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The Four Basic Categories of the PP-ACA
By Rick Kahler CFP® http://www.KahlerFinancial.com
The opening date was yesterday, October 1, 2013. And today, the competition is lined-up and ready to go after bronze, silver, gold, and even platinum.
These competitors aren’t athletes, but insurance providers. The field they are entering is the new health insurance exchanges [HIEs] as mandated by Obamacare [ACA].
The New Year
Beginning January 1st 2014, nearly everyone in the US will need to have health insurance or pay a tax penalty. Those not insured through their employers can apply for coverage through these health insurance exchanges, also called “marketplaces.” Enrollment began October 1st, 2013 for coverage starting in January, 2014.
These exchanges are intended to make it easier to find insurance providers and compare their coverage and costs. Each state’s exchange website will list all the policies available in that state, with prices and policy provisions.
So far, over half of the states (including my State of South Dakota) have opted to use exchanges managed by the federal government instead of setting up their own.
The Four Basic [Colors] Categories
Bronze, silver, gold, and platinum describe the four basic categories of policies that will be available through the exchanges at different costs. Here is a very brief summary of each category.
Bronze
The least expensive option is a bronze plan, which might be the best choice for younger people with lower incomes and good health. The plan will pay 60% of health care costs and the insured will be responsible for 40%.
Silver
The second level, silver, will pay 70% of health care costs.
Gold and Platinum
Gold covers 80%, and a platinum plan covers 90%. Obviously, the categories with higher benefits also will have higher premiums.
The Essential Benefits
All these plans are required to cover “essential health benefits.” These include preventive and wellness care like cancer screening, chronic disease management, pediatric care, many prescription drugs, injury rehabilitation, mental health and addiction treatment, maternity and newborn care, hospitalization, and emergency services.
Companies are not allowed to deny coverage or charge more for those with pre-existing conditions. There are no lifetime benefit limits.
The Carrot and Stick Approach
The requirement to have health insurance coverage, the “stick” of Obamacare, is accompanied by a “carrot” in the form of federal subsidies to help pay insurance premiums. It’s estimated that two-thirds of Americans will be eligible for subsidies, which will be figured on a sliding scale. The upper limit for qualifying is four times the federal poverty level, which amounts to about $88,000 a year for a family of four.
Other Outlines
This ME-P summary is just the barest outline of the health care changes coming our way. To find out more, it’s a good idea to spend some time online, especially at two sites that offer a lot of helpful information.
- The First site is the federal government website at www.HealthCare.gov. It provides links to the state exchanges, plus detailed information that for the most part is explained in straightforward, plain English.
- The Second site is the Henry J. Kaiser Family Foundation at kff.org. An especially useful tool available here (http://kff.org/interactive/subsidy-calculator/) is a calculator to determine the federal subsidy that applies at your family’s income level.
Obamacare 2014
The elements of Obamacare that take effect in 2014 represent a huge shift in the way we cover health care costs. I strongly recommend that you start now to figure out what this will mean for you and your family.
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Don’t wait until December and end up making hasty decisions in a last-minute rush. The more informed you are; the better insurance choices you can make.
Assessment
The changeover to the new insurance environment is likely to be chaotic and confusing. Navigating it will take some energy, commitment, and stamina. When all the scrambling is over, we can only hope the ultimate winners will be the American people.
Conclusion
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Filed under: Health Insurance, Information Technology | Tagged: ACA, Affordable Care Act., Healthcare Exchanges, Kaiser Family Foundation, ObamaCare, PP-ACA |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Amount of Eligible Uninsured Who Could Purchase Marketplace Coverage for $100 or Less after Tax Credit
– Total Marketplace Tax credit eligible – 18,586,000
– Silver plan for $100 or less – 6,425,000
– Bronze plan only for $100 or less – 4,343,000
– Percent of Marketplace eligible who could purchase coverage for $100 or less is 49.1%
Source: Department of Health and Human Services Office of The Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy
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Everything You Need to Know About Health Care Reform
[A 25 Minute Video]
http://diseasemanagementcareblog.blogspot.com/2013/09/everything-you-need-to-know-about.html
Thanks to Managed Care Magazine, and the DMCB, as we re-post this interesting 25 minute interview with Princeton healthcare economist Uwe Reindardt, PhD.
