Impacts on people under age 65
The Affordable Care Act (aka ACA or ObamaCare) focuses primarily on people under age 65. While not perfect, it's the law, improving access to health insurance, striving to reduce health care costs. It's survived barrages of misinformation from those who'd benefit from its demise politically and financially. Implemented slowly since 2010, it's about to go into full gear in 2014.
* Lottery Winners? Not exactly, but if you qualify for coverage you could neither afford nor get due to pre-existing conditions, or no longer risk foreclosure or bankruptcy, you may well feel like a winner. Sharing community benefits like roads and schools makes us stronger, costs less, and is our common right.
* Grandfathered plans. If you have Medicare, Medicaid, VA, or a large employer group plan, you don't have to shop the exchange, because your plans meet ACA's exemptions. Folks may keep individual or group health insurance in force since 3/23/2010 meeting ACA's requirements, or they may shop the exchange marketplace. Check with exchange certified insurance agents, or your employer for details.
* Subsidies & Tax Credits. Plan enrollments start October 1st - December 15th through certified agents, or directly around November 1st. You must provide financial and household information to see if you're eligible for premium tax credits or direct subsidies via the exchange. Graded subsidies are available to people with incomes up to 400% of FPL Federal Poverty Level or about $46,000 for individuals, or $94,000 for families of 4; people with incomes to 138% of FPL, a little less than $16,000/person, can get ObamaCare premium subsidies or directly qualify for OHP, (Oregon Health Plan) or CHIP (Children's Health Insurance Plan). Participants may get tax credits advanced monthly to pay insurance premiums through the exchange.
* Shopping on the Exchange. Residents may shop online or in person, see what's available, based on age, income & location. There are over 218 choices you can get advise on from volunteers, or certified insurance agents at no cost to you. Low income folks qualify for expanded Medicaid or reopened OHP plans, through ObamaCare. Affordable dental, vision plans are available.
* Important Dates. Open Enrollment (OE) for the Insurance Exchange runs from 10/1/13 - 12/15/13; plans start1/1/2014. Extended OE runs from 12/15/13 - 3/31/14; coverage starts the following month. People who miss these OE periods will have to wait until next year to enroll, unless they qualify for exceptions like moving out of the area.
* Penalties/Fees/Benefits. All plans must cover "essential health benefits" (eg, doctor/hospital services, labs, Rx, emergency room, mental health, maternity, wellness). If your insurance meets ObamaCare's "Essential Benefits" & requirements (OHP, CHIP, Medicare, VA/TriCare, many grandfathered plans) they're exempted from penalties, as are low income folks, and Indian tribes. Those who can afford plans but don't get them are subject to penalties/fees from 1% of income or $95/person (half/child) in 2014, rising to 2.5% of income or $695/person in 2016, whichever is higher, indexed thereafter. Additionally they must still cover 100% of their healthcare costs.
* Existing Benefits. ObamaCare already covers children 19 & younger; young adults may stay on their parent's plans until age 26. Preventive care like checkups, cancer, diabetes, colon, prostate, other screenings, mammograms, and contraceptions are free. Insurers may not deny coverage due to health conditions, pregnancy or disabilities, nor cancel plans retroactively.
* Plan Options. The richer the benefits (Coinsurance/OfficeCopays/Deductibles/Out of Pocket limits), the higher the premium. There's Standard Bronze 60%/$60/$5000/$6350; Silver 70%/$35/$2500/$6350; Gold 80%/$20/$1300/$6350; Platinum 90%/$10/$100/$1000, plus several other options of benefits/premium per group. Also available are catastrophic plans for those under age 30; plus plans for individuals, small groups (2-49), and Large groups (50+) with various options, deductibles, and co-pays. Plans allow you to keep your doctors if they're in their network. Shopping the exchange shows you plan options, and determines eligibility for subsidies.
The controversial Affordable Care Act (aka ObamaCare) has survived many attempts to repeal it and endured masses of misinformation from those who'd benefit from its demise, financially or politically. But it's the law, having passed both Congress and the Supreme Court. While not perfect, it'll improve health care access (but does not give full universal coverage at much lower costs, as would say Medicare for all). So, let's look at its impacts on seniors aged 65+, since most have focused on impacts for those under age 65 instead.
* Preventive Services. ACA increases use of preventive services, lowering health costs for all, with no copays to seniors. Included are annual wellness exams, heart, colon, prostate, mammography, diabetes, bone density, other screenings. Also covered are smoking cessation, alcohol misuse counseling, vaccinations. Additional diagnostic tests or treatments are subject to insurance copays.
* Closing the Medicare Part D Rx gap or "Donut hole". From 2010-2020, ACA’s reducing the amount seniors on Part D Medicare pay for prescriptions once they get in the gap. 6.6 million folks on Medicare have already saved over $7 billion via ACA. They're now paying 47.5% of the plan's gap costs for brand names and 78% of generic Rx costs in 2013, reducing to virtually nothing in 2020.* Extending Medicare Solvency. ObamaCare extends Medicare Solvency from 2016 to 2024. The term "solvency" means when Medicare will start to spend more money than it takes in. It does not mean the program would end then. ACA already raises Part A taxes on wages by 0.9% on earnings over $200,000 for individuals & $250,000 for couples; it also raises a 3.8% tax on non-wage income ie, dividends, interest, rents etc. Removing the cap on Medicare taxes for wages over $113,700, would extend Medicare solvency for 75 years.
reduces Medicare spending growth from 6.8% now, to 5.5% annually, per
the Kaiser Family Foundation, resulting in $716 Billion in savings.
This will not reduce benefits to seniors as misstated by some, but
via over payments to hospitals, reducing hospital payments for seeing
uninsureds, lower payments to medical equipment & home care,
reducing subsidies to Medicare Advantage plans, the rest savings from
waste, fraud & abuse.
* Reducing Medicare Advantage plan subsidies. "Advantage" plans (HMOs, PPOs etc) get around 14% federal subsidies that traditional Medicare Supplement plans do not. Yet they've not been very successful in driving down health costs; subsidies have averaged over $1100 annually for each member. ACA is supposed to cut subsidies to advantage plan but lobbyists & allies successfully delayed this for 2014. These plans threaten to privatize Medicare, costing seniors many more $billions for their health care later.
* ObamaCare includes the Elder Justice provisions requiring more disclosure from nursing homes, also making comparisons between them available for seniors and their families. There is also funding available for medical students to help fill future medical provider shortages.
Oregon Birthday Rule (non-ACA law). The ACA eliminates pre-existing health conditions and underwriting questions only for those under age 65. Starting in 2013, Oregon Insurance Department rules allow Oregonians on Medicare supplements to switch to the same or lesser plan without any health questions within 30 days of their birthday, to save premium. Medicare supplements with health questions are still available year round.
ObamaCare/ACA brings a number of changes to help seniors improve health coverage and lower health care costs. Check with health insurance agents, SHIBA volunteers, navigators from Cover Oregon, accountants, CMS Medicare, other sources for details and information. Despite the misinformation, ObamaCare is what we have now, to make the best of.
--Paco Maribona. Certified Senior Advisor & Independent Insurance Agent541-764-5155