Healthcare Reform Benefits

Mystified and overwhelmed by Healthcare Reform laws? This is Part One of a series of articles on medical insurance requirements, benefits, and compliance according to the Healthcare Reform Act, or Obamacare.

I’m going to try and share some of the potential positives first, because I know this is a really overwhelming topic, at least it was for me when I started! This particular topic was requested by a reader, so keep those requests coming.  :^)

Benefits

Healthcare Reform benefits young people in particular because their parents’ health insurance covers them until they’re 26, whether or not they live at home, are students, or even if they’re married. That gives you time to get a job with decent benefits.

No one can be denied coverage based on pre-existing conditions.

Individuals who make up to $45k are eligible for federal subsidies if they buy their insurance on the state exchange, making their health care more affordable.

There are also more options available for financially challenged individuals to access healthcare than before. Will Healthcare Reform threaten your piggy bank?

Subsidies Available

There will be federal subsidies available to help cover the cost of insurance, but it’s up to you to make sure you’re getting any federal subsidies you’re entitled to, so it’s going to take some research on your part to be sure you’re getting what you deserve. Each state has ‘navigators’ available to explain the plans, but they aren’t allowed to come right out and tell you what to do.

Healthcare Savings Accounts

One excellent provision available for those whose employers provide them are Healthcare Savings Accounts, or HSA. Figure out how much you will spend on medical bills, insurance deductibles, glasses, and prescriptions per year (up to $2000) and enroll. The HSA funds will be taken out of your pay before income taxes are calculated, which saves you money. A portion of that total will be deducted and put in the HSA from your paychecks. When you get a medical bill you turn it in to the administrator of the HSA and they will either cut you a check or they will give you a debit card for your copays. It’s a really good deal. Definitely do it, but be sure you are going to use every penny of it, because what you don’t use you lose. My particular provider (Allegiant) has an app, and I just take a picture of my bill or the statement from my insurance company and they direct deposit the funds to my account.

Essential Health Benefits Available

There will be people who will have access to healthcare options they didn’t have before. According to The Centers for Medicare and Medicaid Services Website, the Affordable Care Act requires non-grand fathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories:

  • ambulatory patient services;
  • emergency services;
  • hospitalization;
  • maternity and newborn care;
  • mental health and substance use disorder services including behavioral health treatment;
  • prescription drugs;
  • rehabilitative and habilitative services and devices;
  • laboratory services;
  • preventive and wellness services and chronic disease management;
  • pediatric services, including oral and vision care.

Once again, every state is going to be slightly different, some of them will have better benefits, coverage and prices than others.  Some of these services were not necessarily available before to people without insurance or with poor insurance.

Yes, I know it’s Difficult

Honestly, this type of stuff is one of the hardest parts of adulting, not only because you have to take the time to figure out what your needs really are (not what you’d like them to be), but you also have to predict the future a little bit. It can also feel a little like you’re never going to be able to understand, much less afford, what you need. I get it.prescription costs

If you have chronic health issues you’re going to need more coverage than someone who is healthy as a horse, who feels comfortable carrying catastrophic coverage only, so try to be realistic about your personal needs.

According to the law, though, everyone will have access to preventive care, like yearly checkups and other “Essential Health Benefits” (see above) that they may never have had before, and that’s a good thing because it could catch problems that we’re not aware of in their early stages.

So these are some of the positives of the Healthcare Reform Law. *

Next we’ll talk about when open enrollment is, who is exempt, and what qualifying life events make it possible for you to sign up for coverage outside of Open Enrollment. We’ll also talk about the penalties you’ll pay for noncompliance, types of insurance, and how to find and get the best use of your state’s resources, as well as how to get the best care for your personal needs.

*Just to be clear, I’m not promoting the agenda of the government on this issue, and I’m not for or against it. I’m just sharing the facts that we have to deal with, and in this particular post trying to find the bright side of something we have to do anyway.