| CNN | - |
(CNN)
-- As the politicians fuss and fight over the merits of the biggest
overhaul of the health insurance system in this country, you may be
wondering, "What does this all mean to me?
What's up with Obamacare and my health care?
updated 10:59 AM EST, Sun November 3, 2013
Can people keep plans under Obamacare?
STORY HIGHLIGHTS
- Over half the population is minimally impacted by Obamacare
- Small business owners will have more policies to pick from
- Individuals who are uninsured will benefit most from Obamacare marketplaces
It's all about me
The Affordable Care Act, or Obamacare, as it is now commonly known, went into effect in 2010 and was affirmed by the U.S. Supreme Court in 2012, despite the 42 times the House Republicans tried to repeal it.
It will have the most dramatic impact on the 48 million
Americans who don't or haven't been able to get insurance. By 2014,
everyone -- with a few exceptions -- has to have insurance or face a
penalty.
I get insurance through work. Why should I care?
More than half of
Americans get health insurance through work. For those keeping score at
home, that's 55.1% of the population, or about 149 million non-elderly
people, according to U.S. Census data.
If that's you, news about
Obamacare marketplace computer problems and people getting letters
saying they're losing their coverage -- that doesn't affect you.
Few Obamacare choices in many states
Obamacare costing taxpayers billions
Panel: Obamacare roll out 'embarrassing'
What you do have to worry
about is that e-mail reminder your company sends you this time every
year telling you about open enrollment season.
You may notice that information packet is a lot easier to read
and the different plans are a lot easier to compare. You've got
Obamacare to thank for that, since it is now mandatory that these
companies communicate clearly about what they have to offer.
If your child is under the age of 26,
under Obamacare, they can stay on your insurance. It doesn't matter if
they live with you or not or whether they're married or single. As long
as they don't get insurance anywhere else, you can keep them covered.
Also because of Obamacare, many health plans
must offer you free preventative care services. You can get your blood
pressure or cholesterol checked, get a colonoscopy or a mammogram, ask
for a flu shot, seek counseling for alcohol or smoking, find out if you
are depressed and seek other preventative screenings. Since studies show 70% of all health care conditions are considered preventable, in theory this should keep a lot of people healthier.
If you are a woman,
you no longer need a referral to see a gynecologist. Maternity care is
provided. So is birth control, which would come at no cost in most
plans.
Now if you are denied a payment
new rules give you a chance to appeal a decision and if that doesn't
work Obamacare lets you take your appeal to an outside independent
review panel. The law now says the insurance company has to let you know
why your claim was denied and they have a time limit in which they have
to answer your appeal.
Will I pay more for my insurance?
Your plan will probably take a little more out of your check next year, but really that's nothing new.
Some companies, such as UPS and Delta, did blame Obamacare
for rising insurance costs, but experts say employees will pay more for
their policies because the economy is improving. When people feel more
secure financially, they go to the doctor more and get test and
procedures they put off when they felt less secure, according to Tim
Nimmer, the chief health care actuary at Aon Hewitt an employee benefits administrator.
Aon Hewitt's research
on the cost of insurance predicts employees will spend just under
$5,000 on premiums and out-of-pocket expenses next year. That's up 9.5%
from the year before -- higher than the increases for 2013, which were
more in the 5% range. Over the past 10 years, average premiums for a
family have kept going up a whopping 80%, according to a Kaiser Family Foundation report.
Another reason you'll pay a little more is because employers are continuing to shift the cost of insurance to employees, studies show. There are also new fees on employers and insurers to help cover insurers with new high-risk enrollees.
"I think they key point
is to recognize that victory in health care is not that the cost of your
health care is going up, it is that it is going up more slowly," said Jonathan Gruber, one of the architects of both the Massachusetts and Obama health care plans and the author of a graphic novel that simply explains health care reform.
What happens when I use my benefits?
When you do use your
benefits and go to the doctor, you may have to wait a little longer for
an appointment since you'll be competing with more patients who now have
insurance.
You may have already been waiting a bit, since there is a primary care physician shortage according to the Association of American Medical Colleges.
We're down about 20,000 now, and the number is expected to get worse as
physicians age. And it's not just doctors who are in short supply; we
also need more nurses, according to the Institute of Medicine.
"Keep in mind, the
Affordable Care Act didn't create this crisis," said Dr. Reid
Blackwelder, president of the American Academy of Family Physicians.
"We've got an aging population that needs more care and a growing
population."
If you do go to the hospital, in theory you should be leaving it healthier. The ACA penalizes hospitals
that see patients return after treatment, and facilities have started a
number of innovative programs to try and keep patients well and out of
the hospital.
If something
catastrophic happens to you and it's expensive, that's also where
Obamacare will make sure your insurance continues to cover you. In the
past, insurance companies could dump you if you spent too much. Those
costs are capped under the ACA and there are no lifetime spending limits.
The one thing that was
supposed to change under the ACA that has been delayed is a mandate that
all companies with more than 50 full-time employees get benefits.
Companies will eventually face fines if they don't offer insurance. That
doesn't go into effect until 2015.
What if I own -- or work for -- a small business?
A giant part of the small business community, 96% of small businesses
have fewer than 50 workers. If you own that kind of business, you don't
have to worry about that employer mandate. If you work for one, you
will be able to buy a policy in the new Obamacare marketplaces.
