mommabmb

LEMSA

I didn't wanna totally thread jack, but can you direct me to a non biased site that will sum up the healthcare law, requirements, etc?

I work as a provider in a large county ER so I have no involvement in billing, but I get asked about it all the time. Aside from directing them to a non functioning website, I don't really know what to tell them.

Thanks!!

PrimRoseMama

Watching this thread! I feel so confused about all the health care stuff.

MommyKristin88

I need to read up on it, too. Her reply in the UO thread mentioned some things I didn't know. I freaking work for a health insurance company. I should know these things, but it's rarely discussed here.

mommabmb

Here is the most un-biased spot I can find

https://obamacarefacts.com/obamacare-facts.php

There are a lot of links there to more specific questions. I also made a handout for our doctors I will share with you in a second...

mommabmb

** Sorry, I had to edit it to remove any confidential informaiton, but here is the handout info I promised  **

Signed into law in March of 2010, Obamacare is legislation that does not create insurance, but regulates the private health insurance market. The intent is to increase benefits, rights, and protections offered by insurers. The marketplace was created in order to allow simple price comparison and determine eligibility for subsidization of premiums.

 

Facts about Obamacare changes:

·         85% of Americans will experience no change in their Insurance providers. Americans with employers who offer qualified plans or those on Medicare or Medicaid need to make no changes.

·         15% of Americans are currently uninsured and do not qualify for Medicare, Medicaid, or a qualified employer plan.

o    Of the 15% of Americans who don’t have coverage, all will have to either obtain insurance on their own or get an exemption before 1/1/14 in order to avoid paying a penalty (either monthly or on their tax return). The current fee charged is 1% of your income or $95, whichever is less for adults and $47.50 for children. There is a maximum penalty of $285 per family.

o    About half of the uninsured will be able to get cost assistance using the state marketplace. In order to qualify for assistance, persons must make less than 400% of the federal poverty guideline. This means that for an individual making less than $46,021 or a family of four making less than $93,700 will qualify for at least some subsidies.

o    A small percentage of these uninsured Americans will now be eligible for Medicaid (that weren’t previously eligible) due to expanded federal funding to state Medicaid benefits.

·         No health plan can:

o    Charge more or deny anyone coverage due to health status or gender

o    Include a lifetime or annual limit on coverage

o    Deny a claim for a pre-existing condition

·         There are four kinds of plans being offered by the marketplace: Bronze, Silver, Gold, and Platinum. There are higher premiums assigned to better coverage.

 

Common Confusion about Obamacare:

·         Obamacare is NOT an insurance carrier. Obamacare is legislation regulating private and government insurance.  Open enrollment for plans will remain, and coverage can’t be dropped or chosen without a qualifying life event.

·         All physicians are NOT automatically on plans offered through the pathway. Physicians need to enroll in those plans separately. Current website setup makes it appear that all Medicare providers will be accepting these plans, which is not the case.

·         Americans who struggle with paying for coverage but are offered a plan through their employer can NOT opt out of their employers plan in order to sign up for a plan using the pathway.

·         It is NOT always beneficial for uninsured to use the marketplace! Persons who do not qualify for assistance may still find better rates for better coverage through private insurers.

·         Not EVERYONE will be saving money! Due to changes in regulations, some patients will be paying higher premiums for either unchanged or lesser coverage. 

LEMSA

Thank you!

coraggiosa

One thing that should be noted is that if you are planning on buying insurance from the exchange, double check that whatever insurance you choose will be accepted by your doctors and hospitals. For example, one group of hospitals (all owned by the same company) where I live are not accepting one of the two insurance company options on the ACA exchange. I believe they accept non-exchange insurance policies from this company (Anthem BCBS), but they will not be accepting the ones listed on the exchange. Luckily, the other insurance option was able to come to an agreement with this hospital group (which includes the best hospitals in the region), and their options on the exchange will be accepted. 

I've done exhaustive research on this because we have insurance for just our family because we run a small business. It's a real pain in the ass, honestly. I can't wait until I finish nursing school and start working for a company that just provides insurance for our family. The nice thing about the ACA is that now we will at least be getting some help financially in regard to insurance. Small business owners are really penalized by the insurance system in this country, and the costs of insurance really make it difficult to be a small business family.