By September 30, midnight either Obama’s Healthcare Plan, or The Affordable Care Act, Obamacare, will become effective immediately or will be postponed for another year. October 1st is also the deadline for upcoming insurers to be able to apply for healthcare insurance. The discussion is important to all of us for more than one reason. Depending on what your personal situation is, will determine how you fit in with the new healthcare plan: it may help you financially, or with current health problems, or emotionally, providing assurance that your health care bills won’t drain you financially. Or it may become a source of concern over maintaining your current job or getting a new one. You may also have religious concerns over the government wanting everyone to be insured. The following summarizes information on obtaining health care coverage, Obamacare and future alternatives.
This is a short refresher on how an employer picks an healthcare plan and company. An employer, whether small or large, sets aside money for their employees’ medical insurance. The employer has contacted several healthcare insurance companies, or insurance carriers, to receive a quote or fee amount for insurance for the total of their employers who will have coverage. They make a decision on the insurance company who can serve their employees the best and of course who is affordable. In the more recent past, employers have not provided insurance to part-time or contract employees. Also, they may pick one insurance carrier one year, and change the next. They may use more than one insurance company. An human resource administrator will go over with each employee who’s eligible, the healthcare options that are available within the company. The best coverages are more costlier. In addition, those who are married, single parents and individuals may want to provide coverage for the spouse, significant other and/or children. Partners of the same sex are an additional consideration, and the laws that govern their residential state.
Fees for these situations are covered by using a combination of high deductibles and/or high monthly premiums to low deductibles and/or low monthly premiums. The lowest premiums or deductibles is usually a single employee, like a recent college graduate. The insurance carrier has contracted with a list of practitioners, hospitals, laboratories, and specialists, grouped together, are a network, like Bon Secours doctors, laboratories and hospitals here in Richmond. The insurance company contracts with one or more networks, charges an annual fee or premium, to the employer; which the employer recovers by charging all or partially back to the employee for their individual or family health costs, calculated by that insurance company. Usually the better financially the company is, the better the employee’s options for healthcare. The exception may be the doctor or hospital employers, who will most likely be covered in-house.
The Aflfordable Care Act today
The Affordable Care Act will offer an option for those employees, who have high deductibles, or high premiums that they can’t afford to pay by giving them another option. Applicants will have to show that their current insurance is too high and not affordable, and request coverage for the National Plan or Exchange Program. The enrollment begins October 1, 2013 of this year. For those who are self-employed, part-time, contract employees who aren’t covered, and aren’t provided coverage, they can apply also to the new plan. If you are a minimum wage worker or make less than $14, 400 per year, can enroll in Medicaid in Virginia or possibly sign up for the National Plan. If you make less than $10.000 a year, you will be expected to enroll in the State’s Medicaid Program. If you little or no income, and you don’t qualify for Medicaid program, you may be excused from joining the Healthcare plan and the fees may be eradicated.
Medicaid, is a federal program that each state interprets and applies to its residents accordingly. It is usually available to those who have low to moderate income and have children under 18 years of age. To determine if you qualify, you would contact your local Social Services Department. If you are over the age of 18, are a college students 21 or 22 (the average insurance limit), you can still be kept on your parent’s insurance until the age of 26. This would help college students who will not graduate in 4 years, graduate students, and recent high school graduates with only part-time or no employment.
Senior citizens participating in Medicare or Medicaid have received a discount on their prescription drugs, that has already been applied. Anyone can also apply for a national discount pharmacy card online while applying for insurance at https://www.healthcare.gov. New doctors, alternative emergency clinics, dentists, clinics and some hospitals will allow uninsured individuals to pay on a sliding scale. Small businesses have been given credits for those with less than 25 employees, for those who have signed up for a group health care plan and pay at least 50% of the premium. Note that small businesses with less than 50 employers are not required to provide insurance.
The Affordable Care Act in 2014
All individuals will be expected to enroll in one insurance plan or another if possible. By tax year 2014, fees will be accessed for those who deny coverage. Conversely, new applicants will receive tax credits. Also, updates for check-ups for all will be effective. For instance, if may lose the requirement to receive certain tests by a certain age, and be required to do some others. Some will also be at no charge. Pharmacies will be making changes as well. Certain drugs may not be able to be dispensed at your local pharmacy and have to be sent to a specialty compounding pharmacy, and that drug will be covered.
Also, of course no individual can be denied coverage with a pre-existing condition, if the carrier denies you, you can join the Exchange Program and you will be covered, providing certain conditions are met.
The Future in Healthcare
Jencare medical facilities are a recent way to experience a medical team of physicians, nurses, and lab assistants, without the expense of a hospital. Jencare offers primary care physicians, dentists, acupuncturists, cardiologists, podiatrists, and nephrologists, or kidney specialists. This team currently serves those who have Medicare and Humana HMO. To sign up for this facility, you choose a primary care physician who works with the facility.
Jencare has four facilities in the Greater Richmond area: Mechanicsville, Midlothian, Downtown and Colonial Heights. Although relatively new, the center currently is doing well, is expecting to add more physicians, both primary care and specialists.
This option will allow more satisfaction among customers, less errors, more time with physicians, and quicker results. Errors are important when diverting emergency situations. Mistakes can be made in medications from one doctor to another, causing unnecessary trips to the emergency rooms. So the hope is to cut down on unexpected visits to the hospital.
Other possibilities may be allowing all to easily contribute to Health Savings Account for those who don’t have steady income, more emergency outpatient centers, and the use of nurse practitioners and/or physician assistants in Minute Clinics, who provide first aid.
For insurance carriers, who will have to spend more of the premiums to provide healthcare, having the option to bid on the Exchange Program will be an added plus to their particular company.
The important things to remember is that healthcare , is still in the hands of the insured, and not the insurer. Being your own self advocate for your health is the best option. Find a care center, a physicians’ group, or a comb of services under a trusted healthcare provider that works for you, and gives you a better sense of well-being.
For more information visit www.healthcare.gov and www.naic.org/index.health.reform.section.htm.