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Affordable Care Act: Underwriters offer info to counter confusion

By Messenger Staff | Published Wednesday, November 6, 2013

One month into the rollout of the Affordable Care Act’s Health Information Exchanges, confusion and frustration do not appear to be subsiding.

Compounding the turmoil is a growing amount of misinformation that has many Americans more uncertain than ever about the choices they face in purchasing health insurance coverage for themselves and their families.

“Polls continue to reflect a broad lack of understanding about the new law, confusion about the process and choices for enrollment and an increased frustration with the glitches that have plagued the rollout of the Health Exchanges,” said Mark Bellman, president of the Texas Association of Health Underwriters.

“An increasing amount of misinformation seems to be adding to these complexities as health agents continue to hear from hundreds of Texans each day,” he added. “The good news is, many consumers are reaching out to a professional benefit advisor to get answers and avoiding making costly mistakes with their choices.”

The Texas Association of Health Underwriters has highlighted 10 areas that appear to be generating the most confusion among Texans:

I can keep my current coverage.

Because the Affordable Care Act (ACA) contains new requirements for coverage, many plans currently sold will not be in compliance and will be eliminated. For example, the ACA requires that all policies cover 10 essential benefits – such as maternity, which is not included in most individual policies in Texas.

An individual currently covered by a non-compliant plan will be forced to change coverage. Employers offering health insurance were given the option of “grandfathering” their existing plans to avoid being forced to change their employees’ coverage. If a business did not “grandfather” their existing plan, employee benefits will change and could improve or erode depending on the employer’s ability to absorb cost changes resulting from the Affordable Care Act.

I am required to purchase insurance coverage through the Health Insurance Exchange.

Consumers are not required to purchase coverage through the Exchange. Most Americans will be required to carry health insurance that can also be purchased outside of the Exchange in the commercial market.

Insurance coverage purchased through the Exchange will cost less because it provides Americans with a government subsidy.

There is no guarantee that insurance purchased through the Exchange will be more affordable than coverage options in the commercial market. Subsides are available in the Exchange that may reduce the cost. People with incomes between 100 percent of the poverty line (or about $23,550 for a family of four) and 400 percent of poverty ($94,200 for a family of four) may be eligible for a subsidy.

Whether or not you are eligible for subsidies, it is recommended that you compare rates, benefits and physician and hospital networks in the commercial market with those in the Exchange. This comparison will be particularly important for consumers wanting to keep their current doctor.

Individuals are required to contact a navigator to purchase coverage in the Exchange.

There is no requirement for contacting a navigator. Navigators will have limited, if any, knowledge about rates outside the Exchange and are likely to possess only a basic understanding of coverage benefits. Consumers with questions about the best coverage for themselves and their families would be wise to contact a professional benefits adviser.

The “Obamacare” insurance options are competing with coverage from plans offered by Blue Cross Blue Shield, Aetna and United Healthcare.

“Obamacare” refers to the entirety of the federal health care reforms or the Affordable Care Act. Therefore, it is not a specific health plan. It includes such things as the types of coverage that can be offered, rules for pricing and penalties for those who don’t purchase coverage.

All employers are required to provide health insurance coverage.

Beginning in 2015, employers with 50 full-time equivalents will have a responsibility to offer health coverage or face penalties, depending on where their employees get coverage and if they receive subsidies.

Employers with fewer than 50 full-time equivalents will not face any coverage requirements. The law’s effect on businesses depends upon a variety of factors, and employers will want to consult with their professional benefit adviser to determine the best course of action.

I am better off letting my employees purchase their own coverage rather than buying a group plan for my business.

This is a subject of considerable complexity. An employer must weigh a number of issues including number of employees, wages and other financial considerations to determine what best fits their particular situation. A health insurance professional will be able, and in some instances necessary, to guide an employer through the maze of considerations.

I am required to cover my children, under the age of 26, on my insurance policy.

There is no requirement that parents cover their children through age 26. Parents have the option of carrying their adult-aged children on their health insurance plan. If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old.

The Affordable Care Act has been postponed.

Portions of the bill that involve certain types of employers have been postponed, but the individual health insurance requirement goes into effect in early 2014. The open enrollment phase for individual insurance plans is currently underway, and the deadline to enroll remains March 31. The date to enroll and avoid a penalty has been extended from Feb. 15 to March 31.

The Exchange will allow me to compare rates of policies both inside and outside the Exchange.

The Exchange does not provide a comparison of rates both within and outside of the Exchange. For rate comparisons, a consumer will want to seek professional guidance.

Attempts to defraud consumers have already been reported as scam artists try to exploit the confusion and misinformation about the law and illegally gain access to Social Security numbers, credit cards, bank accounts and other personal information.

Consumers should remain wary about providing personal information in the process of purchasing health coverage to comply with the new law.

“There are a lot of moving parts to the new law, and those purchasing coverage will be well-served to ensure they have the full picture of their options and the consequences of their decisions,” Bellman said. “Their choices could determine their ability to afford the care needed to remain healthy, manage an unexpected injury or deal with a life-altering illness.”

The Texas Association of Health Underwriters (TAHU) is a state trade association representing licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers seeking health insurance coverage. TAHU is a state chapter of the National Association of Health Underwriters.

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