Group Health Insurance
Health care reform
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Medicare related coverage
12-09-2017 by Colleen King
As we closed in on the first 'open enrollment' deadline, December 15th in order to get a January 1 effective date, with the rates as nuts as they are, people are desperate to find 'something else.' I get it, but there isn't anything else.
When the Affordable (?) Care Act came into being, new plans that were developed had to meet the new standards, and there are costs built in to that. Everything's guaranteed issue, regardless of pre-existing conditions, and you can't be charged more if you have something wrong. All plans have to cover a certain set of benefits, including everyone's favorite, pediatric dental and vision. I poke fun at that one because my clients that don't have kids aren't happy about paying for that, and we can't strip it out. All plans have to cover maternity, another favorite amongst young men. Well, as I tell clients, I have a free prostate exam available to me but not much use for that. There's always something in a plan that you won't use, but we can't strip those things out.
What people have to understand, to me, is that everything is Obamacare--the plans all have to meet these standards, on or off the exchanges. I ask people what they think 'Obamacare' means, most of the time they don't really have an answer. And I'm not poking fun at that, it's all confusing. Some thing it just means the plans available on the exchanges, but it's everything.
I know people are going nuts over all of this, but be very careful of 'less expensive options'--There is a product, offered by a few different entities, called Health Care Ministries. These are exempt from the ACA rules, so if you buy this, you are spared the penalties for not having ACA compliant coverage. But I started to look at these, thinking I would contract with one as a last ditch alternative for my clients, but the more I looked, the less interested I was. These just seemed like a liability action waiting to happen. You pay a monthly fee that is MUCH less than insurance, and supposedly they will help you pay for office visits, hospitalization, but not necessarily all of your costs. And one person I spoke with who did enroll in one out of desperation last year, found that if you developed a 'condition,' they could drop you.
Here's the thing--these are NOT considered insurance, so they aren't regulated by state departments of insurance; you have no consumer protections that I'm aware of. I don't believe from what I have seen that you have any recourse. So as they say in marketing, if it sounds too good to be true, it usually is. Be very careful if you go this route, do your reading and research.
Meantime, the deadline for a January 1st effective date is December 15th for a health plan. Ultimately open enrollment ends January 31st, so i you miss Dec. 15th, you aren't shut out, you just don't have a Jan. 1 start date.