With a slew of changes pending and an open enrollment period set to begin in just three days, the Boyne City Gazette takes a local look at the Affordable Care Act (ACA), also known as “Obamacare.”
The second of two informational sessions concerning the state and federal insurance options of the ACA—entitled “Get Covered, Stay Covered: Health Insurance Options”— is scheduled for 6:30 p.m. to 8 p.m. on Tuesday Nov. 18 in the Charlevoix Public Library’s Trustees Conference Room.
“I think you’ll find the word ‘affordable’ in the Affordable Care Act is mostly true,” said independent Charlevoix insurance agent Tom Mielke. “That’s mostly due to the subsidies which have done a very good job of making it affordable because it is based on people’s income.”
The Healthcare Marketplace’s open enrollment period is from Nov. 15 to Dec. 14, in order for coverage to begin on Jan. 1, 2015.
However, the enrollment process can be completed any time for folks who qualify for the Healthy Michigan Plan.
Mielke said he initially had mixed feelings concerning the new health care regulations but said he has since seen many people in need helped greatly by the ACA.
“It’s not a horrible thing,” he said. “Is it sustainable? Who knows.”
According to interactforhealth.org, the major changes slated to begin in 2015 include the following:
• Medicare – Beginning in 2015, Medicare payments will be reduced to hospitals with high rates of hospital acquired conditions (HAC). This is when a patient needs more care due to something that could be prevented, such as a patient getting a new infection due to unclean facilities or bad care, or when an object is left inside a person during surgery.
• Exchanges – By 2015, all exchanges must be self-sustaining. They can charge insurers fees to pay for operating expenses. But, they cannot use any money collected for staff retreats, promotional giveaways, excessive executive salaries, or public education programs about changes to federal or state laws.
• Tax Changes – Beginning in 2018, insurers will be taxed if the value of their employer-sponsored health plans either exceeds $10,200 for individual coverage or exceeds $27,500 for family coverage.
Pam Luce, Outreach and Enrollment Coordinator with the non-profit Michigan Primary Care Association, will present a brief overview of insurance options, along with information regarding coverage renewal and changes to plans.
A question and answer period will follow her presentation.
A question frequently asked of Mielke is “What’s Obamacare?”
“There is no insurance program called ‘Obamacare,’” he said. “It’s the same insurance companies as before—Blue Cross/Blue Shield, Priority Health and Blue Care Network—this just lets people sign up and get a subsidy if your income qualifies you to have a subsidy.”
The most popular insurance being chosen by his clients, Mielke said, is Blue Care Network.
According to the U.S. Department of Health and Human Services, through the ACA’s Health Insurance Marketplace, Michigan residents can compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.
“At the end of the first annual open enrollment period, enrollment in the Marketplace surged to eight million people nationwide,” it states on the Health and Human Services website. “In Michigan alone, 272,539 individuals selected a Marketplace plan between Oct. 1, 2013 and March 31, 2014 (including additional special enrollment period activity through April 19, 2014).”
Of the 272,539 Michiganders who selected a plan:
• 54 percent are female and 46 percent are male;
• 35 percent are under age 35;
• 29 percent are between the ages of 18 and 34;
• 75 percent selected a Silver plan, while 13 percent selected a Bronze plan; and,
• 87 percent selected a plan with financial assistance.
Mielke said there have been some people with higher incomes who saw their insurance rates go up 20 to 30 percent.
“They weren’t happy with that but I didn’t see anybody canceling their plans,” he added.
According to the eHealth “Health Insurance Price Index Report for Open Enrollment and Q1 2014,” which covers the periods from October 2013 to March 2014:
• Premiums for individual coverage averaged $271 per month while premiums for family plans averaged $667 per month.
• Over the same period, the average annual deductible for individual plans was $4,164 and the average deductible for family plans was $7,771.
Approximately 40 percent of the people Mielke has helped enroll under the new law had no health insurance prior to the ACA.
And, he said, “It’s above 80 percent that have paid their bills.”
The ACA website was notoriously difficult to navigate during the first year of the roll-out but Mielke said things have improved.
“The enrollment procedure as it went on the website actually became pretty solid as long as you have a good, fast internet connection,” he said. “I only had trouble with about 10 percent of the people I enrolled.”
For more information on the ACA session, call Pam Luce at (231) 335-3180.
To get signed up for health insurance, call Tom Mielke at (231) 547-2500 or e-mail him at firstname.lastname@example.org.
“Sign-up typically takes about a half-hour to 40 minutes for individuals or, for a couple or family, closer to an hour,” said Mielke. “It’s very involved.”