Health Care Reform: What do I Absolutely Need To Know?

Kelley-Jensen2Author: Kelley Filice Jensen

There is so much information circling around the internet and media outlets about Obamacare, health care reform and the new law.   I feel very overwhelmed by it, and I only care how it affects me.  What do I absolutely need to know?

1)       If you have health insurance through an employer with more than 50 employees, you will probably not be affected by health care reform.

2)      If you have health insurance through an employer with less than 50 employees,    your employer MAY change the way he provides health insurance to take advantage of subsidies available to employees.  If so, the health insurance broker he works with will help you with your health insurance.

3)      If you do not have health insurance, you need to buy it, or pay a penalty.   The penalty is small the first year, but in increases.

4)      Subsidies, also known as premium assistance credit, will be available for people with low income, as determined by the Federal Poverty Level.

5)      If you can get insurance through work, you must get insurance through work.  People who are offered employer sponsored health insurance are not eligible for subsidy (premium credit assistance), unless their employer’s plan is unaffordable.

6)      Unaffordable has been defined by the new law as more than 9.5% of wages, but read the full definition.

7)      If you have an individual health plan; it may go away because it does not conform to the new law, and you will have to shop for a new health insurance plan.

8)      There is no such thing as retro-active insurance, so if you are in an accident and you are uninsured, you cannot apply for health insurance to help you pay for the bills you incur as a result of that accident.

9)      Health care exchanges are government sponsored marketplaces where you can buy a PRIVATE health insurance plan.   Some states have their own exchange; others have a federally sponsored exchange.  California’s is called Covered CA.

10)  You can buy health insurance from three sources:

a)       Go directly to an insurance carrier – not an easy way to compare plans, because you will only be able to see plans offered by that one company, and there is never any cost savings going directly to a carrier.  They are not allowed to offer discounts.

b)      Go directly to the exchange in your state – depending on your area, it may be a state sponsored exchange, or a federal one.  The exchange will have assisters to answer your questions and help you enroll.

c)      Go to a licensed health insurance agent – agents have the most experience with health insurance and health insurance carriers, so they may be best able to explain the health plans to you.  Choose an agent that is certified by the exchange  in your state, to help you receive subsidy available through the exchange.  Agent’s fees are paid by health carriers, so their services are free to consumers.

Lastly, the point of having health insurance is to have access to health care.  Too often people who are uninsured never see a doctor.  They might notice a pain, swelling or other symptom, but they brush it aside until the symptom is undeniable, at which point it has become a major disease rather than a manageable condition.  Having health insurance allows for exams and doctor visits, at least annually, to prevent major illness.  That is the most important thing to know, that health insurance is the starting point for your health.

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