If you have a private health plan for you and your family, you will probably receive a notice of plan cancellation shortly. Please don’t panic and understand that it is all part of the metamorphosis we are all going to be forced to take over the next year.
Remember that pledge: “If you like your insurance, you can keep it”? Well, that is a dream for most of the population in the real world. In reality, any policy written, rewritten or changed substantially since March 23, 2010 is considered NOT grandfathered and therefore will be cancelled and replaced with an ObamaCare approved plan. If you hear nothing else I write, hear this: Just because Obama approves it doesn’t mean you will. And you must review the plan details.
In the new world, choices will be reduced DRASTICALLY. Your new world will consist of cookie cutter plans with much smaller physician networks. In California, PPOs will be replaced widely with EPOs. Get used to that term because it is going to take hold. A PPO covers you if you use the a PPO physician while allowing lesser coverage if you don’t use a PPO physician. An EPO ONLY covers you if you use a network physician. If you don’t, you are not covered. This limitation along with a much reduced list of PPO physicians greatly reduces your choices in where you get care.
Why did my family costs go so high?
One of the MAJOR changes with ObamaCare is how a family rate is put together. In the past, a family could have 3 to 10 members and all be eligible for the same rate. Not so any longer. All family participants are now rated separately. Remember that 22 year old you put back on your plan just because you could? That adult child will now carry and adult rate to the table with them. Surprise!
Back to the cancellation letter you are about to receive. In essence, ObamaCare requires ALL non grandfathered individual policies to be cancelled 1-1-14. BUT, that doesn’t necessarily mean you don’t have coverage. Your carrier should move you to a plan closest to your current benefits or cost. Which benchmark they use is up to the carrier. If you don’t like where they put you, look at the options they give you. If you plan to make a change, don’t sit on it. You can only make a change during this national open enrollment and annually at future open enrollments. (Again, there are exceptions for qualifying events.)
To recap:
- You probably can’t keep your plan.
- Watch for changed family deductibles, higher out of pocket maximums, far higher specialty drug costs, and many hidden co-payments.
- You might not be able to keep your doctor.
- Don’t forget to take the time to inquire about the new physician list. IT WILL BE SMALLER.
- You aren’t going to be free to change whenever you want.
A guarantee issue market comes with limits. Rule vary case by case. This first Open Enrollment will run from October 1, 2013 to 3-31-14. In subsequent years, Open Enrollment will be the fourth quarter of every year for January 1 effective dates.
There will be new choices. Use a GOOD insurance agent to guide you. Look for years of experience and specialty in health care. Many newbies are picking up overnight expert designations and titles. Don’t fall for the scam. A good agent will have all the information available for private market and government subsidized plans through your State Exchange. If they don’t, use Find an Agent at http://www.NAHU.org.
Since subsidies are only available if you buy a cookie cutter plan through your State Exchange, you should advise the agent you would like to inquire about the Exchange. Any agent worth a nickel will be able to give you a good estimate of your subsidy.
Whatever you do. DO NOT go directly to an Exchange. They will be staffed with less educated and completely non accountable employees. Agents are free and will explore ALL of your options, so use them.
If you get to keep your plan and you like it, stay there and let the guinea pigs work out the kinks for a few years. I know I am holding on to mine!
Paula L. WIlson, RHU, REBC
paula@paulawilson.com
paulalwilson 
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