NEW YORK (MainStreet) – After reading this piece, you should have determined whether you are a candidate for health insurance in the state exchanges. If you are uninsured for any reason, that's you. If you are unsure, go back here and here to look at the list.
So what's next? Dr. Sherry Glied, Ph.D., from the Department of Health Policy and management chair at Columbia University's Mailman School of Public Health told me that a lot of the success of the Affordable Healthcare Act hinges on how easy it is to use the system.
Well, so far it's not easy. But she says once people get used to things, it will become second nature. We're just haven't acclimated to it yet.
Since I am currently uninsured, I want to be ready to make an informed decision about the actual plans that will be available come October 1. I am going to do my homework now (since it has taken many days to get a handle on how it will work).
This is kind of like getting a new Smartphone. You have no idea how to work it initially and a few days later, it is like you've had it for years.
Follow the steps I took to get educated about the ACA and see how it may affect your family's budget (without wasting a whole bunch of time figuring things out).
(Disclaimer: I am an educated health reporter, and it took many days worth of research and fact-checking to figure this all out and get it down on paper. What must it be like for a regular, busy American who has no idea what it's all about?)
STEP 1: Visit the official government ACA website
I started by entering my email right on that home page to get important ACA news updates. Then, I clicked the interactive, "See your options" button and answered the questions. I found that what I would qualify for depends on my family size, state, age, employment and income. But I also learned that many preventative services and screenings I currently opt out of now without insurance would be covered at no charge (other than paying the premiums). I guess that would be good. The website says I will find lower premium health insurance choices than what I might currently be purchasing (although I am currently not purchasing anything except for my kids' insurance). To enroll on October 1, 2013, I am told I need a social security number and a current tax statement.
This all sounds great, but what's it going to cost me?
STEP 2: Find your state's Healthcare Marketplace
Next, from the same ACA website homepage click "Get Insurance" to find you state's exchange, which is where you will be able to compare costs, plans and purchase new insurance on October 1 for coverage that begins January 1, 2014. I found that my state uses the federal government's marketplace, although many states have their own exchanges you can link to from this page.
There, you'll learn about the four "metal" plan tiers: Bronze (40% co-pay), Silver (30% co-pay), Gold (20% co-pay) and Platinum (10% co-pay). The Affordable Care Act ensures that all health plans offer the same essential health benefits and the list is quite long and comprehensive:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care, according to the official website.
You might think the metal tier categories reflect the quality or amount of care the plans provide, but instead, the categories represent levels of premium costs compared to out-of-pocket costs. So, the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs. The marketplace also offers "catastrophic" plans to people under age 30. This doesn't apply to me, but I wish it did.
The website advises if you expect a lot of doctor visits or need regular prescriptions you may want a higher-premium, lower out-of-pocket cost Gold or Platinum plan. If not (like me), choose a Bronze or Silver plan with lower premiums. But if I were to get in a serious accident or have an unexpected health problem, Bronze and Silver plans will require me to pay more of the costs, until I've reached the maximum every year. After that, I am protected from the rest of the costs if I were to get hit by a bus or be diagnosed with the big "C."
Yikes - so how do I calculate all this?
STEP 3: Plug your info into the subsidy calculator
Here's where you can see how much the government might kick in (called a "subsidy") toward your healthcare coverage to make it more affordable (which I've heard might be more than I think). On October 1, you will be able to see the actual health plans offered in your state and the actual premiums. But for now, you can use this calculator, thanks to the Kaiser Family Foundation.
So, I entered my income (I'm using the Adjusted Gross Income from my 2012 taxes), family size, ages and tobacco use of each member and hit "SUBMIT." So here's what I'm eligible for, with a family of 5, based on a silver plan the calculator is calibrated for:
- Household income in 2014: 214% of poverty level
- Unsubsidized annual health insurance premium in 2014: $16,358
- Amount you pay for the premium: $4,013 per year
- You could receive a government tax credit subsidy of up to: $12,345
- Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $10,400
So, let's review: I would pay $4,013 per year in premiums for my family ($334.42 per month) plus approximately 30% of my portion of the costs of any visits and treatments up until I reach the Maximum Out-Of-Pocket (MOOP!) amount of $10,400. I could get a Bronze plan for a yearly premium of $1,213 ($101.08 per month) and pay 40% of the costs and any treatments until I reach an even higher MOOP that was not disclosed on the calculator.
A Silver plan might add a lot of expense and worry to my monthly budget that I think it was designed to alleviate, but I think I could work with a Bronze plan, (as long as we don't really use any healthcare services). We'd all get the preventative services we should be using for free and the protection of a limit on maximum expenditure if something really bad happens.
Go check it out for yourself. Follow my steps and input your numbers.
--Written by Naomi Mannino for MainStreet