Many people will likely see their rates go up a bit. But the good news is that the reforms mean thousands more Louisianians will now have health coverage.
The challenge comes from the fact that insurance companies must take all customers, no matter their health condition. It costs more to cover people with pre-existing conditions. That's why rates will go up for just about everyone.
Plus, the new law says all plans must include a minimum amount of coverage, called essential health benefits. That means we will add to all plans such things as: ER services, maternity care, mental health, lab services, pediatric care and vision services. Most plans will see this coverage added starting in 2014. More benefits add to the cost of a plan. Grandfathered plans will stay the same, though their rates may still change because of new rating rules.
The minimum penalty is $95 per adult in 2014. This will increase if you have minor children and do not buy insurance for them. That amount will go up each year after that. It could go up to a maximum of $695 per adult, per year, or 2.5% of your wages. Of course, only the government can fully evaluate what fees and penalties it charges you. It's important to remember that someone who pays the fee won't get any health insurance coverage and will still be responsible for 100% of the cost of their medical care.
Health Insurance Marketplaces
You can start enrolling in October 2013. The easiest way to get coverage will be at www.bcbsla.com.
Health Care reform will be funded in part by cuts in some programs and by taxes and fees on insurance companies, drug manufacturers, individuals, businesses, certain medical devices and equipment, and certain services.
Starting in 2014, when you purchase coverage, you will not be denied coverage for a pre-existing condition and insurance companies cannot exclude your pre-existing condition from what it covers in your plan.
No. If you are on Medicaid, you do not have to buy insurance.
The reform law says that plans must have a specific set of benefits. The law calls these essential health benefits. It is possible that the plan you now have does not include these Essential Health Benefits (EHB). If your plan does not include these Essential Health Benefits, we will soon let you know about our new plans that meet all of the government's new rules. You will be able to pick from one of those.
Grandfathered plans are exempt from many of these changes.
If your policy was in effect on March 23, 2010, and you made no changes to it since that time, your policy is a grandfathered policy.
If your policy was in effect on March 23, 2010, but you made significant changes to it since then, such as increasing your deductible, coinsurance, or copayments, or dropping maternity coverage, then your policy is no longer a grandfathered policy. It is a reform policy.
If your policy was not in effect until April 1, 2010, or later, you do not have a grandfathered plan. You have a reform policy.
A detailed chart on what provisions apply or do not apply to grandfathering is available in the HHS regulations.
Check your plan's materials to determine grandfather status. You may also need to check with your employer or your health plan's benefits administrator at 1-800-785-8364.
Individuals and small businesses can shop for insurance on the online marketplaces starting October 1, 2013. The policies will not go into effect until January 1, 2014.
You always choose your own doctors. How much your insurance pays will be determined by whether the doctor you choose is in the provider network used in your insurance plan.
You can still work with brokers or agents to help buy insurance. They can help you sign up on the online marketplace.
The government is requiring that every health insurance plan in the new marketplace offer complete coverage - from doctors to drugs to hospital visits. The law says that all health insurance companies must offer the same set of basic benefits in all of their plans. We call these essential benefits. Some of these essential benefits include emergency room services, maternity care, mental health, lab services and some kinds of pediatric care.
Large employers will run their health plans as they do now, so you won't see much change.
Most plans will change. If you are covered under your employer's plan, it may be "grandfathered" and not be required to include additional benefits. The reform law says that plans must have a specific set of benefits, called Essential Health Benefits (EHB). It is possible that the plan you now have does not include these Essential Health Benefits (EHB). If your plan does not include these benefits, and your employer group plan is not "grandfathered," we will soon let you know about our new plans that meet all of the government's new rules. You will be able to pick from one of those.