We're getting ready to go into our third year of the Affordable Care Act (Obamacare) and, unfortunately, things show no signs of settling down in the health insurance landscape.
Some carriers are pulling out of various markets across the U.S. (United Health Care, largest single carrier in the country being the most prominent), rates will go up for some plans, and who knows what will happen after the presidential election?
The Democrats want to "strengthen" Obamacare, while the Republicans vow to destroy it.
So it behooves you to keep one eye on what's going on between now and November 1st, when Open Enrollment begins again (during open enrollment you have the option of signing up for the first time, or changing the plan you now have).
A quick recap of how things stand now.
In 2014 the Affordable Care Act went into effect, completely revamping the health insurance, as it then stood. Whereas before the players had basically been insurance companies and providers (doctors and hospitals), a new component was introduced, the Exchanges, which became the main focal point of getting insurance.
If a state didn't want to create its own exchange (and many did not), it participated in the federal exchange.
There were differences among the state and federal entities, but they all had the same goal: getting as many people to sign up and be covered by the health care system as possible.
An exchange provides an offering of plans that have to meet certain government minimum requirements and have to offer specific benefits before an insurance company can sell them.
The plans are either on-Exchange (typically offering some kind of tax credit/subsidy based on a number of factors, the most important which are income and family size) or off-Exchange which are almost identical, but have no tax credit or subsidy.
What the federal government does is subsidize these plans to help lower the monthly premium cost or provide a tax credit at the end of the year.
The subsidy/tax credit is based on a rather complicated formula that takes in a number of factors, including household income size, family size, and the relation of one's income to the federal poverty level.
A major change with the Obamacare plans was that no one could be denied based on medical underwriting.
Before there were several conditions such as being in remission for cancer, multiple sclerosis or type one diabetes that would result in a decline.
No matter what the precondition, guaranteed issue is a given.
Also, on individual/family plans, it was almost impossible to get maternity coverage. Even if it were available, there were all kinds of restrictions, including waiting periods and higher co-pays. Insurance plans are now mandated to offer the coverage.
The classification of plans haven't changed.
Basically the higher the plan--with platinum being at the top--the lower the deductibles and the lower the copays. Conversely, premiums will be higher.
A deductible is the amount you pay before the insurance pays anything, and can vary between $1500 all the way up to $10,000. The coinsurance is what you pay on the remainder of the bill once you have paid the deductible, up to a cap. After you reach that cap, the insurance company pays 100 percent of anything left over.
Plans with very high deductibles fall into the category of a "catastrophic plan," meaning that you're going to have a major catastrophic event before you repeat any benefit from the insurance.
The higher the copay the less expensive the insurance premium since you're going to be paying more before the insurance company has to pay anything. (Typically copays run 80 percent, 70 percent or 50 percent, with you being responsible for the remainder. By the way, true catastrophic coverage is only available for individuals under the age of 30 or who meet certain hardship criteria.
The plans will pay benefits based on actuarial values. The insured will pay the rest of the amount, based on predetermined deductibles, co-insurance and co-pays.
Platinum plans will have an actuarial value of 90%, gold will have an actuarial value of 80%, silver will have an actuarial value of 70% and bronze will have an actuarial value of 60%.
Applications submitted by December 15 will have a January 1, 2017, effective date.
Applications submitted after December 15 will have a February 1st effective date, and those submitted after Jan. 15th will have a March 1st effective date. (If the application is submitted between the sixteenth and the last day of the month during open enrollment, the coverage effective date assigned will be the first day of the second following month).
Your premium amount is based on a number of factors, including where your household income stands in relation to the federal poverty level (FPL).
Federal poverty limits vary by family size.
The following table (2016 ranges; may change for 2017) illustrates the income that falls between 100% and 400% of FPL depending on family size.
Income Between 100% and 400% FPL
$10,830 to $43,336
Family of 2
$14,470 to $58,280
Family of 3
$18,310 to $73,240
Family of 4
$22,050 to $88,200
Cost share reduction is another way to cut the cost of health insurance for those who qualify for an on-exchange plan.
Some assistance in sharing the cost of the insurance will be offered to those individuals who purchase health insurance through the exchange and meet income levels between 100% to 250% of the federal poverty level.
The individual must enroll in at least a silver plan in order to qualify for cost share reduction, in addition to meeting the FPL requirements.
Cost share reduction can result in a significant lowering of the cost of the deductible and of copay amounts.
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|4 People||$24k - $95k|
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