6 Things to Know About Obamacare
I hate the word “Obamacare.” Last year, television host Jimmy Kimmel took to the streets to ask passersby which they liked better, Obamacare or the Affordable Care Act (ACA). They’re one and the same, of course, but the ACA turned out to be much more popular than Obamacare, especially when it was broken down into specifics. It would be easy to dismiss the Kimmel bit as a stunt for the sake of a few laughs, but it’s more disturbing than it is funny because that mindset is everywhere.
The Affordable Care Act is far from perfect and the initial rollout of the marketplace exchanges left much to be desired. Still, I wish that people would delve deeper than the political talking points to get the facts. I have no problem with people who don’t like the ACA when their dislike is based on fact. But since its rollout, I’ve had far too many discussions with people who hate Obamacare simply because it is Obamacare. Some base it on what they’ve heard. Others base it on personal experience — they’ve had to change their policy, have been shifted into a policy they dislike, or their premiums have risen.
My gripe? People who complain about the ACA, but refuse to visit healthcare.gov to shop around for other options or to learn for themselves if what they’ve been told is true. Obamacare cooties and all that. Hate the ACA if you will, but if you don’t do your homework, you may be cutting off your nose to spite your face. Here’s why.
1. There’s no insurance called Obamacare. You won’t get an insurance card with the president’s picture on it, nor is it a political endorsement. The marketplace exchanges provide a way for consumers to shop for insurance. You can compare policies from a variety of insurers. There are different levels of plans — catastrophic, bronze, silver, gold, and platinum. These plans vary in cost and coverage. There are HMOs (health maintenance organization), PPOs (preferred provider organizations), EPOs (exclusive provider organizations), and POS (point of service) plans. Inside the exchange or outside the exchange, it’s still health insurance.
2. If you don’t need or qualify for a subsidy, there’s no need to fill out financial information on healthcare.gov. Just go shopping. For those of us who were faltering in the individual insurance market due to pre-existing conditions (that is, we’ve actually needed health care, not that we’re deadbeats) prior to the ACA, the marketplaces have opened up a whole new world of options. No more exclusions. No more yearly or lifetime limits. No more arbitrary cancellations.
3. You still shop the exchanges outside of open enrollment if you have a qualifying event such as getting married, divorced, losing your job, or moving across state lines. If you simply want to change policies, the next open enrollment is November 15, 2014 – February 15, 2015.
4. Prices vary from state to state and premiums will likely rise. Premiums have always risen. For those of us in the individual market prior to the ACA, a 30 percent rate hike from one year to the next was not unusual. Neither was it unusual to charge women higher premiums than men, but that’s no longer allowed. Because of the new law, insurers must spend at least 80-85 percent of health policy premiums on medical care. If they don’t, the money will be refunded to you.
5. It costs nothing to window shop on healthcare.gov. If your insurance agent insists that you need to buy a particular policy and steers you outside of the exchange, do your homework. Find out what’s available and how much it costs. All the rules, patient protections, and essential benefits are listed there, so you don’t have to take anyone else’s word for it. In the end, you’ll be able to make an educated decision about which policy is best for you, on or off the exchange.
6. You can purchase your plan through the exchange, but when it comes to visiting your doctor, putting in a claim, or checking your EOBs (explanation of benefits) and year-to-date deductibles, you’ll deal directly with doctors, medical facilities, and your insurer — same as if you purchased it outside the exchange.
Some states have set up their own exchanges while others chose to rely on the federal exchange. Some states accepted federal help in expanding Medicaid and others chose to refuse it. Those are local issues, so some states have better options than others. No matter where you live, the rumor mill is working overtime, so it’s worth a little research time.
Personally, I’d prefer a single-payer system, but I’m grateful for the ACA. Thanks to the new law, I have a good health insurance policy. And next open enrollment, I can shop around for a different one if I so choose. That’s a new benefit for people like me.
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