Usually when introducing myself as an independent insurance agent specializing in healthcare, people nod with a “that’s nice’” response. As implementation of the Affordable Care Act (ACA) is now a short six months away, Medicare beneficiaries, individuals and employers all have questions.
Explaining Healthcare Reform basics is a daily event, and since Washington, D.C., released two “whopper” statements in July, I thought a high level explanation would help. Below are brief views for Medicare beneficiaries, individuals with coverage through their employer and those who carry their own coverage.
Medicare beneficiaries. These individuals are the most sensitive regarding healthcare because health doesn’t improve as we get older, and therefore losing coverage could be catastrophic. The ACA does not touch supplemental Medicare coverage as it is offered today. Medicare Supplements and Medicare Advantage plans are available to those currently enrolled and will be to future enrollees. One question always surrounds “Medicare Advantage Plans going away.” A carrier could discontinue offering an Advantage Plan. However, there is a provision stating if this happens, an enrollee is allowed any other supplemental plan without underwriting.
Individuals who receive their coverage through their employer. As of July 2, 2013, neither large or nor small employers will have penalties or requirements beginning Jan. 2014. HHS announced July 2, 2013, they were postponing the employer mandate including penalties for large employers (50+ employees) until January 2015. The Obama administration feels more simplified reporting and time to adjust is still needed by employers. For small employers, there have never been penalties for not offering coverage.
Individuals who have individual/family plans. In January 2014 the Individual Marketplace (formerly The Exchange) will open. As of June 30, Iowa will have two carriers within The Marketplace. Co-Opportunity Health and Coventry will have plans alongside the government. Wellmark and United Healthcare will still offer individual health plans outside the Marketplace. The biggest provision taking effect will be no pre-existing limitations for plans written Jan. 1, 2014 and after. Beginning Oct. 1, 2013, an annual open enrollment period will begin for individuals to choose any plan and carrier for the following calendar year. If a qualified plan is not chosen, a penalty will be assessed. Individuals/families with income from 100 – 400 percent of poverty will be able to choose a plan in the Marketplace and receive a subsidy for premiums. On July 5, 2013, the government indicated no proof of income to receive subsidy for plans purchased in The Marketplace is likely. This could create massive fraud.
If you have questions regarding any of the material above, feel free to contact me. I will always answer questions because knowledge allows you to make informed choices.
Information provided by Janis Van Ahn, Health Insurance Advisor LLC, 5335 Merle Hay Road, Suite 2, Johnston, 515-225-9994, firstname.lastname@example.org.