Health Insurance Exchanges & Your Family – What You Need to Know

I participated in an online briefing on behalf of Anthem Blue Cross and Blue Shield & The Motherhood. I was compensated for my time. All opinions are my own.

One week from today marks the beginning of health care reform in the United States. Starting October 1, you will will be able to shop for insurance coverage through national and state-administered insurance exchanges. Called the Affordable Care Act (ACA) or ObamaCare, this will be the beginning of a complete change in the way we purchase health care coverage and access care. If you are confused or unsure of what to expect, you are not alone. 45% of Americans know nothing at all about the health insurance exchanges and 75% of uninsured adults are unaware that they will have new insurance options.

Up until about a week ago, I fell right into those statistics. I knew very little about the health insurance exchanges. I was confused, skeptical, and worried about how these changes would affect my family. I’m still feeling a little uncertainty, but thanks to Anthem Blue Cross & Blue Shield (WellPoint) and The Motherhood, I was able to attend an online briefing to learn more about the health insurance exchanges. My goal is to pass that information on to you so that hopefully you will be more informed and better prepared for the changes that are about to take place.

What Are the Health Insurance Exchanges?

• A health insurance “exchange” is just another word for “marketplace.” Works similarly to Amazon, Expedia or Travelocity and lets you compare health insurance options. Public and private health insurance exchanges will operate in a similar way.
• Plans will be available for sale October 1, with coverage starting on January 1st of next year. Each state will have its own exchange serving people who buy health insurance for just themselves and their families.
• The vast majority of people who are currently covered by their employers will not see a change or have to use the public exchange.
• When can you use the exchanges?
  • Enrollment begins: October 1, 2013
  • Enrollment ends: March 31, 2014
  • Coverage begins: January 1, 2014 (NOTE: For those who sign up before December 15^th)

What Are Your Options?

1. Continue purchasing insurance through your or your spouse’s employer
2. Buy health insurance yourself – either through exchanges, direct for insurance companies or through traditional brokers
3. Enroll in government programs like Medicare or Medicaid plans – if you are eligible
4. Go without insurance – but pay a tax penalty of 1% of your annual income (this will go up every year). The exception to that is if you make $9,500 or less, then you won’t have to pay that penalty tax.

What Can You Expect from the Affordable Care Act?

• Affordable health care options will be available
• You may qualify for financial help – and protect your whole family
• You can get preventive health care at no cost
• You can’t be denied based on pre-existing conditions
• Help will be available for those people who make about $45,000 dollars a year and for families of four who make about $92,000 dollars a year
• Financial help will be offered on a sliding scale, meaning the more money you make, the less financial help you will get

What Essential Benefits Will All Plans Include?

• 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
  • Women won’t be charged more
  • Cannot be charged more or denied for a pre-existing condition
  • You’ll get preventative care for mammograms, well woman visits, contraception and much more
  • You can choose your own primary care, OB-GYN or pediatrician without referrals

What Plans Will Be Available?

• There are four plans to choose from (Platinum, Gold, Silver, Bronze)
  • Bronze plans have the lowest monthly premium, but will cover 60% of expected costs
  • Platinum plans have the highest monthly premium, but will cover 90% of expected costs
• There will be family plans and individual plans available.
• As far as dental and vision coverage, only pediatric dental and vision benefits are a part of those essential healthcare packages. The law does not expand dental and vision coverage for adults. But they are available for individuals to purchase on a stand-alone basis.

To learn more, check out these websites:

• Healthcarereformforyou.com
• Healthcare.gov
• Anthem.com

I know it’s all a lot to take in. I’m still trying to figure it all out myself. I don’t think we will really know what to expect until the changes go into effect. In the meantime, I would encourage you to discuss the changes with your employer or current health insurance provider (if you have one), read up on the laws, and check out the websites above. Hopefully, this will help you make an informed decision as to what is best for you and your family!