Tuesday, September 24, 2013

The Affordable Care Act, ObamaCare, Health Care Reform... What Does It All Mean?

Anthem BCBS logo
Although I may complain at times about the long hours that my husband often works, in actuality I'm grateful that he has a job that provides for our family in a multitude of ways.

Along with his salary and a really cool sabbatical program that has allowed our family to travel all over the world, his company provides health insurance that has made it possible for us to receive all of the care that we have needed.

But I do know full well that there are plenty of families in our country that don't have the same luxury and that there are moms out there that have genuine reason to worry if one of their kids get hurt or brings home a case of the sniffles. Did you know that the average cost of a 3-day hospital stay is $30,000? Or that without health insurance, a broken arm can cost $2,500 or more (and that's without surgery)?

One week from today things will change, however, as October 1, 2013 marks the beginning of health care reform, which was passed in Washington a couple of years ago. Known as the Affordable Care Act (ACA) or ObamaCare, next month will be the start of a complete change in the way we purchase health care coverage and access care.

Barack Obama bill signing
President Obama signing approval of the Affordable Care Act in 2010

I don't know about you, but I didn't know a whole lot about the ACA and health care reform, not to mention its intention and the effects it will have on our nation. Fortunately, I was able to attend a recent online briefing with Anthem Blue Cross Blue Shield and feel much more informed (although I'm still far from being an expert).

Why was the Affordable Care Act created?

Lawmakers decided that health insurance only works if everyone is involved and that it is no longer acceptable to not have some form of insurance. Is putting your financial health in jeopardy (as well as your actual health) something that you really want to risk?

Therefore, the ACA is a system in place wherein everyone can buy health insurance regardless of whether they have a pre-existing condition and women are charged no more than men. This system allows Americans that do not get insurance through work (for example, if they are self-employed), to get insurance through an online marketplace, or exchange.

Plus, they made sure that a number of benefits — dubbed the "essential benefits" — were included no matter what. For instance, emergency services, maternity and newborn care, pediatric services, mental health and substance use disorder services, preventive and wellness services and chronic disease management.

Finally, lawmakers created an incentive for people to buy health insurance with a tax penalty (1% of your annual income, or $95 per individual, $285 per family, depending on which is greater) for those who do not. The goal of the penalty is for people to see that spending money on health care coverage is a better option than spending it on a government tax at the end of the year.


When is the enrollment period?

Open enrollment is extra-long this year, running from the beginning of October to the end of March, ensuring that people have lots of time to ask questions and weigh their options.

But, if you want coverage to start on January 1st, you need to have signed up for a plan by December 15th. And if, down the road, you experience a life change that requires you to re-evaluate your insurance, you will have the opportunity to adjust things.

How do I sign up for coverage?

Starting October 1st, all Americans will be able to sign up for healthcare coverage, as a result of the health care reform law. Those who don't plan to get health insurance from an employer, or through Medicare or Medicaid, will be able to comparison shop for health insurance through online marketplaces or "exchanges."

If you are buying an individual plan on the exchange, this will be a little like comparison shopping on Amazon or booking a trip through Expedia or Travelocity. Depending on the amount that you want to spend, you choose from one of the four levels (or metallic tiers), keeping in mind that if your deductible is lower, that will most likely mean that you spend more on your monthly premium.

For example, at the Platinum tier, 90% of your expected cost will be covered, but you will pay higher monthly premiums. A gold plan will cover 80% of your costs. A silver plan will cover 70% and a bronze plan will cover 60%.  At each level, there will be a few health plan options to choose from and you will be able to choose your own in-network primary care physician, OB-GYN and pediatrician without a referral.

If you're concerned about the cost, remember that your yearly income will determine whether you qualify for financial help — assistance will be available for individuals who make $45,000 a year and a family of four that makes about $92,000 a year.

How do I choose the right plan?

Because the law guarantees coverage, adds essential health benefits and eliminates pre-existing conditions restrictions, some people, particularly those who have paid lower premiums in the past, may find costs will go up. 

Although a number of the big health insurance companies have decided not to take part in the exchanges, Anthem Blue Cross and Blue Shield and its sister plans are committed to making the process work. Anthem feels strongly that higher costs should not be passed on to Americans and their families and have worked hard to keep rates as low as possible by doing things like negotiating with hospitals to make sure they charge lower rates and working with physicians so that you get the best care possible.

Later this fall, Anthem will have online tools available to help individuals choose the right health plan including a Family Checklist and a Subsidy Estimator.

health care family checklist

In the end, for many, health care reform will mean access to care for the first time in their lives and for others it means access to expanded care. To find out much more about the changes occurring next week and how they will or will not affect you and your family, visit:
I was compensated by Anthem Blue Cross Blue Shield and The Motherhood for my participation in this campaign, but, as usual, all thoughts and opinions expressed are honest and my own.


Unknown said...

I must admit I am very confused about what this new health law would do to my premiums and my job.

Rose-Marie said...

For a person who has coverage through an employer, you're very knowlegeable. It still is not affordable for many people, for instance, older people. Under ACA older people are charged 3x as much as younger people!

Remus said...

Ididn't realize that all the changes started next week..... and I had no idea how it would affect our family. Thank you for the additional links... I will have to check those out

Remus said...

Ididn't realize that all the changes started next week..... and I had no idea how it would affect our family. Thank you for the additional links... I will have to check those out

Unknown said...

For Rose-Marie:

Under the Affordable Care Act, health insurance issuers will be allowed to vary rates based on age, but by no more than a 3:1 ratio. In other words, the ratio limits the amount an older person will pay to no more than three times that of a younger person. Few states have an age rating ban in place currently, so this is POSITIVE news for older adults concerned about their rates increasing. By spreading premium costs over a large range of age groups, the plan aims to ensure that health insurance rates remain affordable across the board. However, younger Americans who typically pay very low monthly premiums will see their monthly payment increase as they become part of a wider, higher risk pool.
According to GoHealth data, only 7 states are compliant with the 3:1 ratio created by the Affordable Care Act. (they now can charge up to 7 times more). By January 1, 2014, health insurers in 43 states will have to change their policies and start charging young adults more for coverage and older adults less for coverage.
Example: A hypothetical 20 year old male currently pays $120 per month for health insurance. When he turns 50 years old he can’t be charged more than 3 times $120 per month or $360 per month.

Unknown said...

Sorry all but you are fooling yourselves - ultimately this system can not sustain itself - when you take the free market out (that will happen when all the insurance companies go out of business because they will) and give government control of our health care (which they will oh so graciously except) and then number of people now owed service compared to the number of people paying in for this service = rationing! It is a reality that you don't get anything for free - someone is paying and our gov't is already broke! I am not willing to give my health choices to the IRS - that's who will be processing our requests for medical service. Find out for yourself.

slehan said...

Thanks for the info and the links. I have good health coverage so I consider myself lucky.

slehan at juno dot com

Unknown said...

great information...I will be reading more into it

knickgirl_3 at yahoo dot com