Today is the day!

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Today is the day… One that will probably match the revolution in health care that arose almost 50 years ago. That was Medicare. This one, which will be revised as often and for the same reasons that we refined Medicare- is popularly (or is that infamously) known as Obamacare (PPACA is the legal abbreaviation for the act.)

Today is the day that the Healthcare exchanges are operational. No, you can get the insurance yet- that happens on 1 January. But, now, it’s open season. Oh- you probably don’t leave in the DC metro area, so I’ll explain. (I didn’t know the term either until I moved here a long time ago.)

PPACA IRS site
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

 

Open season is the time of year that you must check to insure that your health insurance coverage (and that of your family) is appropriate. For the purposes of Obamacare, that is October to December of this year. Then, your insurance begins on 1 January.

What happens if you wait? Well, you generally can’t sign up for insurance- or change your plan, except during this time of year. Unless, your situation changes- the term the government uses is a ‘qualifying life event”. Like, you have a baby, get married, get divorced, retire, etc.  (To be covered in 2014, you must register by 15 December 2013.)

I suspect that those states governed by Democrats will have pretty smooth sailing, while those under Republicans will be a little clunky.  (These states are generally being handled by the Fed, and there may be fewer choices.)  And, in those states, tons of folks (ok, millions) will be denied coverage because their states don’t want to expand their Medicare roles. But, I also suspect that will change with time- because the hospitals and physicians will demand those changes. (They don’t want to be left on the hook for unpaid bills.)

As it is written in Pirke Avot (a tractate of the Talmud, which translates loosely in English as the Ethics of Our Fathers) that the universe relies on three things- On Tora, On work and study, On acts of loving-kindness. Well, we will be judging the success of Obamacare on three things, too- On the costs (premiums), On the benefits, and on our customer experience.

Costs or Premiums

In spite of the claims of a certain political party, the premiums for most folks are coming in lower than expected. (Actually, it seems that this party knows Obamacare will work and folks will like it- and then it will be really impossible to repeal, regardless of who is in the White House.) Yes, our premium costs will be lower than those estimated when the law was drafted (2009). But, on individual cases they may be higher- because the benefits required are going to be better than we currently obtain. And, smokers are going to have to pay more, too.

There also will be income-based tax credits for those folks at the lower end of the pay scale. And, most of those folks will be opting for the “bronze” plan, the low end program that covers basic items. However, the bronze plan could leave you will some pretty stiff bills, if you get injured or are seriously ill.

Next up is the “silver” plan, with more benefits- and costs. And, the top of the line are the “gold” and “platinum” plans. You should also know that these are tiers- each tier will have multiple providers (with different doctor and hospital affiliations) in most states.

Choice or Benefits

This is not going to be Medicare, where there are 30 private plans from which to choose. Oh, some states may afford that luxury, but don’t bank on it. Like, New Hampshire that may only have one entrant. And, Mississippi will be another problem. Those states with one or two dominant health carriers (true for about 1/2 of the US) will see fewer choices.

This may be the weakest link in the program.

Customer Experience

I don’t believe the claims that this will be like shopping on Amazon or Travelocity. Especially since we know what they are like now- and don’t recall how they were when they first opened their (web) doors. Given the complexity of linking financial information to the health insurance, the diminished budget appropriations, and the short time frame to roll out the program (even shorter, since it was thought there would be 50 state programs, not 15 or so, with the Feds picking up the rest).

Given these facts, we can assume some of us are going to have to get our insurance information the old way. Yup, we are going to have to make that phone call to a human. The good thing is that these will be American employees with (hopefully) a better command of the language.

 

The New York Times covers the two extremes of the spectrum – the young and healthy and the over-50.  But, the program is a ‘must check out’ for those who have no health insurance and those who purchase their own plans.
The IRS Resource Page, Publication 5093 (just a list of links…)

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12 thoughts on “Today is the day!”

  1. Roy, this is an interesting article. I live in California and it isn’t going well for us at all. We got notified by our insurance that our current plan will not be available under Obamacare. The cheapest plan (bronze) we can now get will cost us $1200 a month for a family of 3. That is almost triple what we are currently paying. To be truthful it is quite painful. It will be interesting to see what happens with all of this.

