However, to attempt to help ALL concerned, I thought that it might be beneficial to give a little history of the Affordable Care Act to my followers and a brief synopsis of what is now available under the ACA….
***Affordable Care Act…also known as Obamacare, the Health Care Law, ACA, Patient Protection and Affordable Care Act or PPACA;
***Signed into law on March 23, 2010, with over 50 attempts at repeal as of this date; still subject to attacks and a misinformation campaign (which I recently observed first hand at one of the Candidates’ Forums I attended) launched by opponents who would like to see Obamacare repealed;
***Upheld by the Supreme Court as ‘overall’ Constitutional; states could not be forced to ‘expand’ Medicaid and initially a number of states with conservative Governors chose to refrain from the Medicaid Expansion, however, they all seem to be accepting at this point in time…not all want a true ‘expansion’ but some are offering alternatives such as ‘Healthy PA’ that is in the works for the Corbett Administration of Pennsylvania;
***Prior to health care reform, medical bills were the leading cause of family bankruptcy….statistically, it is still the case, however fewer each year since ACA in existence;
***Prescription drug costs were hurting seniors (and most other individuals) on fixed incomes;
***Small businesses were paying 18% more than large companies for similar plans; it was very difficult for small businesses to obtain medical insurance for employees at a reasonable cost due to the fact that most small businesses were ‘rated’, which means that everyone in the group had to give their health history and the premium was determined based on the age of the employees and the health history of the members of the group;
***People with pre-existing conditions had no protections whatsoever and in many cases, insurance was prohibitively expensive; I, for one, lived without medical coverage for nearly eight (8) months due to the fact the COBRA that I was to pay was over $700/month for me alone….I could not even obtain individual coverage for I have two (2) pre-existing conditions, neither of which will kill me, however, the medical costs associated with it could be what insurance companies might consider ‘high’ at various times….so, since I could not afford the $715/month and no one would cover me with the pre-existing conditions, I was out of luck. I finally found a company that would cover me without covering the pre-existing conditions. How about that? And it still cost me about $320/month….
Insurance reforms include the following:
***No higher premiums due to pre-existing conditions;
***No more lifetime limits;
***No more annual limits;
***Essential Health Benefits (another list) included in all Market Place plans;
***Streamlined appeals process;
***Children can stay on parent’s plan until the age of 26;
***Direct access to OBGYN for women;
***Medical Loss Ratio – rebates to consumers if insurers spend too much on admin/marketing (industry policed);
***Insurance companies have to justify rate hikes;
***Gender discrimination illegal. Age rating has been capped; there are presently three (3) rate categories;
***Free Preventive Care;
***Out of Pocket Maximum for 2015: $6,600 (individual) and $13,200 (family);
Essential Health Benefits Package (all Market Place insurance policies must include)
***Ambulatory patient services
***Maternity and Newborn care
***Mental health services
***Habilitative and Rehabilitative Services
***Preventive and wellness care
***15 adult services (includes 10 vaccines)
***22 women’s services
***26 children’s services (includes 12 vaccines)
Not all Essential Health Services are free, however, they MUST be included in all the plans. Preventive health services (Mammograms, Colonoscopys, Laboratory Work, etc. are all free with the health care plans)
A little bit about the Catastrophic Plan…this was really put in place for the millenials or those who receive financial hardship exemptions. The total out of pocket for an individual with a Catastrophic Plan is only $6,600/calendar year;
***Much lower premiums, but high deductibles;
***Covers three (3) primary care visits and free preventive care benefits;
***After deductible is met, all essential health benefits are covered.
VERY BENEFICIAL to speak with a Certified Application Counselor or a Navigator; you can get counseled for FREE (the government or other entities will cover the cost) and depending on your annual income, you may be offered an advance premium tax credit as well as cost sharing reductions. If you went directly to the Health Care Market Place last year, you probably were not given any additional options other than what popped up on the screen.
If you are an individual looking for health coverage or a small business looking to see what your requirements or options are, please call me at SCB Services, LLC at 484-798-1236 or email me at firstname.lastname@example.org There is a link to the Kaiser Foundation www.kff.org on my website www.scbhrserv.com as well as a link to Pennsylvania Health Access Network www.pahealthaccess.org
Open enrollment for Affordable Care Act begins on November 15th ; Healthy PA (Pennsylvania’s version of ‘Medicaid Expansion’) Open Enrollment begins on December 1st. Good Luck to everyone this year and please call with questions!!!