covers 100% of health costs. Neither are true, but Medicare and supplemental coverage is about one third the cost of an individual policy to be fully insured under Medicare. I'm counting on Obamacare bringing the cost down so the Repub's will stop spinning in circles and do some of the people's business. There do need to be some limitations in coverage however because a complete brain transplant will be available one day and at least half of Congress needs that procedure.

Thanks so much for this resource. I'm thinking of a daughter with diabetic hubby out of work and two autistic sons. She works 20 hrs/wk at Starbucks to buy health insurance. In following your links I learned a lot and found this video from Kaiser that gives a simplified intro to Obamacare. http://kff.org/health-reform/video/youtoons-obamacare-video/ With these basics, I feel I can point her towards resources she may need. Thanks again!

Ha! Lauren. Best line I've read in days.

When I was 54 and self-employed I tried to get med insurance but was denied because I'd had uterine fibroids and a hysterectomy. HELLO, wouldn't that make me a better risk, not a worse one? But finally I got coverage. Crappy but better than nothing. Sometimes I asked for the cash rate when receiving services because it was cheaper (how'd you like to pay $160 for a doctor visit?) I had surgery a couple years ago at 58 and had a bill for $26,000, WITH my insurance. When people over 65 complain about how hard things are, I am sympathetic but this is one area it really pays to be older. Thank God for President Obama.

It is too bad that the provision to extend Medicare to the 55-65 age group was not included in Obamacare. People of that age can start running into big health problems and find themselves with medical bills in the thousands of dollars. I have two friends in this fix, both self employed.

I, too, wished for single payer but am grateful for Obamacare as a definite step in the right direction. I have Oregon individual insurance--very pricey, very limited, and always precarious, since, before the law, anyone could be dumped at any time for no reason.
Ronni, as a Portland-area resident, if you had this insurance, you would be covered at only two area hospitals--and neither one is OHSU. So much for the "choice" the Right always claims exists with private insurance.
So many Big Lies, so little time!
I'm so relieved that we've taken this important step forward!

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