There are supporters and detractors of the Affordable Care Act — better known as Obamacare — but no matter where you stand on the issue, unless you qualify for a subsidy, you’ll pay higher insurance rates.
That’s what Jason Greif, an insurance agent with U.S. Health Group, told members of a health insurance reform class at the SmartStart Dade City incubator April 8.
The insurance agent, who has been in the industry for eight years, explained changes in health care law, talking about the pros and cons of the new requirements, and the different kinds of insurance coverage that are available in the health care marketplace. Greif also explained the penalty for not purchasing health insurance, which is now mandatory, and he talked about the risks that people face when they don’t have insurance.
“A lot of people are misinformed,” Greif said.
Part of Obamacare took effect on March 23, 2010, he said, noting that’s when insurance companies had to begin covering what has been defined as essential health benefits.
“There are 10 of them,” Greif said. They include services ranging from child immunizations to maternity care, mammograms to colonoscopies.
“What do you guys think is going to happen to the rates if the insurance companies have to cover everybody’s colonoscopy? They go up,” he said. “I actually am for Obamacare for a lot of different reasons. But it has increased the rates.”
Another big change happened on Jan. 1. That’s when insurance companies could no longer deny coverage.
“No matter what, anybody can get health insurance,” Greif said.
That’s good news for people who were denied coverage before, but it drives up insurance rates as a result. In the past, people with certain conditions could only get coverage as part of a group.
“It’d really be disheartening for me to say, ‘There’s nothing I can do. You have diabetes, I can’t get you insurance,’” Greif said. “Nobody could do anything for them,” unless they were able to get covered through a group.
“It’s almost more of a socialistic approach to healthcare. But for people that are sick, for people that get a subsidy, it’s actually an amazing program because those people were not able to get insurance,” Greif said.
This year’s open enrollment is over. The only way to enroll through the marketplace outside of the enrollment period is to have a life-changing event such as moving, losing group insurance or having a child, Greif said.
The next enrollment period begins Nov. 15.
Those who want to get an idea of what their rates would be can go to a website, HealthSherpa.com, to get a fairly close estimate of what to expect, Greif said.
“This is a great website. The quotes are usually $5 higher or lower. It’s a way you can get an accurate quote and you don’t have to go on Healthcare.gov and create a profile and give all of your personal information out,” he said.
Now, health insurance rates are based on age, tobacco use and ZIP code, Greif said. Eligibility for subsidies is based on income.
Still, there are choices in the types of coverage and the rates that are attached to those, he said. Some coverage types allow people to choose doctors who are inside or outside of their network, while others allow people to use only doctors within their networks.
Some of the networks have more doctors than others, Greif said. It’s important to find out exactly what the plan includes.
Greif recommends a plan that allows individuals the most latitude when it comes to selecting which doctors and hospitals will treat them.
For those who disregard the law and do not get health insurance, the penalty is either $95 or 1 percent of the individual’s modified gross adjusted income, whichever is higher, Greif said.
Regardless of where people stand on Obamacare, Greif said having coverage is essential. Without it, he said, people who have serious medical emergencies or conditions can go bankrupt in a matter of days.
Published April 16, 2014