Health Insurance and the State Exchange

In only a few days, MNsure will be unveiling the new health plans policies on it’s exchange site. You might ask, “what is in it for me?” and “what penalties can be applied”? For those of you who have not followed Obamacare (also known as Patient Protection and Affordable Healthcare Act), here are some key points.

Timeline

In March of 2010 the ACA (Affordable Care Act) was signed. This policy would eliminate pre-existing condition exclusion for children, lifetime healthcare limits. cap annual limits, establish consumer assistance programs, provide small businesses health insurance tax credits, and provide free preventative healthcare services. Some of these changes have been phased into current policies already. In the upcoming week, we will also see a large component of reform made public. Even individuals with insurance through a group employer will have access to the health plans policies that are participating in the state exchange at the tip of our fingers.

Enrollment

The Exchange (for people who reside in Minnesota is MNsure) will be a website to support the virtual market place for two markets: individual medical policies (that meet ACA guidelines) and small group policies. These policies will be available to consumers to view on Sept 6th and the enrollment period will begin October 1st and continue through March 31st 2014. What was once a personal relationship between the insurance purchaser and an insurance company will now become an electronic enrollment file that, through the state, will be sent to an insurance company of choice.

For those individuals who may not be as savvy to the web to enroll on their own, good news! Insurance Agents are still able to assist in enrollment of these policies. By visiting agents, they will help in the completion of online enrollment and provide detailed explanations of all policies on the exchange.

Benefits of ACA and Reform

To date, ACA and Health care reform discussions have centered on slowing healthcare costs escalations, providing health coverage for 47 million uninsured Americans, and reducing medical errors. What role to we play in making this successful? The success of many of these aims depend on individuals making behavior changes – becoming more accountable for their own health, more engaged in the process, and more knowledgeable about costs of their choices.

How many people shop for providers like they shop for cars? When you shop for a car, you compare prices and most likely check it’s actual value on Kelley Blue Book or Edmunds. Do you do the same for services that you have performed at a clinic or hospital? What happens when we see a physician that charges 3 times the average rate for a service? Well, that will impact insurance costs. When healthcare companies negotiate with providers, they consider averages (cost, location of services being performed, etc.). This, eventually, will bring payment for services up and will in turn make premiums higher. Something to think about when we see a doctor.

From 1999 to 2009, insurance premium costs increased 131%. The chart below illustrates in the same period, in comparison, how salaries and inflation rose.

Image

Source

Penalties to Know About

Americans without health insurance in any month beginning in 2014 will be penalized when filing income taxes if they do not qualify for a government subsidy. For those that do not meet the subsidy guidelines, there will be a flat-dollar amount or a percentage of income, whichever is greater. For cost estimations, calculators  have been set set. Click here, to find out how much you might have to pay! 

Questions to Ask

  • Have I done my research on plans available?
  • Will I be effected or do I qualify for a subsidy?
  • How can I keep healthcare down?

In conclusion, being aware of your healthcare costs, searching available options for health insurance, and knowing about potential penalties, can help to keep your own (and Americas) healthcare costs down. How will you help to keep these costs down?

1 thought on “Health Insurance and the State Exchange

  1. Erin,
    I heard a fabulous segment on MN Public Radio today between Kerri Miller and T.R. Reid that discussed the Affordable Care Act and how the United States health care systems compare to other well-off nations. You can hear the 30 minute segment at http://minnesota.publicradio.org/display/web/2013/09/09/daily-circuit-tr-reid.

    During the segment Reid discussed the high-quality care the Mayo Clinics and Hospitals in Rochester, MN are able to provide for relatively low-costs because of the “Patient-Centered Medical Home (PCMH)” care delivery model they utilize, as well as the fact that their physicians and surgeons are all paid a flat annual salary that is not based on the number of tests they order, prescriptions they prescribe, patients they see or procedures they complete. Apparently the majority of other health care systems pay their physicians, specialists and surgeons based on different types of quotas or other measureables that are not as conducive to patient-centered health care.

    I was curious what the PCMH care model was about. According to the American College of Physicians, PCMH is defined as “patient treatment coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand. The objective is to have a centralized setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.” (http://www.acponline.org/running_practice/delivery_and_payment_models/pcmh/understanding/what.htm)

    I found it interesting that PCMH is considered the oddity, and not the industry norm, when all information I read seemed as if it was one of the best care models.

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