Ann Miller RN MHA
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More on the State Health Insurance Exchange Blind Spots
http://thehealthcareblog.com/blog/2013/09/23/state-insurance-exchange-blind-spots-unknown-risks-and-unintended-consequences/
Unknown Risks and Unintended Consequences.
Samatha
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Too Many Choices?
Rick – A new body of work examines how Medicare beneficiaries respond to the many choices they have for comprehensive health and drug-only insurance.
http://blog.academyhealth.org/too-many-choices/
The unifying question is, are there too many choices, overwhelming beneficiaries’ ability to make rational decisions?
Now, what abut Omamacare?
Chesley
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Key Statistics For The First Week of Open Enrollment at Covered California
[Enrollment and Volume Statistics for October 1-5 at California Health Insurance Marketplace]
Unique visits to http://www.CoveredCA.com = 987,440
* Call volume 59,003
* Average wait time 15:08
* Average handling time 16:48
* Applications 43,616
* Partially completed 27,305
* Applications completed household eligibility determined 16,311
* Number of Californians determined eligible for coverage 28,699
* Small Business Health Options Program as of 10/8/2013 430
Source: Covered California
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WTF,
Obama care recipients must now become verified. Thanks government. And, the federal debt is still increasing.
Jimenez
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HHS Transparency
Is it true that there is “no expectations of privacy” when the http://www.Healthcare.Gov website is used? You have to go to the source code to see this disclaimer.
Is the NSA running this program – along with the IRS?
Bruce
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How long does Obama have to fix Healthcare.gov?
They’ve got a few weeks.
http://news.msn.com/us/builders-of-obamas-health-website-saw-red-flags
But, if federal officials can’t get the new online insurance marketplace running smoothly by mid-November, the problems plaguing the three-week-old website could become a far bigger threat to the success of the health law, hampering enrollment and fueling opponents’ calls to delay implementation.
http://www.physiciansnews.com/2013/10/22/how-long-does-obama-have-to-fix-healthcare-gov/?utm_source=10.22.13&utm_campaign=11713&utm_medium=email
What do you think?
Marty
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The Website Fix?
So, the troubled federal health insurance exchange will be fixed by the end of November – two weeks before the December 15th enrollment deadline for coverage to take effect in January, according to Obama administration officials.
http://www.physiciansnews.com/2013/10/28/healthcare-gov-will-work-smoothly-by-end-of-november/?utm_source=Copy+of+10.25.13&utm_campaign=11713&utm_medium=email
“Healthcare.gov is fixable,” said Jeffrey Zients, the former Obama budget official and Advisory Board Company [ABC] entrepreneur who has been charged with overseeing repairs to the online federal marketplace. “We are confident that each week, the site will get better, and by the end of November, healthcare.gov will operate smoothly for vast majority of users.”
We shall see.
Phillip
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Obamacare Resulting In Canceled Health Insurance Policies
The rollout of Obamacare is leading to the cancellation of hundreds of thousands of health insurance plans nationwide.
http://www.fa-mag.com/news/obamacare-cancels-policies-in-latest-hurdle-for-health-care-law-15890.html?section=43
Any thoughts?
Jodi
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Health Policy Canceled?
[What We Know and Don’t Know]
Hundreds of thousands of individual policyholders, at minimum, will have to find new plans as insurers respond to new coverage requirements under Obamacare.
http://www.propublica.org/article/health-policy-canceled-what-we-know-and-dont-know?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
But; is that necessarily bad?
Jose
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Rick,
Here are the five things we now know about Obamacare that could affect your health insurance and medical care.
