A local insurance company owner recently gave members of the Cleveland Rotary Club an inside look at how the Affordable Care Act has begun to impact both her industry and the lives of her customers.
Pam Nelson, both owner of Ocoee Insurance Services and the club’s president, took the club’s recent luncheon as an opportunity to explain how the ACA was set to change how everyone deals with health insurance.
She began her talk with a major caveat.
“Everything I tell you today could change tomorrow,” Nelson said.
As the act has evolved since it was first introduced, the requirements for both individuals and business owners have changed frequently.
Nelson said that fact has been a major point of confusion for many people. On top of that, each person’s situation is different, making definitive answers of how the health insurance laws will impact people hard to come by. However, she said she would try to give an overview.
The Affordable Care Act dictated that insurance companies had to begin offering a slate of 10 “Essential Health Benefits,” some of which had not been offered by local insurance plans, she said.
Under current laws, new policies are required to include the following:
n Ambulatory patient services;
n Emergency services;
n Maternity and newborn care;
n Mental health and substance abuse services;
n Prescription drugs;
n Rehabilitative and habilitative services and devices;
n Laboratory services;
n Preventative and wellness services and chronic disease management; and
n Pediatric services, including oral and vision care.
Nelson said including pediatric oral and vision care was something that “almost all” of the companies offering plans through online insurance exchanges had to add.
“Nobody’s plan had that,” she said.
Many people have been upset as of late because their insurance companies had issued cancellation notices in light of the Affordable Care Act. Many people liked their previous health insurance plans and did not want to change, she said.
However, she also said many companies are beginning to rescind those notices after a federal law passed allowing consumers to keep their plans.
“We’re not sure exactly how long you’re going to be able to keep it, but for now you get to,” Nelson said.
Another issue is that many people have also seen their health insurance premiums rise higher and higher.
Nelson said she attributed that to the number of new things insurance companies are having to include in their coverage. Adding new items to a policy can be expensive, and adding a lot at once has made for some expensive policies.
“They’re rich in benefits, and we have to pay for them whether we want them or not,” she said. “My personal coverage has tripled.”
However, whether or not someone is having to pay more for insurance than they once did has a lot to do with factors like their age and health condition. If a person was, say, older with a lot of pre-existing health issues, that person could actually see a decrease. Nelson said the biggest increases have been among the policies for the young and healthy.
Subsidies to help pay for insurance premiums are available, but they are all based on a person’s income level.
One positive she said she saw from the changes was that the insurance underwriting process is no longer happening. Someone with preexisting conditions can no longer be refused health insurance coverage, and Nelson said the only health issue they are allowed to ask about is whether or not someone smokes.
She said it also offers more flexibility for people who might need to change their policies, as open enrollment periods will happen regularly. As the employees of her company have helped people choose insurance plans in the past, Nelson said it was always a bit of a gamble to predict what medical costs someone might incur.
Plans on the federal health insurance exchange website, HealthCare.gov, come in four different levels: bronze, silver, gold and platinum, each providing more coverage and wider networks of health care providers than the last. If someone has a bronze plan, they could switch to a gold plan during the next enrollment period.
However, she said she was worried about things to come because many of those who have had their insurance plans canceled could fail to start new plans before the end of the federal health insurance exchange’s open enrollment on Feb. 28 of next year. While some may see their plans reinstated, many may not.
In addition, Nelson worried about those who are losing coverage under state-mandated TennCare or AccessTN plans being able to gain access to what they need unless they are able to access the subsidies they may be able to apply for online.
HealthCare.gov continues to be riddled with issues, she added. Even with the assistance of employees at her business, Nelson said it takes the average person an hour and a half to sign up for insurance online. While many insurance companies will still allow people to sign up for policies by mail or over the phone, using the website is the only way to get the federal subsidies set aside to help people pay for insurance under the Affordable Care Act.
Beginning next year, those who do not have insurance will be fined by the federal government, which Nelson said would likely come in the form of a tax withholding. In 2014, each adult who does not have insurance will be fined $95 for them and $47.50 for each child of theirs who is not insured. After that year, the fines will increase drastically each year, “forcing” people to get insurance.
While all this is happening, the rules are constantly changing and continuing to create more confusion. Even if someone who has lost their insurance and is able to get a new policy, she cautioned that some coverage networks may be “skinnier” than they were in the past. She said she would not be surprised if next year she hears about patients going to doctors believing they still have the type of insurance they need for that particular doctor’s office, but finding out at the office they do not.
“I usually try to be a positive person, but there are some serious issues,” Nelson said.