Thursday, September 26, 2013

The Affordable Care Act: The Basics & How It Will Impact You

This is a compensated campaign from The Motherhood. All thoughts and opinions are my own.
I hate to admit it, but I am pretty bad about keeping up with current events, politics, news. etc. When it comes to the health care reform laws, the amount of information overwhelms me. Which pretty much left me clueless about what types of changes I would expect to see in January 2014 and what it would all mean for me. Thankfully I had a chance to be a part of a presentation by Anthem Blue Cross Blue Shield to help me better understand it all. It helped get a great deal of answers about the foundation of the reform and I want to pass some of that information onto you all.

While the Affordable Care Act (ACA) goes into effect January 2014, open enrollment starts in just a few days on October 1. And if you want your coverage to go into affect on January 1, you need to be signed up by December 14. So now is the time to find out how this will affect you and what steps you need to take to ensure you have the best health insurance for you set up. Hopefully I can cover some basic questions for you here.

Why do I need health insurance?
  • Health insurance is an important way to protect you and your family in the event of injury or illness.
  • Injury and illnesses can be costly without insurance. For example,  the average cost of a 3-day hospital stay is $30,000 and without health insurance, a broken arm can cost $2,500 or more.

I couldn't even imagine not having health insurance for myself and my family. For kids there are yearly well care check ups, viruses, vaccinations and all of that adds up so quickly. Not to mention with four boys, you know we will be spending some time in the emergency room over the years. There is no way my family could afford to NOT have insurance.

What will be my health insurance options under the ACA?
  1. Continue purchasing insurance through your or your spouse’s employer
  2. Buy health insurance yourself - either through exchanges, direct for insurance companies or through traditional brokers 
  3. Enroll in government programs like Medicare or Medicaid plans - if you are eligible
  4. Go without insurance - but pay a tax penalty

What are the Health Insurance Exchanges?
Yeah so this is one of those areas that confused me. I had no idea what a Health Insurance Exchange was and obviously no clue how they worked. If you are going to be purchasing health insurance yourself and not through an employer or the government, you will want to check out the exchanges in order to help you get the best price.
Photo courtesy of
Oregon Insurance Division
  • A health insurance "exchange" is just another word for “marketplace."  It works similarly to Amazon and lets you compare health insurance options. Public and private health insurance exchanges will operate in a similar way.
  • Plans will be available for sale October 1, with coverage starting on January 1st of next year.  Each state will have its own exchange serving people who buy health insurance for just themselves and their families.
  •  There will be four levels or metallic tiers, depending on how much you want to spend.  The general rule is that your deductible will be lower, the more you spend on your monthly premium.  
    • Bronze plans have the lowest monthly premium, but will cover 60% of expected costs.
    • Platinum plans have the highest monthly premium, but will cover 90% of expected costs.
  • The vast majority of people who are currently covered by their employers will not see a change or have to use the public exchange
  • When can you use the exchanges? 
    • Enrollment begins: October 1, 2013
    • Enrollment ends: March 31, 2014
    • Coverage begins: January 1, 2014 (if you sign up prior to December 15th)

Essential health benefits that all plans will offer.
One of the biggest questions I had about the reform is how it would positively effect preventative care coverage. One of my biggest concerns for my own health is breast cancer. My paternal grandmother had breast cancer and since I inherited some of her other reproductive genes (higher elevations of hormones resulting in double ovulation, hence resulting in fraternal twins), it is quite frankly always in the back of my mind. About a year or so ago when I was at my annual OB/GYN visit, I asked about getting a mammogram done. I was 33 at the time and deemed to young by my insurance carrier for them to cover it. Even though there is a family history there. I found the whole thing absurd. I mean is it ever really to early to start screaning for cancer? Wouldn't paying for a mammorgram at potentially stopping the cancer before it starts be better for all parties? So I am glad to see that women's preventative care is specifically being addressed in this reform. You bet your behind I'll be out getting my first mammogram as soon as I can. Here is what else you can expect to see covered with the ACA:
  • Emergency services
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services, including oral and vision care 
  • Women
    • Women won’t be charged more
    • Cannot be charged more or denied for a pre-existing condition 
    • You’ll get preventative care for mammograms, well woman visits, contraception and much more
    • You can choose your own primary care, OB-GYN or pediatrician without referrals

Who will be eligible to participate in the healthcare exchanges?
Practically everyone is eligible for marketplace coverage. Requirements are that individuals live in the U.S., must be a U.S. citizen or national and cannot be currently incarcerated.

What is the penalty tax if you don’t buy insurance?
The penalty will either be 1% of taxable income or $95 per individual / $285 per family, depending on which one is greater. This will increase over the years with annual adjustments that will continue to 2017. The reality is that health insurance doesn’t work well if the only individuals that purchase it are people that have determined that they need it at a point in time. The idea of insurance is to have a balanced risk pool that is made up of both individuals who require care and individuals who do not require care. The mandate was put in place to make sure that the health insurance marketplace works as effectively as possible.

Where can I go for more information and to find the best healthcare for my family according to my state?
  • We have launched a website for potential new members to educate on reform laws, what the law means to you, timelines for enrollment etc. 
  • We have launched a section of dedicated to ACA information for current members and are in the process of enhancing our online shopping experience and mobile capabilities to clearly discern between on exchange and off exchange options, as well as offer shopping guides and checklists to help people better understand what they need and when. Our goal is to help consumers and employers select a benefit plan that best fits their needs.

Honestly, this is just the tip of the iceberg when it comes to the information on the health care reform. There is so  much more than I can fit into one post, so I strongly urge you to check out the websites listed above for any additional questions you may have. And don't be afraid to reach out to your current insurance carrier or employer to find out if anything will be changing for you specifically. I wanted to just lay some of the basics out for you here to help you get a good foundation and hopefully this post helped a little bit with that. I know I still find it all somewhat overwhelming, but I also think I have a better grip on it now.


  1. I'm still not sure how I feel about ACA but thank you so much for this valuable information! I haven't seen anything this spelled out until now.


    1. That's the thing, everything out there is so darn confusing. it was nice to get it broken down into a language I can understand.


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