By Amy Powell
Unless you have been “competing” under a rock, you most certainly have heard of the Patient Protection and Affordable Care Act (PPACA), better known as Obamacare. This is the new structure of healthcare in the U.S., signed into law by President Barack Obama on March 23, 2010.
The Obamacare structure basically means health plans are set with specific yearly deductibles and co-insurance levels, specific maximum out-of-pocket limits as well as specific mandates, also known as Essential Health Benefits (EHB), that must be included in every Obamacare plan. Examples of EHBs include a 100 percent-covered yearly physical, prescription coverage and even maternity!
Things to Know:
- Open Enrollment – Began on October 1st, 2013 and will end on March 31st, 2014.
- Individual Mandate – All individuals must have a Qualified Health Plan in 2014 or pay a penalty…this will be assessed through your April 2015 taxes.
- Penalty – For not enrolling in a Qualified Health Plan the penalty is $95 per adult OR is one percent of your annual income, whichever is greater.
- Subsidies – The federal government will pay a portion of your monthly premiums based on your qualifying annual household income.
Athletes of every variety need and want to be at the top of their game to compete and that means getting and staying healthy. Picking the “right” health plan for you means selecting the one that meets both your needs and your budget.
For instance, choosing a higher yearly deductible lowers your monthly premium. Perhaps you take a certain medication that is not available in generic formulation. This can be very expensive if you choose a plan that only offers a small co-insurance towards prescriptions versus one with a low locked-in co-pay for your daily dose.
Many plans also offer in-network benefits across state lines which is great if you travel regularly for tournaments. However, some plans are state-specific and offer only in-network benefits when you see a provider of this plan in your state. For athletes on the go needing emergency treatment for an out-of-state accident, this would not be a good option.
The good news is there is still time to enroll for healthcare this year. And there are plenty of options to choose from to meet your needs while not giving your wallet the ole’ one-two punch!
How to Enroll:
- On-Exchange (federal website) – This is the federally sponsored website, www.Healthcare.gov, where one can apply to obtain a subsidized plan only.
- Off-Exchange (direct to carrier) – One can apply directly with a carrier such as Blue Cross Blue Shield or Assurant Health.
- Licensed Agent – Get the assistance of a licensed agent who can help you navigate the various plans and the application process. And it doesn’t affect your rate to ask for help.
The PPACA is a very complicated and constantly changing piece of legislation. Don’t let it intimidate you, however. Be prepared and take control. Life is a challenge; getting quality healthcare shouldn’t be!
Amy Powell is a Licensed Insurance Agent with HealthMarkets Insurance Company in the Phoenix area. For additional information, contact her at [email protected]