Affordable Healthcare Act: What you need to know

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Affordable Healthcare Act: What you need to know


Becky Walz
News Editor


In an uncertain world, amid a government shutdown, many Americans are worrying about the Affordable Healthcare Act (ACA) and its effects on individuals and families, despite promises to increase the healthcare services. Farm Bureau agent Gary DeVilbiss has been selling health insurance for 11 years, and has undergone extensive training to help inform the public.

To help alleviate the questions many community members have in northeast Iowa, DeVilbiss has been presenting seminars on the facts of the ACA, including what it is, who is affected, the benefits of it, what choices need to be made, and when the public needs to take action.

“There are still many developments still taking place today, but Jan. 1, 2014 will be one of the biggest day for changes in today’s world,” said DeVilbiss. “There are a few things in the packages that are so far fetched that it is indescribeable.”

Some changes that have already occurred include the grandfathering of some current plans that were issued prior to March 23, 2010.

“Those plans are not subject to many of the rules and regulations of the plans issued after that date,” explained DeVilbiss.

Some of the changes that have come into play in the grandfathered plans include preventative care paid at 100 percent, no more lifetime maximums, changes in out-of-pocket charges, no pre-existing conditions on children under the age of 19, children can remain on their parents’ plans until age 26, even if they are married.

What changes lie ahead?

Everyone in the United States will be required to have health insurance and have proof of credible health care coverage as legalized citizens. AFLAC plans will not be considered credible and will not meet the minimal standards for ACA.

Additionally, no one can be denied health insurance due to a pre-existing condition.

In order to avoid huge out-of-pocket expenses and tax penalties, many in the U.S. will be looking to purchase health insurance coverage that is ACA compliant before Jan. 1, 2014.

ACA compliant plans will include numerous essential benefits including ambulance services, emergency services, ambulant patient services (such as air ambulances), hospitalization, maternity and newborn care, mental health, substance abuse disorders including behavioral health, prescriptions, rehabilitative and habilitative services, laboratory services, chronic disease management, preventative and wellness services, pediatric services including oral and vision.

What will it cost?

Premiums set forth by insurance carriers will have a unique price structure that begins with the inclusion of deductibles, government fees, co-pay, co-insurance, and drug expenses.

In order to enroll before Jan. 1, 2014, patients will be asked only three questions — their age, tobacco use, and zip code.

“Diving into the government fees involved in the price of premiums is where ACA gets interesting,” acknowledged DeVilbiss.

Government fees included within each premium payment will be patients center outcome research fee is $2 per person per year charge, transitional re-insurance is $5.25 per person per month, annual health insurer fee is $7 to $9 per person per month. Added together it is $15.25 per person per month and every person will pay that amount in fees even if they have a grandfathered plan.

Some of the good news is those with Medicare coverage will be relatively unaffected by the upcoming changes in ACA.

But physicians are already concerned about the influx of patients waiting to be seen when the majority of the population of the United States has healthcare coverage.

“One place that many people get confused is – when a plan is picked you want to know your provider network and know what your needs are and term of summary of benefits and coverages,” explained DeVilbiss.

The Health Exchange

The Health Exchange will be useful for individuals to shop for the best possible plan for themselves. Low-income individuals and families qualifying for subsidies in premiums and those who have had poor health and cannot move into a better plan will benefit most from the Health Exchange. The exchange suits people who need the subsidy the most.

DeVilbiss noted that there are some drawbacks to the exchange include limited product choices, lack of communication with the carrier, limited professional guidance on plan selection called navigators with limited training from nonprofit organizations, web-based.

In fact, communication between the insured and the carrier will be relayed through a call center on the East Coast.

In his observations from conducting his six presentations, DeVilbiss said that over 50 percent of the attendees were senior citizens who were concerned that they would not be covered.

“They will certainly be fine, but they may see changes in visiting their physician in a timely fashion,” he noted.

DeVilbiss also acknowledged that many people don’t understand that they sign up or they don’t have coverage issue or that plans are all through insurance carriers, it is not a government health insurance through federal funding.

Looking into the future, DeVilbiss foresees, families being impacted the most for two reasons – the upfront taxes and in some cases, families may be paying for features that they simply will not use.





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