TUPELO – After years of debate, court cases and making rules, the biggest pieces of the Affordable Care Act will go live in the next few months.
On Oct. 1, people without health insurance will be able to shop in an online exchange, in many cases putting tax credits to work to bring down their out-of-pocket costs.
“Most of the people in Mississippi will qualify for some kind of subsidy,” said Gerald Wages, who has watched health care reform unfold over the past decade in his leadership roles with North Mississippi Health Services.
Starting Jan. 1, no insurance company will be able to deny a policy based on pre-existing conditions. Individuals will be required to secure health insurance or face a penalty on their 2015 taxes unless they qualify for a waiver.
“It’s going to be a good for a lot of people,” said Renard Murray, regional administrator with the Centers for Medicare and Medicaid offices in Atlanta and Dallas.
People with Medicaid, Medicare and insurance through their employers can sit tight. They have met the insurance mandate.
Employers with more than 50 full-time workers have a year before penalties kick in for not offering insurance, but they can’t sit and wait, according to the health care reform team at Ross & Yerger Insurance, which has an office in Tupelo.
“Even though the employer mandate has been delayed, there are still many ACA provisions that were not affected by this transition relief, and employer groups are preparing for these,” the team said in response to questions from the Daily Journal.
People who are shopping for health insurance on their own will have a lot of homework to do, but they stand to gain much.
“Don’t assume you won’t be able to afford coverage,” Murray said.
For example, a nonsmoking family of four making $40,000 a year would qualify for up to $7,904 in government tax credit subsidy for a silver level plan, based on a calculator created by Kaiser Family Foundation. They would pay $1,965 annually for their health insurance premium.
They don’t have to go it alone. By the time the health insurance exchange goes live, there will be trained navigators available to help people figure out their best options, Murray said. Grants for the navigators are due to be announced next week.
Families may want to comparison shop on the exchange and with insurance companies not on the exchange to see what’s the best deal for them. However, they need to be careful to understand what’s included. The tax credit subsidies also are only available on the exchange.
Both on and off the exchange, it’s important to consider the network of providers covered at the highest reimburse rates.
“The lowest priced insurance plan with a limited network of doctors would not necessarily save the person with many medical bills the most money in the long run,” the Ross & Yerger team said.
Over the next three to five years, Wages anticipates many adjustments.
“There’s going to be a lot of stops and starts,” Wages said.
The system will have to shift toward models focused on keeping people well instead of treating people as they get sick. That’s a big transition for a system based on fees for procedures and doctor visits.
“In 10 years, health care will be much improved, with more people covered,” Wages said. “I think we’ll see a lot of people with better health.”
ACA When & Where
OCT. 1 – Health insurance exchanges go live.
JAN. 1 – Adults can no longer be denied for pre-existing conditions.
MARCH 31 – Open enrollment ends on health care exchanges.
JANUARY 2015 – Employer mandate begins.
APRIL 2015 – People who don’t acquire health insurance face a $95 penalty on 2015 taxes unless they qualify for a waiver.
HEALTHCARE.GOV – The Affordable Care Act’s online home
KKF.ORG – Kaiser Family Foundation
MID.MS.GOV – Mississippi Department of Insurance
BY PHONE CONSUMERS – (800) 318-2596
SMALL BUSINESS OWNERS – (800) 706-7893