After the government was reopened in the middle of last month, the noise level about the ACA increased substantially. Depending on point of view, the opinions skewed in various directions. That means that it became quite difficult to figure out what was true and what wasn't true.
I'll make an attempt to explain this section of the law, in which the
plans will go into effect as early as Jan 1. Everyone has until Mar 31
to enroll, otherwise the monetary penalty will take effect. Those who
want the insurance to start on Jan 1 must enroll by Dec 15. The problems
with enrolling have occurred primarily with those who are trying to
register online. I will go into those issues later. But there are 3
other ways to register: call the 800 number on your State's exchange;
download, print, and mail the application and a code will be sent back
to you to finish the enrollment process online; or you can meet
one-to-one with a navigator (a real person) at a designated site (look
up the closest one on the online site) to choose a plan and find out the
amount of discount you can receive.
Now, the problems on the
web sites come from the fact that you have to register for a password in
order to access the plans and prices on the exchange. Registering to
look
at plans does not mean that you must choose a plan. However, in order
to see what discount applies to you, there is more information to
complete, such as what you entered on your last income tax forms from
2012. So, first, you have to realize that without completing this
additional information, you see plan prices that are higher than when
you fill out the application (different from your registration
information). By the way, the only health information requested is
whether or not you smoke, since pre-existing conditions do not add to
the price of a plan. Plan prices, deductibles, and copays are classified
into bronze, silver, gold, and platinum. The least expensive plans are
bronze, but they have higher deductibles and copays. Platinum plans cost
the most, but may not have any deductibles or copays and also the
lowest out-of-pocket maximums. Now, given all of this information, the
ACA plans provide, by law, that PCP visits, recommended bloodwork, and
recommended procedures are
done at no-charge. The emphasis is on encouraging beneficiaries to get
recommended primary care, in order to prevent the development of more
expensive illnesses.
Most recently, the biggest controversy was that
some plans announced that they were ending on Dec 31, so people who had
purchased them are finding they have to look to the government health
exchanges. Why did these plans announce a termination date after the President had assured the public that they could keep their current health plans and practitioners if they happened to be satisfied? Well, that was something the President couldn't control. Some insurance companies realized that their plans didn't comply with ACA, so they decided to stop offering those plans. Now, there were also dishonest companies which emphasized their end date, but then offered higher priced plans and their customers had to make a decision to pay the higher price or wait to see the health exchange prices. Some States recognized this as a scam and proceeded to fine the companies involved - KY did this in the case of Humana. A separate issue that might also cause confusion is that consumers can also access and buy insurance from commercial
marketplaces, which look quite similar to the exchanges, but the prices can be higher and there is no subsidy. Make sure you
are on the government site for your State, not these other marketplaces
that look the same.
I spent most of Oct trying to enroll and was
finally able to do so before the end of the month. Ease of use and
functionality actually depend on the State in which you live. If you
were so lucky to live in a State that designed its own exchange, like
KY, the process was seamless, self-explanatory, and worked from the
start. My State of MD designed its own, but has run into problems in the
interface with the federal web site, the part which identified the
individual and matched the person to income tax return. Actually, part
of that fault arose because the State asked for this year's income,
rather than last year's, so then there was trouble matching the person
and the return, and then when that was corrected, somehow the connection
with the plans got broken. But those States which developed their own
exchanges also expanded those who qualified for Medicaid, so that those
who earned a percentage higher than the poverty level now have a very
economical way to access that more robust insurance. However, in WI, for example, Gov Walker was one of those who objected to
ACA and he refused to develop the State exchange or expand Medicaid, all
to the detriment of WI citizens. So, that left constructing the
exchanges to the federal government. In addition, Gov Walker somehow
allowed insurance companies which operate within the State to charge much
more than
they can in other States. The difference in price can cause insurance rates to be double the rates of most other States, so essentially those who live in WI have the
highest prices in the US.
Why did the glitches online happen?
Well, nothing is perfect in the digital world. Remember the many times
that the Blackberry interface with the internet shut down? Remember how
Windows Vista operating system disappointed users with its buggy
interface? Even, MSN, which charges users to have full functionality has
been known to crash. Then there are those denial of service situations,
in which so many people try to get onto a website that all that usage
causes the servers to stop working properly, as happened to the NY Times in Aug. It happens - and it can
take quite some time to fix it. In fact, one site to which I subscribe
and pay a fee to use, had changed to a different server company, only to
find out that paying subscribers couldn't use it because they couldn't
log on. It took that company 6 weeks to repair the problem. So, the fact
that there
was no quick fix was not surprising. In fact, what has been attempted
with ACA was far larger than anything else that was ever done online.
The biggest connecting piece was the fact that every exchange, all 51
(including DC), had to connect accurately with the IRS, which had to
have the capability of identifying each person who enrolled. Not only
that, but each exchange is different, because each State has different
laws which apply to health insurance. This was quite an undertaking! But
it is getting better, the numbers of enrollees continue to increase,
and this isn't the end of the enrollment period. Remember, the enrollment period ends on Mar 31, when those who didn't enroll become subject to the tax penalty.
If you happen to be one of those people who believe you are invulnerable and really don't need health insurance, think again. It doesn't take much for you to find yourself waking up in the shock trauma unit with massive injuries and no way to pay. Not only did you gamble with your finances and your well-being, but you now face being charged the maximum the hospital can charge for your health care. You see, by having insurance, you can only be charged what that company negotiated with the health care facility, even if you have a catastrophic deductible. Now, not only do you have a disability from the injuries, you face bankruptcy, and every dollar that you can manage to earn, if you can continue to work will be garnished at a certain percentage to pay off the bills for your care. So, health care insurance looks more like a good investment for you. Don't gamble by not signing up for a plan!
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