AI23 Blog Season 1 Episode 6 Is Healthcare a Human Right?

Welcome to Health Care Reform!!!

Does my greeting bring warmth and reassurance that all is now well with our health care delivery system in the US, or does it bring fear and trepidation to your soul? For most of us, it’s probably a little of both. It is a normal reaction to a fear of the unknown. In this case however, the Affordable Care Act, the insurance marketplace, healthcare exchanges, or Obamacare (after our president) will bring a major overhaul of how health care is delivered in our country, particularly with the population ages 18-65. For those ages 65 and over or disabled, medicare will remain mostly untouched. The president has also tasked the Centers for Medicare and Medicaid Services (CMS), which oversees medicare, to also oversee the insurance marketplace. In my opinion, health care reform will hopefully change the focus of our system from emergency care and going to a doctor only when we are sick, to preventive care and seeing our doctors when we are well. Many services related to preventive care will now be absolutely free, including annual checkups, well woman and well man exams, breast and prostate screenings for those populations at high risk and over certain ages, and also cancer and heart screenings for those with genetic predisposition. These determinations will now be made between a doctor and patient.

All healthcare plans in the marketplace will fall into 5 categories of essential health benefits (EHB) they provide with varying premiums, copays, and deductibles: platinum, gold, silver, bronze, and catastrophic (available only up to age 30). Platinum plans will have the most benefits and highest premiums and catastrophic the least. Preliminary figures for premiums in Texas average in the range of $400-600 per month, quite high for most. However, a big difference is that policies will now no longer be underwritten based on a person’s health, only smoker and nonsmoker, and age. For a single person earning roughly $45,000 a year or less and married couples (opposite or same sex) earning roughly $65,000 or less, tax credits from the IRS will pay most, if not all, of the premium. These credits can be claimed in advance, to be paid directly to the health care company, or at tax time for reimbursal. Additional credits are available for dependants, and children up to age 26 may now stay covered on their parent’s plan. Cost sharing credits are also available, based on income, to help a beneficiary with deductibles and copays.

Unfortunately all the euphoria and quantity of people trying to enroll has caused the federal computer and website to shut down frequently. The process of enrolling I can sum up as a 4 step process: 1) set up an account. 2) see if one qualifies to enroll in the marketplace. 3) calculate how much tax credit and cost sharing a beneficiary will receive to purchase a plan, and finally 4) go shopping for a plan!!!

A person can do this process himself, online or over the phone, use a trained navigator, or finally use a licensed professional agent. The cost is the same. Obviously, I favor and am compensated by the chosen company for a person using my professional services, but also because a licensed professional, as opposed to the other methods, can actually recommend a particular health plan based on a client’s needs. I consider the two most important factors being if a client has a doctor they would like to keep, making sure that doctor is in the network of providers of the plan. Secondly, if a client has prescription drugs they are taking, making sure those drugs are in the formulary of that plan. Both factors contribute to lowering overall costs to the beneficiary and facilitating relationships with primary care physician, specialists, and pharmacies.

It should finally be noted that dental, vision, and hearing benefits are not now included in insurance marketplace plans as of this date. Supplemental plans which can be purchased as standalone plans as cheaply as $30-40 per month cover these benefits and also offer free checkups

The new insurance marketplace will require forethought, planning, and patience, as evidenced recently by computer mishaps and government shutdowns, but the end result helps insure the many Americans who before had to be reactive, instead of proactive, toward their healthcare.

Hana Pinard
Owner
Pinard Financial Group
281 687 8711