1. Premiums will go up for many people
2. Many people will lose their current insurance
3. You don’t have to buy through the exchanges
4. Obamacare is immensely complicated
5. The exchanges offer limited choice of doctors.
Giles
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Released Notes Show White House Bungled Launch of Obamacare
Senator Max Baucus, chairman of the U.S. Senate Finance Committee, who worried openly in April that the rollout could become “a train wreck” said he has been disappointed to hear administration officials say they didn’t see problems with the federal healthcare website HealthCare.gov coming, according to Reuters.
http://www.reuters.com/article/2013/11/06/us-usa-healthcare-delay-idUSBRE9A50PT20131106?utm_source=Copy+of+11.5.13&utm_campaign=11713&utm_medium=email
Etianne
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Opinion Poll
Recently, FA Magazine, asked this question:
Will your firm consider buying health insurance through one of the health care exchanges?
YES = 18%
NO = 82%
What do you think?
Barry
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A fix for the ACA?
President Barack Obama just announced a “fix” to the vexing problem of cancelled health insurance policies by saying insurers don’t have to cancel plans next year just because of the Affordable Care Act.
But, insurers can continue the plans for 2014 on two conditions — they have to tell people just what their plans don’t cover, and they have to tell people that they do have the option of going onto the health insurance exchanges to buy new plans with federal government subsidies and perhaps even to go onto Medicaid.
Any thoughts-workable?
Ann Miller RN MHA
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Will Gov’t Force Docs to See Obamacare Patients?
Patient access to doctors is approaching a perfect storm of decreased physician supply, more demand for medical care-especially after Obamacare kicks in-and doctors increasingly refusing to see low-paying Medicare or Medicaid patients.
http://www.forbes.com/sites/merrillmatthews/2013/11/25/when-will-the-government-start-forcing-doctors-to-see-obamacare-patients/?utm_source=Copy+of+11.25.13&utm_campaign=11713&utm_medium=email
If the “promise” of Obamacare’s access to health care is to be kept, government will eventually have to force doctors to accept Obamacare-covered patients. Because such a step would represent such a radical departure from physician autonomy, you might call it the “medical nuclear option.”
Crider
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Healthcare.gov Meets Deadline -But Is It Better?
HealthCare.gov is clearly working better. But, is it actually working? Well, it depends on how you read the data.
A report released by the Obama administration this weekend shows the consumer experience is clearly improved. More than 400 of the 600 fixes on the administration’s “punchcard” of repairs have been made.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/02/wonkbook-healthcare-gov-will-work-that-means-obamacare-can-work-too/?utm_source=Copy+of+Copy+of+11.25.13&utm_campaign=11713&utm_medium=email
System response time has fallen from eight seconds to less than one second. The administration believes HealthCare.gov can now handle 50,000 concurrent users. The site, which was down 55 percent of the time in early November, is now functional more than 90 percent of the time.
Emile
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Will consumers “lie” about income on the HIEs?
http://diseasemanagementcareblog.blogspot.com/2013/12/the-oval-office-tone-at-top-and.html
Or, will they be totally honest and forthright; like Obama?
Homer
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High deductibles fuel new worries of Obamacare sticker shock
The Affordable Care Act includes tax credits and subsidies to ease the cost burden for some, but others will have to choose between higher premiums or inferior plans.
http://money.msn.com/health-and-life-insurance/article.aspx?post=0ad0d4e9-221f-4df8-9239-ac92ee6b222b
Edith
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Copper Plans?
On average, a recent copper plan legislative proposal would cover 50% of medical costs, compared to the 60% actuarial value for bronze plans, 70% for silver plans, 80% for gold plans and 90% for platinum.
The proposal holds the potential for low-deductible but inexpensive plans with very high cost sharing.
Franklin
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Obama Care Site Back Up After Crash On Deadline Morning
Obamacare sign-up closes at midnight today, and enrollment is surging, but a technical flare-up on HealthCare.gov this Monday morning marred the administration’s momentum.
The online portal, which had been handling millions of visitors over the past few days as enrollment pushed past 6 million, was “down for maintenance” starting at around 3:20 a.m.
Bad time for a crash.
http://www.propublica.org/article/judging-obamacare-how-do-we-know-if-its-a-success-or-failure?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter
And, how can we evaluate success or failure, anyway?
Hunter
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