The Obama Administration’s Affordable Care Act (ACA) may have divided the nation, but since the controversial law has been upheld by the Supreme Court, we have no choice but to prepare for its implementation.
The ACA aims to change the way we purchase health insurance. People who cannot get coverage through their employers and those who do not have health insurance at all will see big changes. These consumers will no longer need to endure the confusing task of looking at health plans from various carriers to get the one they need. The new law aims to make the entire process easier and more transparent.
Setting up new marketplaces
The ACA mandates the creation of health insurance exchanges where individuals and small businesses can shop for coverage. These marketplaces will allow consumers to easily compare benefits, services, price, and quality of each plan. They can also find out if they are qualified to receive any tax credits.
All plans offered through the exchanges are certified according to the new law. Information and educational services are also provided to help consumers weigh their options. Each state will have its own health insurance exchange. It will be set up by either the state, the federal government, or through a joint effort.
Sign up will start in October
Consumers can enroll through the exchanges starting Oct. 1, 2013 and coverage will start rolling out on Jan. 1, 2014. Those under 65 can choose a health plan, while people 65 and older will be covered through Medicare.
All health plans offered through the exchanges must provide 10 “essential health benefits” as stated under the new law. The required areas are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) laboratory services, 9) preventive and wellness services and chronic disease management, and 10) pediatric services, including oral and vision care.
If you currently have a very high deductible plan with limited coverage, you might need to replace it.
What are the types of plans you can expect?
Health plans offered through the exchanges will range from modest to generous. The exchanges will give customers the ability to compare plans’ costs and benefits just like travel sites do.
Comprehensive plans with certified health benefits may come with a price and customers will pay according to their income. Families can qualify for Medicaid coverage if their incomes fall below a certain level. Meanwhile, most middle-class families will receive a subsidy to offset the cost.
Under the ACA, a family will not pay more than 9.5 percent of their income in premiums. The government shall provide subsidy through a tax credit. The good news is families will no longer have to wait until they file their federal returns to receive these benefits. The new law will immediately offer tax credits to qualified customers.
Those who are currently under an employer-sponsored plan, Medicaid, or Medicare, need not worry about transferring to a different plan.
This article was contributed by Vista Health Solutions, New York based insurance agency that specializes in affordable health insurance for individuals, families and the self-employed. For more information, visit the Health Insurance Exchange guide.