Health Care Reform: Where do we go from here?

Health Care ReformBy Esmeralda Mercado

In one way or another, all Americans are impacted by the Supreme Court’s decision to uphold the Affordable Care Act. So, where do we go from here? How do we plan and get ready for changes, good and bad? Here are some ideas of things we can do now, before health insurance becomes mandatory, and things we can plan for in 2014.

There are many reasons why people change Health Insurance Plans.

Before 2014:

People with Pre-Existing Conditions
People who previously got denied medical insurance due to their health status will be able to receive coverage in 2014, when the Health Care Reform law is implemented. Applications for the state-based Exchange Health Plans will not be accepted until October 2013. With over a year wait ahead, your next step if you are uninsured, would be to continue looking for affordable health insurance. Consider these options:
• Private health insurance. If you’ve been denied, think about appealing, or checking out the other alternatives below.
• Group medical insurance, if you’re eligible for health benefits through your employer or if you are a business owner.
• MRMIP(Major Risk Medical Insurance Plan) or a Pre-Existing Condition Insurance Plan(PCIP), a state health program for people who’ve been previously denied.
• MediCal, an income-based health program through the state of California. In other states, it’s called Medicaid.

If you have been denied previously and you are interested in more information about other options, click Health Insurance Denied.

People without Pre-Existing Conditions
If you already have coverage, keep it, especially if you have been diagnosed with, or are being treated for a medical condition. If you’re otherwise healthy and just need a more cost-effective option, consider shopping for a private health plan with a higher deductible- just be sure it fits your medical service needs. Generally, private plans with deductibles carry the most affordable prices. To save time, you can get quotes from various carriers by going to a health insurance broker. There’s no extra charge for services.

Uninsured individuals or families would do well getting coverage now, since life often brings unexpected turns.

If you’re a tobacco smoker, you may want to consider quitting before 2014. Currently, many health plans surcharge for smoking, and this will be a factor that will affect your rates in 2014.

Small Businesses (less than 50 employees)
Group health insurance may be your best option if you own a family business and any of your family members has a deniable pre-existing condition. If you have business medical coverage now and it provides you affordable health insurance, keep it. If it’s become too pricey, call your health insurance broker or representative to see if you can downgrade plans. Sometimes, carriers allow for mid-year changes.

2014 and After:
The people who will probably most benefit from the implementation of the Health Care Reform mandate are those who were previously denied medical insurance due to their health status. In 2014, this will no longer be a factor. Instead, what will matter more is if you qualify for tax credits on the Exchange Health Plans, and if it’s better to enroll on a private health plan or a small group plan. Exchange Health Plans are not yet available, so for now, we’ll only consider private health insurance and small group insurance.

Private Health Insurance
Individuals and families who meet the low income guidelines may qualify for a tax credit and enroll on an Exchange Health Plan, however, families that make too much money must decide if it’s cheaper to buy private medical coverage or pay the penalty.

In 2014, the annual penalty will be the greater of $95 for an individual or $285 for a family, or 1% of a family’s income. In 2016 and beyond, the penalty jumps to $695 for an individual or $2085 for a family, or 2.5% of a family’s income.

Small Business Insurance (under 50 Employees)
Unlike large companies, the Health Care Reform law does not require small businesses to provide health benefits to their employees. So, for small businesses, your next step, for now, is to just wait. Wait until Fall of 2013 when you can research to see if it’s less expensive to switch to a private plan and possibly qualify for tax credits. Also, wait and watch your profitability to see if it’s worth the plan change.

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