There are big changes coming for some of us this fall with the Affordable Care Act (ACA). If we don’t currently get our health insurance from work, or Medicare or Medicaid, we will see a changed landscape.
The fact that you had a small suspicious spot in your lung X-ray when you left the military, or a heart murmur when you were born that you outgrew – no problem. No “preexisting conditions” can be used as an excuse for denying you health insurance. Nor can they be considered excuses for higher premiums.
No longer will a person use up their insurance by being sick too long: There are no lifetime caps.
No longer will insurance companies be able to charge a senior five times or more what a younger person gets charged for a similar policy; three times as expensive is the maximum.
There will be no waiting time for health insurance when you change jobs. If you have insurance now that you are happy with, you can keep it until it expires. At that point, new policies will have to cover a basic list of defined benefits that are specified by the ACA. That rule also applies to workplace insurance. Businesses won’t have to change anything until their current contract with an insurance company expires.
An important feature of the defined benefits: All out-of-pocket costs must be included in the deductible, e.g., prescriptions, devices, maybe even transportation to the doctor.
The hope is that competition between insurance companies for the new business lowers prices. Regions with low populations have fewer choices than large metropolitan regions. So far, it is not clear how many companies will vie for our business. Despite the fact that insurance companies have to cover everyone regardless of preexisting conditions, they will make money on larger populations.
At this point, we don’t know if alternative medicine treatments will be covered as well, but naturopaths and massage therapists are actively working on that issue. Other specialties are likely doing the same.
If you buy insurance as an individual, you will be able to buy the new, ACA-specified benefits package from several sources and at several levels. California’s market is offering a basic plan that pays 70 percent of expected health care costs for $276 a month. A 25-year-old in Los Angeles would pay less than $200 for a bare-bones plan. These premium prices are much lower than were expected, probably due to heavy competition.
An important feature of the ACA are subsidies to make insurance affordable for those with lower incomes. The subsidies are based on a gross income between $23,550 and $94,200 for a family of four, with a higher income meaning a lower subsidy. Below $23,550, the entire premium will be subsidized.
Wending our way through the new policies will be facilitated by a person trained to deal with the new rules, called a navigator or patient assister. Hopefully, we here on the Olympic Peninsula will have easy access to such help. Meanwhile, here is a website that will explain the health care insurance exchange as it becomes an actual entity: