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ACA explained

By John Miller, 09/13/13 9:47 AM

9-12INSURANCE 002

Under the Affordable Care Act of 2010 everyone will be required to have health insurance – or get fined.

Heather Hill spoke with a small group of residents at the Potlatch Building at the Nevada County Fairgrounds Thursday night about the ACA. The basic idea, she said, is to reduce the cost of healthcare by getting everyone insured. The cost of insurance premiums, she said, has doubled in the last 10 years and in Arkansas there are 572,000 residents who are either uninsured or under insured. Under the ACA, she added, the cost of a premium will be 9.5 percent of a person’s adjusted gross income or less.

The government won’t tell people what kind of insurance they have to have, or what company to use. Hill and Jennifer Fincher will be in the area working as In Person Assistants (IPAs) to help people figure out what they need and find the best policy to meet their needs. Those with preexisting conditions can’t be excluded from getting health insurance under the ACA, and insurance companies can no longer set annual caps on health care. In fact, Hill said, insurance companies will be required to spend 80 percent of their funds on healthcare.

Insurance for many can be purchased through marketplaces. However, if a person or family has insurance through their employer and want to keep it, they can – providing their employer continues to offer it. Hill said under the ACA employers will have to offer insurance for their employees, but won’t be required to offer family plans. In addition, she said, children can stay on their parent’s insurance until they’re 26, regardless of whether or not they live at home. But, if the child has children, the children would have to be on another plan, such as ARKids. Where ARKids is concerned, Hill said, there will be a minor change. Plan B will no longer exist as the co-pays will disappear because the poverty limit is raised. Everyone on ARKids will be on Plan A.

Each plan in the marketplace is approved by the Arkansas Insurance Department (AID) and must cover services included in the 10 essential health benefits. These are: outpatient services; emergency services (ER visits); hospitalization; maternity and newborn care; mental health and substance use services, including treatment; prescription drugs; rehabilitative and habilitative services; lab services; preventative and wellness services and chronic disease management; and pediatric services, including dental and vision care. Arkansas, Hill said, is the first state to require the dental and vision portions in the plan. Additionally, there will be no lifetime limit on benefits.

“The marketplace is where people can get high quality insurance plans,” she said. “People can get convenient, affordable coverage at competitive prices.” She added, signing up is simple as it can be done via phone, online, by snail mail or in person. Appointments will be required for in person assistance and will take roughly two hours. This is to give the “customer” time to ask any questions they may have. The IPAs, Hill said, can’t tell anyone which company or what plan to use, but will help people get the information necessary to make an informed decision for their insurance needs. People will need to bring identification, their social security card and last year’s tax information with them when applying in person as premiums are income based. Changes can be made to update a person’s information throughout the year, and people will have 30 days to make changes after they occur.

There are some exceptions under the ACA. These include a person’s age, where they live and their tobacco use. They can’t be refused insurance coverage, but it may cost more. Hill said this is because the elderly and tobacco users tend to require more medical help, which drives up the cost of healthcare.

People can go online and set up a profile for themselves and their families and find out roughly how much their health insurance will cost. According to statistics presented during the meeting a family of four, making $45,000 a year can get insurance for everyone for $216 a month. Hill said the actual rates will vary based on the plans chosen and needs of the family.

The plans offered will be silver, bronze, gold and platinum. Most people, Hill said, will fall under the silver plan which is a 70-30 plan with the insurer paying 70 percent of the costs. These plans, she told those present, are like regular insurance and will have co-pays and deductibles. The “color” of the plan determines these co-pays and deductibles. The bronze plan is a 60-40 deal, while the gold is 80-20. The platinum plan is 90-10. The more the insurance company pays, with the gold and platinum plan means the policy will be more expensive. All companies in the marketplace, she said, must offer the silver and at least one other plan.

As to the penalties, the first year a person doesn’t have insurance they will be fined 1 percent of their adjusted gross income or $95 for each adult and $47.50 for each child, with the fine not to exceed $285. In year two, the amount goes to 2 percent, or $325 per adult and $162.50 per child, up to $975.

Illegal aliens and the uninsured can go to emergency rooms for medical help, but will only be treated for their immediate needs. Outpatient services will not be available to these groups, Hill said.

ACA coverage is available to everyone who lives in the U.S., is lawfully present in the U.S., is not in jail because of a criminal conviction, and is under 65-years-old. Benefits start Jan. 1, 2014, with open enrollment starting Oct. 1, 2-13 and running through March 31, 2014.

Medicare, Hill said, will remain unchanged with the exception of the “doughnut hole” for prescriptions will disappear and all medications will be paid for.

For more information on the ACA, call Fincher at903-908-3065; or toll-free at 855-283-3483. The web address is: ARHealthConnector.org.