By
President
HSA for America

Health Care
Reform Update

March 1, 2013
Vol. 9, Issue 3  

 


This is another big year for change, and lots of new information about health insurance has just become available so I’ll share that in this newsletter.  HSA for America will continue to be here to help with your health insurance needs and to explain what your best options may be as they become apparent.  In the meantime, check out our blog if you want to follow the healthcare reform situation in more detail and join the discussion.

Two Major Changes In How Health Insurance Works

Starting in 2014, virtually everyone will be required to carry health insurance, or face a tax penalty.  The biggest change in insurance law is that new plans will have guaranteed acceptance. So if you, or anyone you know, have been declined or had trouble getting health insurance, we will be able to start signing people up in October., And, that coverage will have no exclusions or waivers for health problems.  If your policy has either of those, please let your personal advisor know to help you eliminate them.

The other major change is that millions will be eligible for federal subsidies based on income starting in 2014.   Our mission is to help you keep as much of your money in your pocket as possible, so we’ll help you understand if you qualify for a subsidy, and how to sign up for a subsidized plan if you choose to do so.

Here’s who is eligible for a subsidy from the Kaiser Family Foundation, Summary of Final Health Reform Law.

Annual Income as % of Federal Poverty Level
% of Income Spent on Health Insurance
= 133% of federal poverty (± $14,000 for one)
= 2%
133 - 150% ($14,000 - $15,500 for one)
Between 3% and 4%
150 - 200% ($15,500 - $21,600 for one)
Between 4% and 6.3%
200 - 250% ($21,600 - $27,000 for one)
Between 6.3% and 8.05%
250 - 300% ($27,000 - $32,500 for one)
Between 8.05% and 9.5%
300 - 400% ($32,500 - $41,500 for one)
No more than 9.5%

 

Health Plans Issued before March 23, 2010

If you purchased health insurance before March 23, 2010, it’s considered to be a grandfathered plan.  That just means it doesn’t have to comply with all the rules that went into effect when the Affordable Care Act became law.  It also means that you cannot be required to purchase one of the new federally-approved plans.

No policies, however, can:

  • Limit the amount of your coverage per lifetime
  • Be cancelled when you get sick or made an unintentional mistake on the application
  • Refuse to cover young adults under age 26 through their parents’ policy

Some other provisions also affect all plans regardless of when they were issued.  For example, maximum out-of-pocket costs cannot exceed $6,250 for an individual or $12,500 for a family based on this year’s numbers.

Health Plans Available this Fall

The new policies are divided into four levels of coverage.  Platinum indicates the most comprehensive coverage.  That’s followed by gold with a lower level of benefits.  Then silver plans follow with fewer benefits than gold, and bronze level plans represent the minimum level that’s in compliance with the mandate to be covered.

The Obama administration just released final rules on essential benefits.  They include 10 broad categories, such as emergency services, hospital and doctor services, maternity care, mental health and substance abuse care, and prescription drugs.

And, insurance companies must offer at least one drug per therapeutic category, or the same number as a state’s benchmark plan, whichever is greater.  Insurers must also have procedures that allow you to get “clinically appropriate” prescriptions that are not covered.

If you do not have a grandfathered plan, you will be required to change to one of the new plans by the anniversary date in 2014 of your current policy.

For an expanded version (with more details) about the latest health care reform developments, just click here.

And, let your HSA for America personal advisor know when you’d like help comparing your current health plan to the new plans.  I always advise clients to take advantage of our Annual Comprehensive Policy Review.  Let us do the research to be sure you continue to have the policy that provides the best coverage and value for your situation.  Just contact your personal advisor, or let us know any time you want to review your options.

 


To your health and wealth!




President - HSA for America

P.S. – In future issues, I’ll share some more information to help you decide whether and when to change to a new plan.  The best decision will depend on your personal situation.

 

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