11 Facts About Health Care Coverage

If you’re confused about health care coverage options since the passage of new healthcare laws… you’re not alone.

According to Kaiser Family Foundation and Enroll America, 42% of Americans don’t know that the Affordable Care Act (ACA) is now the law of the land. Which sort of leaves me shaking my head… Personally, I’m still concerned about the full impact of the ACA on our economy. However, now we must figure out how to protect the health and financial future of our families.

So I was curious to attend a webinar sponsored by WellPoint and The Motherhood on the topic of health care coverage options. The detailed discussion, led by Wellpoint spokeswoman Ellie Kay (mother of 7), and Wellpoint expert Patrick Blair (dad of 2), gave me a few facts about the new health insurance exchanges.

Why should you know? According to an infographic in Time magazine, women make 80% of healthcare decisions and more than 85% of consumer purchasing (crazy, right?). Since most of my readers are women, I thought this topic pertinent! Aren’t you glad I’m over here doing the homework for you!?

What you should know about the Affordable Care Act (ACA) and Health Insurance Exchanges (HIE)

1. Health Insurance is important!

Protect your family’s health and financial future – medical costs are devastating to families.
- My first son’s medical costs to be born (in an uncomplicated delivery) were around $9,500!

2. Four health insurance options will be available for next year.

Purchase your employer’s coverage plan (or spouse’s employer)
Purchase through Health Insurance Exchanges
Enroll in government programs (Medicare or Medicaid)
Pay a tax penalty for going without insurance coverage

3. A Health Insurance Exchange (HIE) is like a “marketplace” where you can find the best prices.

It’s like deal shopping on a site like Expedia.
The HIE opens for enrollment October 1, with coverage starting January 1, 2014
Each state has their own Health Insurance Exchange.

What about the cost?

4. Plans come in four payment tiers (Platinum, Gold, Silver, Bronze).

Platinum covers 90% of expected costs, but the premiums are the highest
Bronze covers 60% of expected costs but their premiums are the lowest

5. Financial help is available, on a sliding scale for individuals making about $45K/year and families of four making about $92K/year.

6. Yes, there is a penalty tax. Yes, if you don’t pay for coverage, you’ll still have to pay something. Sorry, this is the part I dislike to tell you, but you should be prepared so you can make the best decision.

The penalty tax is 1% of your annual income, excluding individuals making less than $9,500
The penalty fee increases each year through 2017 (2% in 2015, 5% in 2016).

What are the new benefits of health care coverage?

7. You cannot be denied based on pre-existing conditions.

8. All plans must offer the same Essential Health Benefits:

Emergency services
Maternity and newborn care
Mental health and substance use disorder services
Preventive and wellness services
Chronic disease management
Pediatric services, including oral and vision care
Women’s Health
- Women won’t be charged more
- Cannot be charged more or denied for a pre-existing condition
- Preventative care for mammograms, well woman visits, and more
- Choose your own primary care, OB-GYN or pediatrician without referrals

9. Dental and vision coverage is only “essential” for children.

Adult dental and vision is NOT covered. However, you can purchase stand-alone plans for both.

10. Children are covered as dependents until 26 years old, regardless of college enrollment or marriage.

11. Medicaid has been expanded.

If your income is 133% of the federal poverty level ($31,321/year for a family of four by one report) you will be eligible for Medicaid.

It’s a lot of information! I’m sharing the pieces I wasn’t clear on, because I’m guessing other families would want to know that same information.

If you’re purchasing your own health care coverage, you can find information, including a Family Checklist to help you find the right plan, at these sites:

No matter what your opinions on the new healthcare, come October 1st, many Americans will face decisions. Open enrollment ends March 31, 2014, after that, you’ll have to wait until the following year. If you have a significant life event like a job change, marriage, or child, you can enroll in a special enrollment period.

For your family’s health, I urge you to become informed, read the laws, visit the websites, ask your employer about upcoming changes. Make the best, informed decision for your family about health care coverage options.

What surprised you most about these health care coverage facts?

This post was brought to you by Wellpoint and The Motherhood, and I received compensation for sharing these facts and my thoughts with you. All opinions are my own!