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What is Health Care Reform? Get the Facts!

In 2010, health care in the United States made sweeping changes with the enactment of the Affordable Care Act (ACA). The Affordable Care Act gives millions of Americans access to high quality, reliable health care, while keeping costs affordable. With this new act, insurance companies can no longer deny certain coverage. By 2019, the new law will extend health care coverage to 32 million uninsured Americans and will impact how every American buys insurance and what insurance must cover.

With this legislation, most Americans will have to have insurance by 2014 or pay a penalty. By 2016, that penalty will rise substantially if individuals choose not to be insured. For a family, the maximum penalty assessed will be $2085.00 or 2.5% of their combined income in 2016. For an individual, the penalty will increase in 2016 to $695 or 2.5 % of your income. There are a few exemptions to the rule. American Indians are exempt as are people with financial hardships or certain religious beliefs.

The ACA was designed to help individuals who were either uninsured or who were denied coverage based on pre-existing conditions. Today, insurance companies cannot cancel coverage when you get sick. They also cannot set lifetime caps or annual limits on the dollar value of benefits which is important for individuals with health conditions that require expensive medications or treatments. Preventative care, like immunizations, blood tests and mammograms are now free of charge.

In 2014, states set up exchanges for individuals and small businesses to purchase health insurance. Wisconsin's exchange is www.healthinsurance.org. Insurance offered through these exchanges meet standards for benefits quality and reliability. Consumers can keep their existing insurance or purchase new coverage through the exchange.

For families earning less than 400% of the poverty level, they can receive subsidies to help cover the cost to purchase insurance and will lower the cost of their premiums. Out of pocket expenses will also be reduced for individuals and families under the poverty level. Other sites to compare and save are www.healthsherpa.com or www.healthcare.gov. These sites are designed to provide immediate pricing and determine if tax credits and subsidies can be applied.

In 2016, two or more states can allow qualifying health insurance plans to be purchased across state lines.

At B&J, we're happy to sit down and discuss how the Affordable Care Act affects you and your family. We can help put together a plan that works for you and your budget and determine whether you are eligible for tax credits or subsides.

We'll help you Plot a Proper Course to Determine What Plan Works Best for All Your Health Insurance Needs.


Self-Funded Health Insurance

With increasing costs for typical fully funded insurance plans, more employers are turning to self-funded healthcare plans. With a self-funded plan, employers set premium rates based on claims history and adjust plans in other ways to cut costs. With self-funded programs, employers no longer work with health insurance companies and instead create a coverage plan based on needs. The employer can choose the coverage they want to deliver and avoid paying for what they don't want. If claims are lower than anticipated, they can invest the funds and earn interest. If claims are higher than anticipated, stop-loss coverage pays for excess costs which an employer purchases as protection to the plan. Some employers choose to administer their own plan but most select third parties to oversee. In a self-funded plan, an employer has the choice of funding expenses as they arise or depositing expected or maximum costs into an account monthly.

When using this type of plan, employers assume the liability and risk for uncertain healthcare costs. Self-funded plans offer advantage too. They can provide companies with better cash flow, certain tax benefits and greater overall flexibility.

Many employers today are adding wellness and incentive plans into their self-funded programs. Why? Employers often see an immediate reduction in claims when overall improvements in health and fitness occur. With fully insured plans, wellness initiatives generally do not result in significantly lower health insurance costs.


Fully Funded Insurance Plans

Most of us are familiar with fully funded plans. These plans, have been considered up until now, the traditional plan used for health insurance coverage. Employers work with insurance providers and pay in advance a monthly set premium to cover projected claims. If claims come in below projected costs, reimbursement unlike self-funded plans is not provided. Typically, there's a deductible and or a co-pay the employee pays. Once an employee reaches their deductible, the insurance company pays out the claim.


Individual Health Insurance

Individual insurance for you and your family can be confusing and costly. With the affordable care act, all individuals must be insured or pay a penalty starting in 2014. There are several options for individuals which include:

  1. Health maintenance Organizations or (HMO's) offer slightly better premiums but locations and service can be an issue. Typically, you chose one provider who is you point of contact. In the event a specialist is needed, the provider would refer the patient to the specialist.
  2. Point of Service (POS's) and Preferred Provider Organizations (PPO's) offer more flexibility. With POS or PPO plans, a patient can see a doctor outside of network and see a specialist directly without a referral from their main provider. These plans also make it easier to see a doctor in other geographic areas.
  3. Health Savings accounts or (HSA's) use higher deductibles, offer lower premiums and offer tax advantages. They are similar to a savings account and accrue interest.

Let us help steer you in the right direction to determine if a HMO, PPO, POS or HSA is best for you and your loved ones. We can advise you on where to find savings while maintaining adequate coverage.