OBAMACARE- Almost Two Years Later

So now that some of the dust has settled, where are we with ObamaCare? ObamaCare, which is the popular name given to the ACA (Affordable Care Act) is almost two years old. By now, with a few exceptions, if you had health insurance as an individual (not through an employer) or if you had health insurance through a small group (employer groups with less then 50 employees), your insurance has been changed to meet the requirements of the ACA. While a small number of people have had a small decrease in premiums, for most people, this change translated into smaller networks, higher premiums, added deductibles and in some cases, more restrictions in their coverage.
Let’s look at the good. There are no longer any pre-existing limitations, preventive care, known as the essential health benefits are covered in full regardless of your plan design and plans are more standardized, making them easier to compare. The essential health benefits are preventive care, screenings and immunizations. These benefits should be covered at 100% but it really depends on the way they are billed. People who could not afford insurance were able to get insurance and have gotten their premiums subsidized either in part or full.

The bad? Many of the issues that I had were due to the fact this is all so new, so much of this was and is a “learn as we go” type thing. But one thing I tell all clients – if you think something is being billed incorrectly, do something about it. Call your broker; contact your physician’s office – don’t be shy about questioning it. Let’s forget about the problem with the website at start up – that could be a long conversation with no resolution. The complaints I have gotten from clients will probably sound familiar. The biggest issue have been with the networks. Networks on plans have changed so providers who were in your plan prior to the ACA may no longer participate (you should check this before enrolling); looking up doctors on websites have been found to be outdated or incorrect. The other big complaint is that all plans are in network. People still want to be able to go out of network. The rumor is that next year (2016) there will be plans that will let you go out of the network. As far as deductibles and premiums, we just have to wait until open enrollment to find out. The universal complaint I’ve gotten has to do with the subsidies given to people and why the “paying” people have to pay for this. No one is happy about this.
We can discuss this from a political point of view, but what I’ve taken away from almost everyone is that this was a good idea, just poorly done. Rates for the vast majority of people have been increased. In an effort to make plans affordable, deductibles had to be added. Employer plans that covered only married people were cancelled and these people were forced to enroll as individuals; networks and plans became smaller and more regional. So while this is a start, there is much work to be done.
I’d be interested to hear what your experience has been with ObamaCare. Please reach out to me at my contact information below!
Overall, the ACA has been good for some but bad for most. One thing for sure-ObamaCare looks like it’s here to stay. Hopefully it will be tweaked and improvements can be made – time will tell.