    1. We have had additional discussions, Julie, so I more completely understand your situation.
      I wish I had a magic wand. But, for starters, you can continue with your current insurance plan. There is NO LAW saying you must participate in the program, if you are currently insured. There are going to be folks (for example, in a lot of MS) that will not find plans to their liking. (MS is not a state participant and there are not – as of this writing- participants in some 30 counties in that state.)
      I have not tried it for your zip code, but it may be (albeit with a higher overall deductible) that buying insurance for 1 and for 1+1 is cheaper. (That seems to have been the case here. Why? I nave no magic answer…)
      Please keep me informed, Julie. I really am interested.

    1. I think the only way you are going to discern if it is good for you, Shawn, is to go to Healthcare.gov and find out what plans exist for your needs. No one else can tell you. (OK, they can tell you- but you need to see for yourself.)

  2. Thank you for this explanation Roy. I have coverage at the moment and probably won’t need to change until 2015 when I will be eligible for MediCare. I live in California where Obamacare has been embraced. Los Angeles County has had a pilot program to expand Medicaid which has been quite successful. There is now preventive care, the remaining emergency rooms are not as crowded, unpaid bills have declined, the doctors and staff are happier and the patients are happier as well, over all.

    So far, this pilot program has been largely successful and California is headed toward a single payer system whether the rest of the country follows or not.

    I love L.A.
    Julia Neiman recently posted..Leverage Bigger Profits with a Charitable Mission

    1. Well, it’s only the first day… And, we need a way to get insurance to those who don’t have it. To keep our overall health care costs down (since we all pay for uncompensated care), so folks don’t have to file bankruptcy when they get hit with big healthcare bills, so that folks will get treatment and live better- more productive- and hopefully more financially secure ones… in other words, for, oh, so many reasons.

      Thanks for the visit and the comment.

  3. Roy,
    You sound almost excited by the fact that healthcare is being socialized here. I’m not. I personally would like to go back to the days before insurance, when you could pay a visit to your local doctor and pay him in cash for services rendered . . . without endless forms to fill out or all the rest . . . Here’s my experience with Obamacare so far . . . two years ago, the premiums of our major medcal policy started rising and went from $400 to $600 per month. My hubby is self-employed. I received a notice from our insurance company last week that because of Obamacare, our HSA would be eliminated (the only good thing about the major medical, very high deductible—$12,000 per year–) our deductible would go up, and our monthly premium (wait for it) would double to $1200.00 per month. Which we cannot afford. So we will soon be among the rolls of uninsured, ironically enough, and we’ll be paying the IRS for the privilege. I’m not happy about it (as you might guess!) and am feeling frustrated, yes, even angry. I don’t want the federal government in charge of my health care, like many Americans! Sorry for the rant, Roy, I’m not mad at you, just at this impossible situation.
    Amy recently posted..Fried cornmeal mush: peasant food that I love

    1. Whoa, Amy…
      Let’s stick with FACTS.
      This is NOT socialized medicine. This is a health insurance program- using PRIVATE FIRMS!!! I am sure that’s the tripe you hear, but the facts are critical.
      Secondly, most folks do not have to fill out one form to obtain insurance reimbursement. (See my next paragraph.) That onus is left to the physician, hospital, or clinic. I understand that increases their costs- which gets passed to us, but that program has been in effect for decades.
      Thirdly, the HSA issue is a function of your insurance company. I do admit that major medical is a program that has been hit- since most folks used that as a secondary insurance. (And, yes, major medical programs do rely on subscriber form compliance and not practitioner. Because it is a secondary program, not primary.) Or, your insurance could be from one of the Blues, which elected to NOT alter their programs to be in compliance.
      I have an HSA that will be in effect for at least 11 more months (who knows what regulations will be passed by Congress in the interim)- because my insurance company elected to grow its subscriber base and modified its program to be in compliance.
      Finally, it behooves you to examine what Obamacare offers you- my bet (since I know where you live) is that your plan will be the same price or lower. Especially, if you rely upon it only for secondary coverage. (Major Medical insurance is one designed to cover large and expensive medical procedures. In other words, it is for accidents, unexpected health concerns and long hospital stays. Its deductible is high so the premiums are lower. I had such insurance when my first daughter was born- and it cut in after my primary insurance cut off. [Her APGAR score was 1- it was hair raising.])
      Seriously- you owe it to yourself to go to healthcare.gov and see what really is being offered to you. And, not rely on what someone with an axe to grind has to say.

    2. Oh, I forgot to add.
      I was- am- and will be- for single payer. Yes, that would render it identical to Medicare. And, it will also render that program more capable of ratcheting down costs that are associated with health care. It worked for dialysis now for some 40 years; yes, there have been glitches, but so have there been MORE with private insurance, and they have all been in the news for years…

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