There are some health care benefits you can count on getting no matter the plan you choose in 2014. The Affordable Care Act requires that all new plans cover essential health benefits for all individual and family plans and small group plans. I've underlined the benefits which are typically not included in pre-2014 plans.

All new 2014 plans offer these required essential health benefits:

• Outpatient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric dental and vision

Preventive services will be paid at 100 percent with no copay when you see an in-network provider. Other benefit costs apply towards deductible and will be paid for after you meet your deductible. Depending on the plan you choose, you may still be responsible for paying a copay and coinsurance.

It is important to note that these benefits come with a higher price of coverage.  In addition, approximately 10% of the new monthly premiums are taxes which will help pay for the start up of the Marketplace enrollment system and tax subsidies for eligible citizens.

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller / SHOP Marketplace Enroller from Grand Rapids, Michigan.

CLICK to DOWNLOAD this handy little guide to answer basic questions about PPACA Healthcare Reform from United Healthcare.
Please contact me for any questions not covered in the booklet.

Health care reform requires that all individual and small group health plans offer these 10 essential benefits starting in January 2014. Many of the benefits weren't provided or fully covered in the past, so including them means more benefits with more protection for you.

Ambulatory patient services - Care you receive without being admitted to a hospital - such as at a clinic, physician's office or same-day surgery center.

Emergency services - Care for conditions which, if not immediately treated, could lead to serious disability or death.

Hospitalization - Care you receive as a patient in a hospital, such as room and board, care from doctors and nurses, and tests and drugs administered during your stay.

Maternity and newborn care - Care provided to women during pregnancy and during and after labor; care for newly born children.

Mental health and substance abuse disorder services - Care to evaluate, diagnose and treat mental health and substance abuse issues.

Prescription drug coverage - Drugs prescribed by a doctor to treat an acute illness, like an infection, or an ongoing condition, like high blood pressure.

Rehabilitation and habilitation services and devices - Services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills.

Laboratory services - Testing blood, tissues, etc., from a patient to help a doctor diagnose a medical condition and monitor the effectiveness of treatment.

Preventive and wellness services and chronic disease management - These services include routine physicals, screening and immunizations. Chronic disease management is an integrated approach to manage an ongoing condition, like asthma or diabetes.

Pediatric services - The other nine essential benefits are provided to children along with dental and vision care.

Resources For Health Care Reform Updates - Websites To Check In With
www.KFF.org

www.AHIP.com  

www.HHS.gov

www.CBO.gov  

www.NAIC.org  

www.statereforum.org/states  

www.ncpa.org       

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.

Under the new health care reform laws, there will be some changes coming in the way you pick, purchase and pay for your plan. Here are some of the upcoming steps and dates to remember:

October 1 The Health Insurance Marketplace opens for business for coverage effective Jan. 1, 2014. It is optional for you to participate if you already have coverage.  Most carriers are not forcing any changes to current coverage until 1/1/15 for individual plans.  Group insurance benefits must upgrade to the new benefit requirements effective the renewal date next year.  The enrollment form does not include health status with the exception of tobacco use. 

Plans will be more uniform since they must conform to Essential Health Benefits of the "metal" plans: Bronze (60%), Silver (70%), Gold (80%), Platinum (90%), and Catastrophic (available to those in certain situations, under age 30).  We encourage you use our services for comparing your options an enrolling in a new plan if it is a better option for you.

Open enrollment starts Oct. 1, 2013.
We will be able to enroll you in a non-medically underwritten plan for 1/1/14.  For the initial year only, open enrollment lasts from 10/1/13 to 3/31/14.  Coverage begins wither 1/1/14, or the 1st of the following month (for next year only), to ensure no gap in coverage.  If you do not purchase insurance, most will have to pay 1% of their adjusted gross income as a penalty.  We can assist you in calculating your subsidy so you know what your net cost is anticipated to be.  You have an option of having the insurance carrier receive monthly payments from the government, or you can get a refundable tax credit if you do not receive a monthly subsidy.  In most cases, subsidies are not available for those with group insurance options.

