What to expect as Affordable Care Act comes into effect

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wwltv.com

Posted on September 19, 2013 at 10:30 PM

Updated Thursday, Sep 19 at 10:40 PM

Meg Farris / Eyewitness News
Email: mfarris@wwltv.com | Twitter: @megfarriswwl

NEW ORLEANS -- After three years, the new health care laws are about to go into effect. And since there are thousands of pages of reform, you may be confused about what you need to do.

Here is a step by step look at how you get started.

"Well Obamacare, the signups are supposed to start Oct. 1, and then the coverage supposed to take place January 1, 2014. I researched it a little bit," said Phil Blue, who works in security.

Another New Orleanian was not as informed.

"No, I ain't heard about no health care plan," said Demico Singleton.

So here's what you need to know: From October through March, everyone in the state, with or without health insurance, will be able to explore new plans or options.

In this area, three companies and organizations have applied to sell or enroll people in one of the new plans. Two are non-profit, Blue Cross/Blue Shield and Louisiana Health Cooperative. And one is a profit group, Humana.

They'll be participating in the federal exchange or marketplace to sell plans to people who do, and those who don't, qualify for a subsidy.

That subsidy will not be cash given to you. The federal government will give it directly to the insurance companies, helping to lower the cost you owe for your policy or plan.

Pre-existing medical conditions will not disqualify anyone.

"One of the greatest things about Obamacare, is the fact that I no longer have to say, 'I'm sorry, I can't get you health insurance,' because that has been one of the hardest things I've had to say over 25 years," said Patrick Taylor, president of Benefit Planning Group in Metairie.

Your rates will now be based on your age, geographic location, and how many people are in your family. That information will be shared with several government agencies.

"When you go on the exchange, your information is immediately going through the IRS, Homeland Security, Social Security, TransUnion, Equifax, all these agencies instantaneously will have all your information and merge your information together," Taylor said.

Some of the insurance experts who have been studying this plan for two years say rates could go up.

"We think the rates are going to be about 30 percent to 40 percent more expensive than what they are today, because remember, the new plans, Obamacare has to cover maternity from day one, genetic cancer screening, there's a whole list of benefits that have to be included in those plans, pediatric dental, pediatric vision," Taylor said.

Rates are more likely to go up for young people who will now have to buy expanded plans. Baby boomer rates could go down.

"An older person will never pay more than three times what a younger person pays. That means that a 21-year-old would likely get a significant rate increase, beginning Jan. 1 and the older people will probably be, their rate will be reduced," said Gabriel Janusa, president of Demand Insurance & Benefits, LLC.

Seniors, or the disabled on Medicare, don't need to do anything. You will not qualify for a government subsidy in the new plan marketplace.

If you have coverage at work, you can still go on the exchange to see if another plan is better. But if your employer group health plan is affordable, according to the new federal guidelines, you will not get a subsidy.

If you are on Medicaid, you can still go on the exchange to see if you qualify to buy health care with a subsidy. But because Louisiana did not expand Medicaid coverage, some will still need to rely on the Charity Hospital system.

"Unless you're a pregnant mom or child, you're not going to get Medicaid, so there's still going to be this hole, this gap of people that won't be insurable or eligible for insurability, unless they are getting it through their employer," said Taylor.

"Since Louisiana didn't expand Medicaid coverage, people that have an income between 100 percent to 133 percent of the federal poverty level, they would not qualify for a subsidy. So they are really out hanging out to dry. But the folks that have incomes from 133 percent to 400 percent of the federal poverty level, they may qualify for a subsidy on the exchange," explained Janusa.

That means that the working poor may get some relief on the cost of premiums, but the poorest won't.

And the Medicaid system is changing as we speak. Beginning in January, many now on Medicaid will have buy health insurance on the marketplace, with the hope you will qualify for a government subsidy and cost sharing.

Others will still use the Charity Hospital system. So check on your case with the Medicaid office.

We have several links to help everyone and businesses on health care reform on a special web page.

 

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