The government shutdown began with cries to repeal the Affordable Care Act (ACA). The shutdown ended with a political assault on ACA’s website malfunctions. Now reports are that the President lied when he promised insurance policies would not be cancelled if you liked your current plan.
In Florida, 300,000 people are being informed they cannot keep their current insurance option. Blue Cross Blue Shield Chief Executive Patrick J. Geragthy summed it up like this, consumers may find new and better options with new benefits and government subsidies available to low- and middle- class people.
What is the truth?
Companies like Florida’s Blue Cross are letting their customers know that they cannot keep their current option because the ACA requires insurers to provide “essential benefits” in the plans they offer. Politifact, says that “while letters were going out to hundreds of thousands in the form of cancelation letters to those who buy their own coverage, that “consumers will have ‘continuous health care coverage’ and will insurers will assign them a particular plan, or gave them the option to contact Florida Blue and choose another plan.”
Here is why. Many of the plans purchased by individuals before the ACA didn’t cover essential benefits required now by law in the ACA. Now all insurance plans must cover:
1. Outpatient care without being admitted to a hospital
2. Emergency room visits
3. Hospital inpatient treatment
4. Pre- and Post-natal care
5. Mental health and substance use disorder (behavioral treatment, counseling, & psychotherapy)
6. Prescription drugs
7. Medical services and devices after suffering an injury or for a disability or chronic condition. (Includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.)
8. Lab tests
9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
10. Pediatric services including dental care and vision care for kids
Experts at the Georgetown University Health Policy Institute say “Under the ACA, beginning January 1, 2014, insurers must renew their policyholders into policies that cover a minimum set of essential health benefits and provide a minimum level of protection from catastrophic out-of-pocket costs. They are also no longer allowed to increase premiums based on a policyholder’s health status.
As a result, many insurers are discontinuing old policies that do not comply with these new consumer protection standards. And the underlying federal law has not changed. If they discontinue a policy, they must provide policyholders with 90 days notice and they must offer them the option to enroll in an alternative policy.
But, for the first time, most consumers have a new option – they can shop for a plan on their state’s health insurance marketplace. For most people shopping on the marketplace, the policies available there will be a better value than anything they have been able to buy on the individual market.”
So there, the President didn’t lie, he just didn’t fully explain and people didn’t learn that their plans may not be the same. They actually may in some instances provide better services that insurance companies must cover. The term “cancellation” of a policy does not mean loss of coverage.
• Many insurance companies will automatically enroll consumers in a recommended health plan.
• And consumers who lack affordable coverage can shop the Marketplace and choose from an array of health plans.
• A majority of Americans have employer-based health insurance that fit the ACA’s requirement of essential benefits;
• The ACA strengthens not weakens employer-based health insurance and provides for newer protections in your health insurance plan available in the individual marketplace;
• Prevents companies from charging more for a pre-existing condition;
• Requires insurance companies to provide 10 essential benefits;
• If your plans already had these protections when the law was passed you will keep it as it will be grandfathered out of these changes.
The letters people are receiving from insurance companies are in large part, because their plans are changing or being upgraded to include new benefits. As insurers have made clear – they aren’t dropping people.
A majority of people in the individual market today qualify for discounted or free health coverage when signing up for coverage through the Marketplace. One study found that 48 percent of people who buy insurance through the individual market will get a tax credit that averages at over $5,500. An additional 1 million in the individual market today will qualify for Medicaid in states that choose to expand it next year.
Although the law allows people to stay in plans they had when it passed with no changes “grandfathered plans” many insurance companies have started upgrading their plans to improve the quality of coverage.
Nothing in the ACA makes insurers force people out of plans that consumers were enrolled in before the law passed – but it does require insurance companies that didn’t provide the essential benefits to upgrade these plans.
Almost half of those buying in the individual marketplace will find they are eligible for tax credits that will lower their premium and should visit http://www.healthcare.gov to learn more.
The law provides millions with better coverage they choose. Most in the individual market today can get that coverage through their same insurance company.
A few simple but important things to know about the ACA:
• 43% of Americans in the individual insurance marketplace can no longer be discriminated for having a pre-existing condition.
• Children can stay on their parents plans now until they are 26 years of age.
• 8.7 million women who buy insurance in the individual marketplace can no longer be charged nearly double for the same plan as men;
• No annual dollar limits on benefits or dropping folks when they get sick;
• 34% of enrollees lacked mental health coverage, 9 % lacked prescription drug coverage, and 625 lacked maternity coverage, these basic benefits like mental health, prescription drug, and maternity coverage are now covered.