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.
|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.
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.