There are a couple of words that cause more stress in my house than even “colonoscopy” and “root canal” and those words are “health insurance.” Over the years, my family has been insured through employers, we’ve been self-insured, we’ve signed up for insurance through the government (COBRA) after a layoff, and we’ve sought insurance as a small business owner.
None of it has been pretty. Much of it has been pricey. Some of it has been downright painful, such as when we ended up paying out of pocket for nearly $100,000 of medical and mental health care for a family member because our insurance company decided an eating disorder wasn’t life threatening (even though the doctors said it was).
Because of my health insurance dramas, I’ve been eager to see how President Obama’s Affordable Care Act (ACA), also called ObamaCare, will affect families’ lives and health insurance experiences. I’ve done some research, and here are a few ways I think the ACA may rock your world in 2014 (if it hasn’t started rocking it already).
1. You won’t be the victim anymore.
I don’t know about you, but I always felt like my health insurance company was purposely torturing me. The forms were incomprehensible, trying to figure out (let alone appeal) a claim was impossibly complicated, and I felt like no one was on my side in a very out-of-control, precarious experience.
The ACA changes some of that. It began with a Patient's Bill of Rights presented in 2010 that outlined all of the ways your insurance company could no longer mess with you, from raising your premiums without notice to throwing roadblocks into the appeals process. Some of these changes have been rolling out for a few years now, but with 2014 being a pivotal year for the ACA (see an Obamacare phase-in timeline here), taking charge of your own insurance and your own healthcare is going to be getting a lot more attention. Reviewing your bill of rights is a good start.
2. You can’t be turned down for health insurance.
Since 2010, children age 19 and under couldn’t be denied health insurance because of a preexisting condition. Starting in 2014, the same goes for everybody else. That means if you are obese, have delivered a child (yes, some insurers called that a preexisting condition), or have high triglycerides, asthma, anorexia, cancer, ADHD, schizophrenia, diabetes—you name it—you can’t be discriminated against when it comes to receiving health insurance.
No impossible-to-read small-print riders can be attached to your policy that basically prevent you from being insured for the very thing you most need to be insured for.
3. If you don’t have insurance through an employer, finding affordable insurance will be easier.
Everyone will have to have insurance under the new law or pay a penalty. Open enrollment starts in October 2013, with coverage starting January 2014. You’ll be able to shop around to find the plan that’s right for you via health insurance marketplaces, also called exchanges. States got to choose if they wanted to run their own exchanges; if they chose not to, the federal government will run your state exchange (see the list of state exchanges in this PDF). Whether run by your state or the federal government, the exchange will establish a set of competitive rules aimed at getting you a plan that covers the Essential Health Benefits the government requires at the lowest cost. Not all of the plans out there will be able to sell on the exchange. The plans have to compete to get a spot.
You’ll also use the exchanges to apply for any federal subsidies or tax credits you’re eligible for either because you don’t have access to insurance through a job or because your income is at or below poverty level. These exchanges give you more bargaining power than you’ve had before in the insurance shopping biz. Keep in mind, what you pay for health insurance will still depend on your location, your family size, and (in some states) whether or not you smoke (see #7).
4. You’re less likely to go bankrupt because of medical bills not covered by insurance.
Right now, insurance plans can no longer limit how much they pay out to you for medical care during your lifetime. There are no maximums. Starting in 2014, there won’t be any dollar limits on what insurance plans will pay for your medical care during a single year, either. That will be a financial lifesaver for an individual or family who has a devastating and expensive health crisis occur within a calendar year.
5. If you work for a small business, they may have to offer you health insurance.
If your employer has more than 50 fulltime employees, the new law requires them to offer employees health insurance in 2014—or they’ll have to pay a penalty per employee. The good news for small businesses under 100 employees is that the company can use the state health exchanges to shop for insurance for their employees, which should help it get the kind of bargaining power that larger companies get because of their size.
Even if your employer has fewer than 50 employers, it can choose to offer insurance to its employees. The ACA has established subsidies and tax breaks to help businesses offset the cost of insurance. Read more small business info here.
6. You’re really going to have to remember to floss.
Dental care for adults is not covered under the Affordable Care Act (pediatric dental care is). Since the link between oral health and general health is well researched (heart disease, erectile dysfunction), the pressure is on you to keep those pearly whites sparkling.
The good news is you’ll be able to get your own supplemental dental insurance through the health insurance exchanges, and because of the collective buying power offered by the exchanges it might even be less expensive than what those seeking private dental insurance had to pay before. If you have kids, you might get a supplemental family dental plan and apply the pediatric federal subsidies for the children’s part of the premium cost.
7. You’re still going to want to quit smoking.
Of course, you know smoking hurts your health in numerous ways, from aging your skin to damaging your heart. After 2014, it could also hurt your pocketbook even more. The ACA allows states to charge smokers up to 50% more for a health insurance plan. This could make “affordable” health insurance pretty darn pricey, some critics say. And it prevents smokers from the very health plans that give them access to the nicotine patches and smoking-cessation programs that help them quit.
That’s why some states, including Massachusetts, Vermont, Rhode Island, and the District of Columbia have decided not to charge smokers more. California’s legislature is debating such a provision. Still, it makes quitting before 2014 look even better, doesn’t it?