Clearing the Air About the Affordable Care Act

healthcare-reformBy Christopher Timm, MBBS, MHSc., MIPC President & Founder

Obamacare. The name is enough to send people scurrying for their pitchforks and torches. Whether you support or abhor it, change is upon us, and Americans should embrace the reality that health care reform is here to stay. Although it is a hot button issue, many citizens remain unclear about the finer details of the law, and the repercussions for the average American.

Formally known as the Patient Protection and Affordable Care Act, Obamacare seeks to enable greater access to health care services and curb rising health care costs. The main solution (at the moment) is to provide all citizens with some level of access to health services, whether it is through government funded programs, or simplifying the health insurance process.

For the majority of insured Americans, there will be little to no changes regarding their health care plans. Most health care reform is directed at the uninsured, and underinsured populations. Uninsured patients, or those who cannot afford care, create a burden on the health care system, along with driving up costs for services. Therefore, the greatest priority is to create a marketplace where these people can easily select and afford an appropriate level of coverage.

The solution generated by the government and insurance companies is to develop and establish insurance marketplaces featuring a variety of coverage plans. These plans range from bronze, silver, gold, to platinum levels, and vary by state. Although there are many details and nuances, bronze plans typically have low/cheap premiums, but high out of pocket costs, whereas platinum plans have the highest/most expensive premiums, but low out of pocket costs. Before selecting a plan, patients should thoroughly review the material, and consider every option. The right plan for you depends on your own health, financial situation, and other personal considerations.

Although available to everyone, these coverage plans are intended for the uninsured, small businesses unable to afford group plans, and those who have individual coverage but may want to shop for better deals. All individuals are free to check out these marketplaces online, however most Americans receive health insurance through work-based group plans, and will likely remain on them.

Unfortunately, these marketplaces are not open at the moment since the enrollment period is closed until fall. Those who wish to purchase new plans may enroll beginning November 15, 2014 until February 15, 2015 for coverage that could start as early as January 1, 2015.

Patients can find out if their current doctors or health care providers are covered in new marketplace plans, or can find covered providers in a variety of ways. First, you can check online by visiting select health plan’s provider directories which list contracted doctors, hospitals, and other health care providers. You can also call your insurer about specific providers at the number provided on your insurance card or website. Finally, if you have an established doctor, you can always contact them to see if they accept your health plan, or try the marketplace call center at 1-800-318-2596.

These marketplaces are one of many new exciting programs and policies enacted by the Patient Protection and Affordable Care Act. To learn more about them, and other changes, visit www.healthcare.gov or contact your local health care provider.