Ready or not here it comes. The first stages of implementation of the Affordable Care Act are only a few weeks away. Its goal is to provide health care coverage to some 55 million Americans who currently have no health coverage and to expand coverage to those who are underinsured. This monumental plan takes effect January 1, 2014.
Universal coverage is the goal of the plan and will be attained in two ways. First is the individual mandate which requires anyone without any type of health care coverage either through the government or an employer, to purchase an individual policy or face a financial penalty, referred to as a tax. The second way is that employers of more than 50 full-time workers will be required to provide insurance or pay a penalty of $2,000 per worker. If you are one of the millions covered by employer purchased insurance plans, Medicare or Medi-Cal you need not make any changes.
Those who have no employer offered health insurance and thus have to purchase their own coverage may see an increase in rates next year, but it is projected that almost half of these people will be eligible for tax credits to offset the increased premiums. Health insurance marketplaces called exchanges will allow consumers to compare costs and benefits among the available plans and to see if they qualify for tax credits to offset the price of their insurance premiums. These new plans are, for the most part, private (not public) and will compete to earn your business based on price, benefits and quality of service.
You can enroll beginning October 1 at the official website at www.coveredca.com, or by telephone at 888-975-1142 toll free.
People with incomes between $23,000 and $94,000 for a family of four, can receive financial help on a sliding scale to help offset costs. The same help is available to single individuals earning up to $46,000.
Those with very low incomes will be enrolled in Medicaid (Medi-Cal in California). As of January 1, 2014 Medi-Cal eligibility income levels will rise to $15,900 for individuals and $23,550 for families.
The first open enrollment period will last from October 1, 2013 to March 1, 2014. One may sign up via the internet, telephone, mail, or in person at designated centers. Once enrolled, it could take several weeks for the new coverage to take effect.
The law states that people cannot be denied coverage or charged higher premiums because of preexisting conditions. However, premiums may vary depending on age, tobacco use, geographic location and family size.
The new law requires that insurance policies cover the following 10 essential benefits:
- Hospitalization and rehabilitation services.
- Outpatient care (office visits) and emergency care.
- Prescription drugs and laboratory services.
- Preventative (wellness) care and mental health services.
- Pediatric and maternity/newborn care.
The law also eliminates lifetime limits on medical expenses, prohibits insurers from dropping or denying coverage, provides for your child to be covered on your policy until age 26, and caps annual out of pocket expenses up to an estimated $6,400 for individuals and $12,800 for families.
This is a monumental change in health care coverage. Soon there will be a significant change in health care delivery. Stay tuned.
- Terry Hollenbeck, M.D., is an urgent-care physician at Palo Alto Medical Foundation Santa Cruz in Scotts Valley. Readers can view his previous columns on his website, valleydoctor.wordpress.com, or e-mail him at firstname.lastname@example.org. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor.