Recently I took a girls trip to Mexico. During one of our adventures, while dining inside a cave, my friend made some sort of science fiction movie reference, and then looked puzzled at my lack of reaction, or most likely, blank stare. (I may have called her a nerd.) Then we ran into these unusual masks on the street that excited her to no end. Again, my reaction was nothing short of “you’re weird”. It was at that moment when she looked at me and said, “Tanya, I’m not a nerd, you just don’t know S#@^!” And she was right! I didn’t know what Lucha Libre Masks were and why they were such a big deal in Mexico. I didn’t get her movie reference while in the cave because I don’t watch science fiction movies. Maybe because I have girls, or maybe because I’m not interested. Point is, I was clueless.
Which brings me to the Affordable Care Act, ACA, Obamacare, whatever you want to call it…what I do know is that most people don’t know S#@^! about it. When the head of a prestigious doctor’s office thinks people will still be denied coverage due to medical conditions, reality sets in. Time for some ACA 101!
Q: I have pre-existing conditions, will they be covered? Can’t I get denied?
A: Yes, they will be covered. No, you can’t get denied.
Q: Will I be charged more for my pre-existing condition?
A: No. Rates are based on your home zip code & county, your age, and smoking status.
Q: Can I buy health insurance any time I want to?
A: No. Only during the Annual Enrollment Period, (with certain exceptions, known as Special Enrollment Periods).
Q: What happens if I miss the Annual Enrollment Period?
A: You will be “locked out” of the insurance purchasing period, and subject to a 2% penalty based on your household income.
Q: When is the next Enrollment Period:
A: It starts November 15, 2014 and runs through February 15, 2015. Earliest effective dates are January 1, 2015.
Q: Do I pay more if I work with a broker or agent?
A: No, brokers and agents are no additional cost to you, they get paid by the insurance company, but your premium is the same with or without.
Q: I’ve heard doctors don’t accept Obamacare, is this true?
A: If your doctor is in the network, they are under contract to accept your insurance. Be sure to check the network before signing up for a plan.
Q: What exactly is an Obamacare plan?
A: A health insurance policy written by an insurance company like BlueCross, Aetna, Humana, etc., that must provide certain Essential Benefits and provide certain levels of benefits known as metallic levels. The plans must also accept everyone and not impose pre-existing condition limitations.
Q: What if I can’t afford it?
A: You may qualify for a subsidy based on family size, income, and access to affordable employer group coverage.
Q: Do I have to go directly to healthcare.gov to find a plan?
A: No, it is recommended that you work with a broker. They will evaluate your situation and see if you will qualify for a subsidy. If so, they will guide you through and help you pick the right plan. Again, you don’t pay extra for the help of a broker. The broker gets paid by the insurance carrier.
Q: I have a plan and I like it. Can I keep it?
A: Maybe. If it was written before March of 2010 it may be Grandfathered, and you can keep it. If it was written after March 2010 and before January 2014, depending on the insurance company, your plan may be going away. If not this year, then most likely next year. You will be forced to purchase a new Metallic Level ACA Complaint plan.
Q: Who do I call to help me, my employees, family, and friends?
A: Tanya Boyd & Associates is at your service. 972-203-8180 www.tanyaboydassociates.com