CUSTOMER SERVICE, LEGAL & REGULATORY, OTHER • October 28, 2016
1 minute Read
If you run a medical office, you may be fielding questions around this time of year from patients still trying to parse the Affordable Care Act, or Obamacare.
The next enrollment period for the Health Insurance Marketplace runs Nov. 1 of this year to Jan. 31 of next year. That’s why many Americans are just now brushing up on their insurance options even though the act was instigated in 2010 and put into effect in 2014.
Last year the Huffington Post pointed to surveys indicating 81 percent of those enrolled in health plans through the Obamacare marketplaces are very or somewhat satisfied with their insurance, while 74 percent rate their coverage as excellent or good. However, 56 percent of Americans polled earlier this year said the Affordable Care Act has had no effect on them, while 25 percent say it’s hurt them and only 15 percent say it’s helped.
Though the act is long, complex and often difficult to understand, here are a few tenets you might explain to patients:
1. The act calls for 95 percent of Americans to be insured; some exceptions include those with very low income, the incarcerated, and undocumented aliens. Others must be covered under some insurance plan or pay a penalty that helps offset care for the uninsured. Thus the penalty for 2016 is $695 per adult and $347.50 per child, capped at $2,085 per family, or 2.5 percent of household income above one’s tax return filing threshold. Use this calculator to help your patients determine their eligibility for a penalty.
2. The government has created a Health Insurance Marketplace (Healthcare.gov) allowing uninsured Americans to choose from a set of insurance providers now mandated by federal law to provide certain minimum benefits. Those include ambulatory patient services, emergency services, hospitalization, laboratory services, maternity/newborn care, mental health services and addiction treatment, rehabilitative services and devices, pediatric services, prescription drugs, preventive and wellness services, and chronic disease management. Many lower-income individuals and families qualify for federal subsidies that help lower the costs of such insurance.
3. Those covered by their employers generally keep that insurance, which is now subject to added rights and protections. But they may opt to replace or supplement employer offerings or cover dependents through the marketplace.
4. Those receiving Medicare because they’re retired or disabled should stay the course; those who qualify for Medicare cannot get Obamacare or Medicaid and must go with Medicare
5. More people are eligible for Medicaid under Obamacare, but exact coverage depends on individual state legislation. Patients should apply to their state marketplace to determine their benefits.
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IMPORTANT INFORMATION: This is not investment, tax, or legal advice. Should you have questions, please consult your own attorney, tax accountant, or other appropriate expert having expertise in the area of your question or before making important decisions in these areas.