If you do employ more
than 50 people, chances are you already offer insurance to your workers
-- 90% do -- and business owners who are happy with their insurance plan
can stick with it. In fact, many insurance companies are offering
discounts to clients who renew their policies.
If you are in that 3% with more than 50 workers and you do not provide insurance, you will have to start -- or you'll have to pay a penalty starting in 2015.
The government has opened a small business marketplace, also known as the Small Business Health Options Program (SHOP).
It is meant to provide an easier and cheaper venue for business owners
to shop for insurance for their employees. SHOP's website lets business
owners compare plans.
The government offers tax credits
to these smaller business to help pay for this insurance. These are
worth up to 50% of your premium costs. Small businesses can still deduct
the rest of their premium cost not covered by the tax credit. It is
only available for plans bought through SHOP.
Is anyone directly impacted by all this Obamacare talk?
If you don't have
insurance or haven't qualified for insurance in the past, you'll need to
have it by March 31 of next year. If you don't, you'll be fined up to 1% of your income or $95, whichever is greater.
You can buy a plan from a broker at any time. If you want to buy through the new Obamacare marketplaces, open enrollment stretches through March 31. You'll only get a tax break/subsidy if you buy a policy through the marketplaces.
If you are like Jeff
Jones in Lexington, Kentucky, who wants a policy to start on January 1,
you'll have to make up your mind on which plan is right for you by
December 15.
Jones lost his job with
the University of Kentucky and is unable to get on his partner's policy.
"I've been shopping around online but haven't decided on which policy
yet," he said.
Jones has been
comparison shopping through Kentucky's state marketplace website. There
have been some technical hiccups, but he's been able to see what he'd
qualify for based on his expected income. A diabetic, he says he is
grateful this is an option now. Currently, insurance companies could
deny him a policy since he has this pre-existing condition. Obamacare ends that practice next year.
If you can get into the website, you can sign up for a policy through Healthcare.gov.
There's also a phone number to call: (800) 318-2596 (TTY: (855)
889-4325). The number is staffed round the clock. Information is
available in more than 150 languages.
There will also be
specially trained advisers in communities. These "navigators," as they
are known, can help you in person. If you would like to find the closest
navigator, go to Localhelp.healthcare.gov. Plug in your ZIP code and it will give you the closest location to get help.
So bottom line, what does this cost?
Costs of plans vary,
depending on where you live in this country and your age; the White
House says you should be able to buy a plan for less than a $100 a
month. If you want to see what your bill may look like, check out the
Kaiser Family Foundation's calculator. The nonpartisan foundation's tool provides an estimate of your costs, depending on where you live and the plan you pick.
The bronze level is
basic, silver is midrange and gold and platinum are higher-end. There is
also a catastrophic option. Catastrophic insurance covers three doctor
visits per year at no cost and preventive care such as screenings and
vaccines. This plan will carry a higher deductible.
What do I get for my money now?
All plans bought through the exchanges must offer the same coverage benefits. Mental health
is covered, behavioral health is covered, maternity care, emergency
care, hospitalization, newborn care, prescription drugs, rehab, lab
services, and pediatric services. All offer free preventive care. Nearly
all cap out-of-pocket costs to $6,350 and $12,700 per family. No one
can be turned away. No one will be penalized because of their gender
(women often paid more in the old insurance system). Only smokers may be
penalized in some plans and some older people may pay more.
Dental is covered for kids, but it is not for adults. You'll have to buy a separate policy for that or find a policy that offers it.
There are more limited doctor and hospital networks
offered in these plans. That's how insurance companies have been able
to keep costs down and offer all these benefits. Insurance brokers
advise you look to see if your doctor or favorite hospital is considered
in-network with whatever plan you buy. Otherwise, you will have to
switch doctors or pay a higher fee for seeing him or her.
Didn't Obama say I can keep my policy?
Some people who do buy their own insurance have been getting letters from their insurance companies saying their plan has been canceled. That's because their old plans don't qualify under these Obamacare rules that mandate insurance cover all these benefits.
With these plans you
will pay a monthly premium, and may also have a co-pay or be asked to
meet a deductible when you go to the doctor or hospital.
Is there help to pay for all this new insurance?
The good news is, if you
go through the exchanges rather than buy directly from an insurance
company, you will likely be eligible for tax breaks and subsidies to pay
for your insurance. The assistance is available to those with incomes
of up to four times the federal poverty level -- this year, that's
$45,960 for an individual or $94,200 for a family of four -- and will be
calculated on a sliding scale.
You can take this subsidy as a tax credit or the government will pay the insurance company directly.
You may also want to check to see if you will qualify for Medicaid. So far, 26 states
are moving toward expanding who is eligible for the federal
government-funded health program for lower income families and
individuals.
I've got Medicare. Does Obamacare change that?
You are in a group that doesn't need to worry about Obamacare. Medicare doesn't change with Obamacare.
So then, why the fuss?
Studies show people are
politically riled up about all this change in health insurance, but when
it comes down to it, Gruber said the sky won't fall next year and
things should get better.
"Once people experience
it and go through this initial transition, which is going to be rocky,
then they're going to realize the benefits of having a system like
this," Gruber said.
"Yes, if you are young
and healthy it will be more expensive, but right now this is an
insurance market which not only is discriminatory, but the typical
person who buys their own insurance has a very weak insurance plan.
(Under Obamacare) everyone will have will have guaranteed, real
insurance that's fairly priced."
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