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.

Be sure to purchase coverage before the end of March. If you miss that period, you will have to wait until the next open enrollment period. Please note: you can purchase dental and vision coverage at any time (including outside of the open enrollment period), even if you don't experience a qualifying life event.

Here’s a list of life events that qualify you for a special enrollment period:

• Losing your health coverage through a life event

1. Examples of these life events include: getting a divorce, losing your job, losing your Medicaid or CHIP eligibility, your current plan being decertified or expiring COBRA coverage
   
2. Please note: If you voluntarily quit your health plan or are terminated because you didn’t pay your premiums, you are not eligible for a special enrollment period.

• Getting married
  
• Having or adopting a child, or placing a child for adoption
  
• Permanently moving somewhere with different health insurance options
  
• Experiencing an enrollment error
  
• Having a change in income or household status that changes your eligibility for tax credits or cost-sharing reductions
  
• Your plan or issuer substantially violating a material provision of the contract you’re enrolled under
  

If you need more information, help understanding special enrollment periods or help choosing a health plan that’s best for you, talk to one of our experienced health insurance experts by calling 888-883-5290.

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.

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!

For  those of you who have Golden Rule Insurance, you are a member of FACT; here is the link for the website to learn more about the travel and merchant discounts available to you.  

April had the most rain on record in West Michigan this year which caused wide spread flooding. If you have experienced flooding recently, they offer a benefit you can apply for.

Teachers, you can get money for your classroom.

 FACT also offers student scholarships.  Check it out, you never know what benefits you'll be able to use until you do!
 
http://www.usafact.org/
 

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!

Get Quotes Now
Assurant
Golden Rule/United Health One
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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 

Source: Healthinsurance.org

Insurance usually allows you to maintain checks on your general health as well. Depending on coverage, annual physicals and other diagnostic tests may be free or cost very little. Prescription medications - perhaps the most grossly overpriced product in America today - often cost much less as well.

Not the best answer, but not far off from the concept of shifting the risk to the insurance company and away from your own personal finances. 

Need more reasons?

+ Auto insurance costs less if you have health insurance.

+ Preventative Care is free these days when network providers are used (see your plan for details).

+Network discounts allow for reduced costs for medical care and prescriptions which can save money.

+Health Insurance premiums may be tax deductible (consult your tax preparer for details to see if you qualify).

+Choice of medical providers, choice of care plan, and choice of carriers.

While our current medical insurance industry is not perfect, continued efforts work towards improved efficiency, cost containment, and quality outcomes for the insured.

We welcome your feedback and referrals so we can continue to serve our valued clients.