Looking at the benefits of health care reform

Looking at the benefits of health care reform

Your health should always come first. That’s why it’s so important to keep up with health care reform’s changes. And, even though the Affordable Care Act (ACA) has been in place since 2014, there’s still a lot of confusion about health insurance and how the new health care laws affect people.

You probably know that the new laws require all legal U.S. residents to have health coverage – or pay a tax penalty that goes up every year.

Sweeping changes like these can be frustrating and hard to understand. It’s good to remember that there are positive benefits to these changes. With open enrollment coming in November, now is a great time to think about your health insurance needs.>

Coverage is important

Without health insurance, if you get sick or have an accident, you’d face unexpected bills that could put a strain on your budget — and put your savings at risk. Health insurance protects you from the big medical bills that often come with accidents and illnesses.

Plus, with the new laws, you’ll likely pay a tax penalty if you don’t have coverage.

There are different ways to buy coverage

If you’re looking to buy a health care plan, you have three choices:

  • Through work: If your work offers a health care plan, this is your best choice. Many companies help pay for part of the premium, which is a fee for health insurance. Also, when you choose a plan through work, you pay for your premium using pre-tax dollars. So you won’t have to pay taxes on your premium.
  • Through a health insurance company: If you can’t get health care coverage through work, or if you want more benefits than your work offers, you can buy what you need from an insurance company. You want a plan that will protect you from the rising costs of health care, so look for insurers with dependable service and solid financial reputations.
  • Through the Health Insurance Marketplace: To help people get health care, the government set up a Health Insurance Marketplace where you can shop for and buy plans. Some people who need financial help to pay for a plan can get that if they buy through the Marketplace.

Here’s an easy way to understand how the plans are set up

The new health care law requires all new health insurance plans to fit one of four levels: bronze, silver, gold or platinum. These plan levels make it easier to compare costs and benefits so you can choose the right plan for your needs and budget.

Here’s how benefit coverage and costs change at each plan level:

Bronze (lowest cost) covers 60% of your premium.

Silver (average cost) covers 70% of your premium.

Gold (higher cost) covers 80% of your premium.

Platinum (highest cost) covers 90% of your premium.

You’ll enjoy more benefits with your health plan

The goal of health care reform is to improve health care for all Americans. That’s why the new law adds benefits to your health plan. Your new health plan will offer:

  • In-network preventive care at no extra cost: This includes yearly checkups, shots, tests and screenings.
  • Coverage for children age 26 and younger: Children covered on a parent’s plan can stay covered until they're 26 years old. They’re covered whether or not they live at home. They don’t have to be a full-time student, and they can even be married or have children of their own. However, their dependents can’t stay on the plan.
  • Coverage – no matter what: Health insurers can’t refuse to cover you or renew your plan because of a pre-existing condition such as cancer, asthma, high blood pressure or arthritis. If you have a condition, health plans have to cover you.

Preventive care helps you stay healthy

Preventive care services can help you avoid getting sick and improve your health. In the past, you had to pay a copay, coinsurance or deductible for preventive care. Now, you won't have to pay these costs or file a claim for these services as long as you get care from a doctor in your plan's network. That includes:

  • Many cancer screenings, including mammograms and colonoscopies.
  • Counseling on quitting smoking, losing weight, eating healthy foods, treating depression, reducing alcohol use and other topics.
  • Preventive care checkups, which are covered for all ages.
  • Routine vaccines against diseases like measles, polio or meningitis.
  • Counseling, screenings and vaccines for healthy pregnancies.
  • Flu and pneumonia shots.

Remember, you get preventive care with $0 out-of-pocket costs and basic benefits no matter which plan level you choose.

You can still make changes, even if life gets in the way.
There are a lot of life events — from having a baby to losing your job — that may allow you to change your health plan during a special enrollment period. If you’ve had a change in your coverage, family or income that qualifies, you can shop for a new health plan without waiting for the annual open enrollment period in November.

Time is limited to qualify for a special enrollment period. Most people have just 60 days after a qualifying event to enroll in a new plan.

Open enrollment is around the corner

To learn more about your health plan choices with Anthem Blue Cross and Blue Shield and
R. Kashmiry and Associates, Inc., or to sign up for an ACA plan, call 1.330.758.4163 or 877.860.6295.