January 1 Tax credits (or subsidies) become available. Go to http://kff.org/interactive/subsidy-calculator/ and use theSubsidy Calculator Tool to see if you qualify.

Be forewarned, there are a lot of moving parts to this and it's getting more complicated than ever.  Your accountant may have recommendations for your situation due to income projections changing for 2014.  Keep in mind that open enrollment ending means that you won't be able to purchase coverage anytime during the year, without a qualifying condition.  A qualifying condition would be loss of group coverage due to job loss or change of family status (birth, divorce, adoption, marriage).  The next open enrollment would be October 1st, 2014 for January 1, 2015 effective date.

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.

If you have questions about the Affordable Care Act, here's a short video overview on how it works. It is the law and it is being implemented. You will be affected, no matter who you are. This is the largest social change in our country since Medicare started in 1965. Take a few minutes to watch this from Kaiser Family Foundation, then let me know if you have any questions.

Insurance is getting too complicated due to Healthcare Reform, it's not the same insurance world we were  all able to navigate through a few years ago on our own.  It may look like you are getting the best deal ever while navigating through a site for a health insurance agent in Georgia or California, but beware before you apply for insurance online with an out of state agent! Your local insurance agent can't make changes to the plan that you purchase during the first year of coverage and you will be stuck with a bad plan and no local agent to help you. If you are declined for coverage by applying online yourself for perhaps a plan that is not really suited for your needs (which is why it looks so cheap), then that is a red flag that you are uninsureable and it will be hard to find someone to help you. Insurance plans can not just be cancelled and re-applied for. 

A local health insurance agent provides a valuable service and can help you get a suitable plan in place that meets all your needs for the best price in your state.

Call Jeanine Today!

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.

How does the Patient Protection and Affordable Care Act (PPACA) affect people?

Since 2010, insured have enjoyed free wellness care, as long as it fits the guidelines set forth in PPACA.  (See www.Heathcare.gov/prevention for details of the wellness treatments you are eligible for.)

To ensure he didn’t have any concern for lung cancer, my friend, a former smoker, asked during his recent wellness visit for a chest x-ray and was denied.  The doctor said it wasn’t necessary.  His mother died of cancer at age 62.  He is turning 57 this year and felt it was necessary for his peace of mind.  He is willing to pay for it and couldn’t get the Doctor to order the x-ray.  Only 1% of lung x-rays show cancer, but what if he is the 1%?

The bigger picture is that behind the scenes, PPACA is changing Doctor’s compensation from a “fee for service” (where providers profit from providing more services) to “capitated” payments (where providers profit by providing fewer services) or some hybrid.   Meet the new final authority for health care in America.  It’s not Congress, not the Court, and not “We the People”.  It’s an Independent Payment Advisory Board (IPAB), an unelected, unaccountable 15-member panel empowered to set healthcare standards for spending, care and efficiency that will affect all of us.  It is quite possibly the most dangerous aspect of the entire PPACA law.  IPAB is not required to hold any public hearings and its decisions are not subject to administrative or judicial review.  It has the power to tax and ration care.  This is all by design.  The authors of Obamacare decided to take the difficult matters away from politicians.  The “quality and efficiency” standards set by IPAB affect ALL health care, not just Medicare and Medicaid.  This means your utilization of your private health insurance will be affected, even if you are willing and able to pay for treatment.  There will be one standard of care for all.   IPAB has determined too much money is spent in the last year of life. 

Furthermore, as IPAB is reducing compensation to Medicare/Medicaid providers, fewer Doctors can afford to continue serving this population.  There is a silent exodus already in motion from Doctors.  This movement is the beginning of rationed care. 

So how does PPACA affect you?  It will depend on your age, wealth and health.   

