Key parts of the Affordable Care Act go into effect tomorrow, with heath insurance exchanges opening for enrollment.
Jay Hancock of Kaiser Health News returns to Here & Now to answer more of your questions.
2 questions answered
Barry Washington wants to know what plans under these exchanges will cover? When he gets sick, will they cover everything 100 percent or are they going to be at the mercy of these for-profit health insurance companies?
“Probably the first question to ask when you’re starting to consider these plans, and there’s a couple of points to be made here. He mentions the profit of the insurance companies; one of the things the Affordable Care Act does is limits the profit, so if they don’t spend a certain amount of their premiums on health care, they have to refund the money. It should said that all these plans cover preventive care, annual checkups, vaccinations, things like that with no out-of-pocket costs, so go to your doctor, get the preventive stuff, it’s not going to cost you anything. However, you should check the deductibles and copay's of each of these plans. As Barry points out, some of the premiums are low, they do come, some of them, with multi-thousand dollar deductibles. On the other hand, there is an out-of-pocket limit under the Affordable Care Act. Individuals cannot, will not pay more than $6,350 out of their pocket. So even with a haughty deductible, there is some ceiling on what you’re going to pay out.”
Cathy, whose husband was recently fired, which caused them to lose their private employer insurance, has children who are now covered by state insurance and wants to know what happens if they apply for the exchanges and then her husband gets a job and gets coverage?
“One of the things that happens in the exchange is you get subsidized based on your income, and so, right now, if there is unemployment insurance income going on, that is counted as part of your income. If he gets a job and the income goes up, that affects the subsidies—that all factors into the exchange software. When you’re on there, if it works the way it’s supposed to, and there are some doubts about that, it may take a while. When you go on there, all of that gets plugged in, and you can even factor in what if situations and see how the prices might change, how it affects you in some different scenarios, what you think might happen to your income."
To hear more of Jay Hancock’s answers, listen to the audio at the top of this page.
This segment aired on September 30, 2013.