By Ron Braziel
The Affordable Care Act (ACA) – also known as “Obamacare” – has brought Americans health insurance exchanges or “marketplaces.”
With all the changes in the healthcare industry, there are a number of implications for the self- employed, small business owners, and families of employees that are covered by their employer.
Here are a few:
• Complexity continues to increase. There are a multitude of coverage options falling into five different plans, entitled: Bronze, Silver, Gold, Platinum and catastrophic. These plans can be either HMOs or PPOs and in many cases, there are multiple options for both the HMO and PPO Plans. In addition, you can have multiple deductibles in each of the four key plans, and prescription drugs have a separate deductible before any coverage starts. In addition, you have to decide if you want or need pediatric dental coverage.
• Networks have changed and continue to evolve. Most people today are aware of the changing nature of networks under the ACA. More doctors seem to be retiring or changing the way they do business. Many are moving away from the traditional structure and either offering concierge services, going to work for hospital systems or offering their services for cash. But you should know that there are new options such as MyMD ASAP and CallMD that give you the option of talking with a physician and potentially getting a prescription filled at a much lower cost.
• Costs: Be aware that the cost of coverage is going up, with the average increase for 2015 in Arizona rising about 11 percent. When you consider that now insurance companies cannot access their risk (they can no longer ask any health questions) because of guaranteed issue and community rating, it is no wonder that we are seeing, and will continue to see, costs going up.
• Options: You can still elect to go without health insurance or purchase a lower cost plan that is not compliant with the ACA. If you take either of these options you could be subject to the Shared Responsibility Tax (SRT) which will be two percent of your Adjusted Gross Income in 2015 paid in April of 2016 when you file your taxes. My advice: Know your options and choose wisely so that you don’t have any surprises come tax time.
All of this adds up to more complexity in the healthcare world and therefore it is important to seek the advice of someone you can trust. The FFM is not that place because it is not set up or designed to give advice about your coverage options. Instead, find an agent or broker that knows the law and can help you make an informed decision based on your unique situation.
With 15 years in the health insurance business, Ron Braziel is a personal healthcare advocate with US Health Advisors. To find out more, call him at (480) 510-4140.