*“Hidden Dangers of Obamacare” was used as a resource to this article.

Jeanine Kinzie - Licensed Health and Life Insurance Agent
If you would like to talk to an expert about what this means for your and how you can best protect yourself and your family in the future, Contact Jeanine!

In case you haven't heard, major reform implementation is coming in October 2013. This change is optional for you this year.  We will be agents for you whether you are entitled to a subsidy through the exchange or not.  We will provide you with options for keeping your current plan and what new plans are available.

The Affordable Care Act is expected to help increase access to health care. Health insurance exchanges will be an important part of that.

Most people get health insurance through their employers. But people without this option will now be able to shop for health insurance on exchanges, as an alternative to buying coverage directly from individual health insurers. Exchanges will be open for business in October 2013, allowing consumers to shop for health plans that will begin on January 1st.

Click on the video below to watch and find out more.

Experts predict that by 2016, more than 25 million people will use exchanges to buy health insurance.

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Call or email Jeanine to discuss which options are right for you and your family.

Health Care Reform Takes Effect In 2014
What Does This Mean For You NOW?

When the Affordable Care Act was introduced, it seemed like a good idea. Healthcare costs were escalating faster than inflation. People with pre-existing conditions found it difficult to get coverage. Preventative care wasn't used for early detection the way it was intended due to cost. 30 million people were uninsured and sometimes weren't able to cover the cost of their medical care. Something had to change. My opinion is and was that the changes required to fix the system didn't need a complete overhaul, but that's what we're getting.

We have been led into the Patient Protection and Affordable Care Act of 2010 with the sweetness of free preventative care, children under age 26 allowed staying on their parent's plan, and no child under age 19 being declined for coverage. Next year, we won't have any medical underwriting so all policies will be guaranteed issue. Rate disparities between age bands will be reduced to a ratio of 5:1 to 3:1 which will result in significant rate increases for people in their 20's (not on their parent's plan).

For policies beginning in 2014, PPACA compliant health insurance plans will be very expensive. New health insurance premiums will be very extensive and policies will cover much more than the average policy covers today. While you may be content with your coverage, more benefits always equal more premiums. A bigger increase will be applied to individual policies since group policies already cover more of the essential health benefits. (See details below on essential benefits.)

Republican House Energy and Commerce Committee members, the Senate Finance Committee and the Senate HELP Committee issued a report looking at several previously released studies to make the point those premiums for Individuals and Small Groups are likely to spike in 2014 due to healthcare reform provisions. The reports I have received show a nationwide average increase for individuals purchasing new coverage next year to cost 50-116% more than this year. New group coverage is expected to cost 32% more than this year due to ramifications. We have creative solutions to reduce the increases implemented on current coverage. New product designs and supplements are being rolled out monthly. Yet rules for implementation are still forthcoming.

The exchanges being put into place for purchasing insurance are expected to charge 30-50% more than purchasing insurance from an agent will cost. This is due to extra fees and taxes collected to help pay for the subsidy low income may receive when purchasing coverage thru the exchange. By the way, the proposed application for the subsidy is currently 45 pages long! The Internal Revenue Service is responsible for much of the financial eligibility after the application has been reviewed by Homeland Security. When we discuss your policy, I will advise you if you will be better served by the exchange than what I can assist you with. It's very complicated and I can't give too much general advice. Exchanges will open October 1st for January 1, 2014 effective dates.

Many uninsured people are waiting to see what happens and what will be available to them. This may leave them with less affordable options. Please encourage your friends and family to talk to me about the affordable options NOW and can put in place today. If you have questions you'd like addressed, please email or call me. Contact Jeanine!

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More Information
For more details, please visit www.uhc.com/united_for_reform_resource_center.htm, www.healthcare.gov, and www.kaiserhealthnews.org for more details.

Click on the image to DOWNLOAD this infographic to see additional options for gaining coverage beginning 2014.

Source: Keiser Family Foundation www.kff.org