Confused about Health Care Reform?

Hello, Utah Kids families!  My name is Brandee Garvoille, I have a son that’s almost 15, and a daughter, 10 years-old; both are on the Autism Spectrum, have other learning disabilities, and severe ADHD, so things can be a little crazy at our house!  Not to mention, I also work full-time!  I began my career in the insurance industry by working on the carrier side.  I worked with IHC Health Plans (which later became SelectHealth) for almost 6 years.  The Insurance Exchange recognized my talent, and hired me to start working with them in 2005.  I have an extensive understanding of all aspects of placing and servicing insurance policies that I learned while working on the carrier side.  In 2007, I obtained my insurance license, which allowed me to expand my roll with The Insurance Exchange even more.  I love my job!  As crazy as it sounds, I’m passionate about insurance!  However, I know how extremely frustrating it is; the denials, the benefits, the customer service, and to now throw “Obamacare” in to the mix.  I love when I can answer questions, and help people with their insurance needs!

On November 15^th the second Open Enrollment for individual healthcare through the Federally Funded Marketplace, or directly with the carrier of your choice, begins.  For most of us, there are still a lot of questions, and some confusion, in regards to HealthCare Reform, aka Obamacare, aka PPACA, aka ACA.  In this post, I’ll do my best, to break it down and explain it in laymen’s terms.

The biggest thing that came about with the implementation of the Affordable Care Act, that especially affects our special needs kids, is that everyone is now guarantee issue.  You cannot be denied or rated up on an individual policy for health conditions.  Waiting Periods and Exclusions for Pre-Existing Conditions have also been eliminated.   This was huge for our kids! 

One of the biggest confusions has been when an individual can apply for coverage; you are no longer able to apply for an individual policy whenever you want.  Open Enrollment is November 15, 2014 through February 15, 2015.  Outside of Open Enrollment, you are only able to enroll in a plan if you qualify for a Special Enrollment Period.  A few examples of qualifying life events include:

·         Marriage or divorce

·         Having a baby, adopting a child, or placing a child for adoption or foster care

·         Moving your residence, gaining citizenship, leaving incarceration

·         Losing other health coverage due to losing job-based coverage, COBRA expiration, aging off a parent’s plan, losing eligible for Medicaid or CHIP, and similar circumstances.

An important thing to remember is that voluntarily ending coverage doesn’t qualify your for a Special Enrollment Period.

In order to make health insurance more affordable to you and your family, it is possible to have help from the Federal Government in paying your premiums.  This assistance is called Advanced Premium Tax Credits aka Subsidies.  In order to obtain a subsidy, you must apply through the Federal Marketplace, several carriers (Altius, Humana, SelectHealth), allow you to go through their website, as it is connected to healthcare.gov, to see if you qualify for a subsidy.  These subsidies are generally available for the following people:

·         Individuals who are not offered insurance through their work

·         Those who are not eligible for a public plan like Medicare, Medicaid, or CHIP

·         Those with annual income between 100 and 400 percent of the Federal Poverty Level.

These subsides are based on certain criteria such as family size, age, and income.  To qualify for a subsidy, you must:

·         Be a citizen or legal resident of the U.S.

·         Have a family income between 100 to 400 percent of the Federal Poverty Level based on Modified Gross Income.

·         Not have access to a qualified employer-sponsored health plan that provides minimum value (actuarial value of at least 60 percent) and that is affordable (does not cost you more than 9.5 percent of your income)

·         Not eligible for public coverage-including Medicaid, CHIP, Medicare, or military coverage

·         Use your subsidy to purchase insurance.

Many of you may be on a “grandfathered” or “grandmothered” plan; this is part of ACA that says you can keep your current coverage without changing.  Many employers, and some individuals, have chosen to remain on their old plan, and not change to a plan that complies with ACA.  However, if you ever want to change this plan in any way, i.e., your deducible, co-pays, or co-insurance, etc., you would have to move to a new plan.

There is a tremendous amount of information that is available, a tremendous amount of regulation, and requirements in regards to PPACA.  The information above is only meant to be a summary of the more pressing issues dealt with on a daily basis.  The good news is you never have to try and navigate this alone!  Please don’t hesitate to contact me, Brandee Garvoille, with questions on your specific situation.  My office number is (801) 262-2691, or email me at brandee@ieutah.com.