Still confused about the change in health insurance? We’ll help you figure it all out at no charge. First, if the policy you have has been “grandfathered” in under Affordable Care Act (ACA) because you’ve had it since Marcy 23, 2009, you can keep it. Grandfathered plans will generally have lower premiums than new plans. If you do not have a grandfathered plan, you will have to change to a new approved plan sometime in 2014. You can see below when some of the major carriers will be updating their policies to the new ACA-compliant coverage. (Note – before then you’ll want to talk to us, so you can review all your options).
See What’s Happening with Non-Grandfathered Coverage
Anthem Blue Cross Blue Shield will offer you a choice if your policy is not grandfathered in under new requirements. Anthem will send a form to be signed and returned indicating acceptance of the compliant policy most like your current policy on the anniversary of your date of coverage. Or, you can keep the policy for 12 more months by completing a new policy option acceptance form that will be effective December 1, 2013. If you extend a non-compliant plan, you will need to change policies in December 2014 because the plan will be discontinued.
Assurant will renew non-grandfathered plans on December 31, 2013. That will allow you to keep existing pre-reform coverage through December 2014.
Celtic will discontinue non-grandfathered policies when they come up for renewal in 2014. If you get a Celtic policy December 1, 2013, it will end June 1, 2014. If you apply in August, that coverage will last for a year.
Cigna will send you a letter in October or November explaining if you can save money by switching to a new plan or advising you keep your existing policy for one year. All Cigna plans will renew on December 31, 2013.
Humana will let you keep policies that have been grandfathered in under new coverage requirements for as long as you pay the premiums. For other policies, Humana will offer you a choice of the two compliant policies most similar to your current coverage.
United Healthcare will renew non-grandfathered policies December 31, 2013, and you may keep them until the end of 2014. They will also continue to renew policies that have been grandfathered in under new requirements for as long as you pay the premiums.
If I didn’t list your carrier, it probably means they haven’t released the information yet. But don’t hesitate to contact us directly if you have questions about your particular policy.
Understanding Tax Credits
There are four different categories of new plans: Bronze, Silver, Gold and Platinum. The plans must have the same benefits, which are known as Essential Health Benefits. However, companies may add more benefits. That won’t bump a Silver plan, for instance, into the Gold plan category, though. Categories are based on average expected out-of-pocket costs for policyholders.
With Silver plans, the plan will cover 70 percent of health-care expenses for an average group of policyholders over a 12-month period, and policyholders will pay for 30 percent. That could include co-payments, co-insurance and deductibles. It does not include premiums.
That 70 percent applies to all policyholders in general. Individual cost sharing depends on what medical services you need. The general out-of-pocket costs are based on using health care providers that participate in the plan’s network. Your out-of-pocket costs are likely to be much higher if you need a provider from outside the plan’s network.
Even for in-network services, your out-of-pocket costs can vary. Silver plans could have annual deductibles ranging from $250 to $2,000, or co-insurance from 15 to 30 percent after you’ve met the deductible.
The tax credit will be based on the premiums of a selected Silver plan available in your state, but you can use a tax credit to buy a Bronze, Silver, Gold or Platinum plan. The amount of credit you get will depend on your annual income and the number of people in your household.
Credits are designed to keep your annual cost for health insurance below a certain percentage of income. If an individual makes between $32,500 and $41,500, for instance, credits are expected to keep health insurance costs from exceeding 9.5 percent of that. A family of four earning up to $94,200 would also pay more than 9.5% of their income, or $745.75, for a Silver plan. There are several levels of credits for all size families. For an individual earning about $14,000 in 2014, the credit is expected to keep the cost of health insurance down to two percent of their income or less.
Not Sure What to Do?
If you have a grandfathered plan, you probably want to keep it, at least for now. But if you don’t you will be required to change to a new plan sometime in 2014. In most cases you can keep your current carrier, and they will simply map you to a new plan. But if you want to make sure you’re staying in the plan that offers you the best value, just get in touch with us, or with your Personal Advisor, when you’re ready to talk. The two of you can discuss your coverage, compare it to new options as soon as possible, and get answers to your questions so you can make an informed decision.
To learn more, I also invite you to attend our upcoming live webinar on health care reform, and how the law may affect you.