Now that open enrollment is here you might be wondering about Obamacare and what the future holds for your healthcare insurance. Well, it looks as if some of the kinks have not yet been ironed out. For example, the insurance companies are still not sure of what to charge you. As you may know insurance companies can’t charge sick people more than healthy people or refuse to cover them. They’re also limited in what they can charge older customers versus younger customers.
Obamacare or the Affordable Care Act has, in fact, made insurance cheaper for those that don’t buy insurance through their jobs but via the individual marketplace. However, without the health-based pricing of the past, which excluded some consumers and helped the insurance companies control their costs, thet are finding it harder to calculate their premiums. In addition, there is the P word, which is that insurance companies still need to turn a profit as many of them are public corporations and have to answer to their shareholders. And some of them are having a hard time balancing this versus the mandate that their plans offer stability, affordability and accessibility.
If you can figure out the math you could get a tax break
More than 5.4 million people this year selected insurance through the federal government’s marketplace and of this 87% selected a plan that included tax credits. In order to qualify for these credits, peoples’ income had to be equal to or lower than 400% of the 2014 federal poverty line, which was $95,400 per family of four. The problem here is that the size of these credits was based partially on consumers’ estimated income for this year. If your actual income doesn’t match what you estimated – which is probably a common occurrence, especially if you’re self-employed – you will have to report the difference when you pay your taxes for 2014. And if you received too much in subsidies, you will be required to pay back the difference. Plus, experts believe this confusion is very likely to occur again during this year’s open enrollment.
If you’re out of network you might be out of luck
If you use doctors and hospitals within your plan’s network of medical providers you will have lower costs than if you go out of your network. In fact, some plans wont pay at all if you receive out-of-network care – except in the case of an emergency. There’s an additional catch if you’re covered by policies under the Affordable Care Act. It’s that out-of-network charges don’t count towards your annual out-of-pocket costs. What this means is the cost of out-of-network care can theoretically be unlimited.
Like the old song says, “Shop around”
If you’re currently under an ACA plan, and do nothing you will be automatically reenrolled in your plan for 2015. But you should shop around by visiting your state exchange to see what options are available for next year. Some insurance companies will be leaving the market while others will be entering it or expanding their presence. And some insurance companies have planned on making changes in their premiums.
Your plan may not cover the top hospitals
How do insurers control costs? It’s mostly by controlling what they pay the providers in their networks. While the average hospital is usually willing to discount its rates, this is not true for high-profile cancer treatment centers and top academic hospitals. What this translates into is that if you want to be treated in one of these hospitals, you may wind up out of network.
You might have to be Sherlock Holmes to determine who is in network and who isn’t. While this might seem like a fairly simple question, you may find you have a problem answering it. The insurance companies publish lists of their in-network doctors but can be sort of lax about keeping them maintained. Even if you do your homework you could find that you’re on the outside looking in if your doctor leaves your network. Unfortunately, this isn’t very uncommon either because doctor-insurance contracts can often be terminated with little or no notice.
You can back down your insurer
Do you believe that your insurance company refused to pay a claim or made an error in billing you? Then you can appeal the decision. To do this you will need to go first to your insurance company. If you don’t get satisfaction there, you’ll have to go to your state insurance department. Where do most disagreements come from? It’s usually about whether or not treatment was necessary or when the language of your plan was unclear. Believe it or not, a very high percentage of disputes that reach the appeal stage are resolved in favor of the consumer.
You may be surprised by surprise charges
You really have no way to anticipate which providers will be involved in your care. As an example of this, you could go for an ultrasound at an in-network center but then get a bill for the full cost of the out-of-network radiologist who read your ultrasound. The good news is that many insurance companies now offer cost-estimation tools to help you avoid these unpleasant surprises. You can also call your insurer and doctor before you get a procedure and ask whether any of people involved in it are out-of-network. Of course, in the case of an emergency it’s just about impossible to do this.
You could end up paying more for the “cheapest” plan
Deductibles, copayments and coinsurance are other components of your health insurance bill in addition to your premiums. What this means is that plans with low premiums could result in higher costs for some consumers. One health insurance comparison website, HealthPocket, analyzed the plans available under the ACA and found that the plans with the highest premiums – called platinum plans – can actually be the best buy for some people because their out-of-pocket minimums are low.
Those high deductibles are not going away
If you have a high deductible plan you will have relatively low premiums. However, you may be required to pay out-of-pocket for many services until your spending hits a threshold. After that, your insurance kicks in. This is supposed to incentivize you to shop for better deals, which would reduce costs to the overall system. As you may know, most Affordable Care plans have relatively high deductibles. In fact, the average bronze plan, which is the one with the lowest premiums – has a deductible of $4959. You might think that this unfairly burdens you because the costs of medical services are seldom transparent. There have been studies showing that if you might cut back on unnecessary care when faced with higher costs, this can result in a greater expense and complications if you come down with a serious illness.
There are things about Obamacare you don’t know because you haven’t been told. To learn what they are, just watch this video …
The lesson to be learned
The net/net of this is that if you want to get the best plan for you and your family under the Affordable Care Act at the lowest cost, you need to be a very smart consumer. As you have read, you should go to your state health insurance exchange and compare the various plans available along with their deductibles, co-pays and coinsurance requirements – as well as their premiums. Read everything carefully so that you know exactly what to expect before choosing a plan. While this might take time and effort, it’s the only way you can ensure that you’ll be getting the best healthcare plan at the most affordable cost.