For us in the insurance industry there are literally thousands of things we need to know about "Obama Care" or PPACA as we prefer to call it. PPACA reaches everywhere and touches different people, industries, regions etc. in a plethora of ways. To say PPACA is complicated is like saying the ocean is a little wet. But as we reach outside our office we see that there is a great need to understand the law and what it means and doesn't mean. I can sit here and write for days and days and still not touch upon the issues or details that might mean the most to you. So I have condensed it into 5 hot spots that I think people should know.
1) It's not going away! - Cry all you want it is here and moving forward. Now the trick is to deal with it.
2) There will be winners and losers! - The winners will be those people that have tried to be responsible and purchase insurance, but have been unable to because they had preexisting conditions. They had been kept out of the market and were not allowed to "play" so to speak. There are also those that have made too much to qualify for government programs but could not afford coverage on their own. They will now be able to enter expanded programs or be given subsidies for their insurance. The losers will be the people that hardly used their insurance, but had purchased very basic policies to cover them in the event of a major injury or illness. They are now forced to pay for benefits they will never use. Take for instance a client of mine who is a 60 year old male. He is in remarkable shape, takes very good care of himself and enjoys his life as a single grandpa. He now has included in his medical plan maternity benefits, Autism benefits, and free mammograms and oral contraception. Will he ever need those benefits? No, but he now pays for them.
3) Health plans will look different! - Beginning in 2014 the health plans will all be divided into "metallic" plan designs. What this means is that they will all be assessed an actuarial value. Depending on that value they will be classified as either Bronze, Silver, Gold or Platinum. Bronze will be the most basic at an actuarial value of 60%. That means that if an average procedure were to cost $10,000 the plan would pay $6,000 and the insured would be responsible for the other $4,000. Silver will be 70% so that same $10,000 procedure would be spit with the plan paying $7,000 and the insured paying $3,000. The gold plan is a 80% plan and platinum is 90%. Please note that these are actuarial amounts. Each plan will have those values worked into it's formulas, you may not see them if you don't have a large claim.
4 ) The "Exchange" is not a place! - It is a mechanism to figure out who gets subsidies and what plans qualify for those subsidies. Here in California our exchange is Covered California.
5) You think you have it tough? The employers have it tough! - There are so many new regulations coming out for employers, they wont see day light for quite some time. The paper work will be endless, the compliance will be daunting and costly and the regulations are a moving target. They will need all the help they can get and maybe a nice glass of wine to help at the end of the day.
So now that you know all that are you ready for Obama Care? If you have questions or need answers please feel free to call us any time at 714-680-5900. We are ready!
