FLINT TWP. — Todd Chaney does not have all the answers yet about the Patient Protection and Affordable Care Act (aka Obamacare), because they are still being sorted out. But he gave a concise, easy-to-understand 30-minute presentation to the West Flint Business Association last week on what is known about sweeping health care changes coming next year.
“The government has basically taken the whole industry and they are mandating all of the benefits and how they flow to the end user.” said Chaney, who is a benefits specialist at Security First Benefits Corporation, 3526 Miller Road.
“The law is much more complex than at first glance. There are a lot of changes almost on a daily basis,” he said.
He outlined key Affordable Care Act (ACA) provisions including what the plans will looks like, how much they will cost, ability to keep current plans, who is eligible for a federal subsidy, how to enroll for coverage, penalties for failing to enroll in a plan and new ACA taxes and fees charged to every plan.
Ability to buy an insurance plan will be easier starting Jan. 1, 2014 but “for most individuals they will be more expensive next year than they are this year,” he said.
The reason so many people are losing their current insurance, which has been making headlines recently, is because their plans are being eliminated because they will no longer be compliant with ACA mandates effective in January.
One reason insurance will be more expensive next year is because every plan must provide ten essential health benefits: hospitalization, maternity and newborn care, mental health and substance abuse coverage, prescription drug coverage, ambulatory patient services, laboratory services, preventive and wellness services, rehabilitative and habilitative services, emergency services and pediatric dental and vision.
So currently optional benefits such as maternity care, mental health and substance abuse coverage and prescription drug coverage will become mandatory Jan. 1.
“Maternity benefits and prescription drugs are two of the largest cost factors added to an insurance plan, so that is where a lot of the new added premiums are coming from,” Chaney said.
He summarized the different levels of coverage to be purchased which are named after precious metals and thus called metal levels. For example, a platinum level of coverage is set at 90 percent, the highest level, and means the insurance company will pay roughly 90 percent of all claims with a two percent leeway up or down.
The gold level is set at 80 percent (plus or minus two percent), the silver level is 70 percent and the bronze level is 60 percent.
There is also a “catastrophic” level available only to adults under age 30 who must prove financial hardship to obtain higher deductible plans that are more affordable.
Other coming plan changes include maximum out-of-pocket expenses and no restrictions on pre-existing conditions.
Chaney said that the elimination of preexisting medical restrictions is one he likes because one of his biggest struggles has been finding affordable coverage for people with chronic health problems.
“You can have someone who has terminal cancer and they can buy a plan effective January 1 and the insurance company cannot turn them down,” he said.
Chaney gave a detailed explanation of how Advanced Premium Tax Credit (subsidies work) based on poverty level incomes.
The Internal Revenue Service (IRS) will enforce the subsidy claims when income taxes are filed. That means that anyone who makes a fraudulent income claim to qualify for a subsidy will be forced to pay it back when they file their income taxes.
Chaney also discussed enrollment dates which are being phased into a calendar year after an Initial Annual Election Period from October 1, 2013 through March 31, 2014. After that the only time to add or make policy changes will be Oct. 1 through Dec. 7 of every year, with coverage beginning January 1. Special provisions are made for circumstances such as births or deaths.
Chaney also stressed that beginning Jan. 1 everyone is responsible for obtaining minimum essential health benefits for themselves and their dependents. There are per-person penalties imposed for those who do not, that will increase every year.
Chaney also briefly touched on Medicaid expansion coverage and ACA requirements for small and large employers.