What Do Kentlands Residents Need to Know About Obamacare?

“Open season” for health insurance shopping begins Oct. 1.  While the name reminds one of hunting, the reality of shopping for healthcare is not all that scary. Starting this year, the Affordable Care Act (ACA) requires by law that all individuals must have health insurance. “It’s a move toward more preventative health care rather than sick care,” said Dourakine Rosarion, special assistant to the department of health and human services director of Montgomery County.

Photo | Phil Fabrizio Dr. Maria Hayes of Alluring Smiles is concerned that the Affordable Care Act may result in less treatment options approved for patients.

Photo | Phil Fabrizio
Dr. Maria Hayes of Alluring Smiles is concerned that the Affordable Care Act may result in less treatment options approved for patients.

For those of you who already have health insurance, either privately or through an employer, nothing changes. However, you can shop around starting Oct. 1 and check out the potentially cheaper plans on the Maryland Health Connection. The Maryland Health Connection is a marketplace of insurance companies that the Maryland Insurance Administration created. Insurance companies within the Maryland Health Connection have agreed to keep their rates competitive and to provide “essential health benefits,” which include immunizations; preventive care and screenings for infants, children and adolescents; screening for gestational diabetes; HPV DNA testing; counseling for sexually transmitted infections; counseling and screening for HIV; contraceptive methods; breastfeeding support, supplies and counseling; and screening and counseling for interpersonal and domestic violence.

In addition, insurance companies are prohibited from denying coverage or changing rates based on pre-existing conditions. The rates will be based solely on age.

Starting in 2014, all employers will be required to offer health insurance to their employees. Employees may opt out of their company’s plan in favor of a plan in the exchange.

There are many levels of coverage available, and these are called bronze, silver, gold and platinum. For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person; the individual would be responsible for paying 40 percent of the costs. For the silver plan, insurance would cover 70 percent of all health care costs and for the gold plan, insurance would cover 80 percent of health care costs. For a platinum plan, an average individual would pay 10 percent out-of-pocket for their covered benefits and the insurer would pay 90 percent. While the premium that you must pay for a lower level insurance is lower, the out-of-pocket cost for each healthcare visit will be higher. Thus, the level of insurance that you decide to purchase depends largely on how often you anticipate visiting the doctor.

The biggest thing that Kentlands families and individuals should know about, said Jack Fleming, insurance broker with the Kentlands-based Comrade Financial Group, is the tax subsidies. “Just because Kentlands families are generally better off, doesn’t mean that you won’t qualify for subsidies,” he said.

The main factors in calculating a subsidy are income, number of people in your household and cost of coverage in your area. You can qualify for this subsidy if your income is less than 400 percent of the federal poverty level, which is about $46,000 for an individual and $94,000 for a family of four in 2013. These subsidies only apply to insurance plans bought through the Maryland Health Exchange. According to the Congressional Budget Office, six out of the seven million people expected to enroll in the first year of the marketplace will be eligible for subsidies.

Many healthcare providers in the Kentlands area are not directly affected by ACA as sole practitioners, said Dr. Michelle New, a clinical child psychologist. However, New is hopeful that the ACA will allow her clients to get better reimbursement for their out-of-network health expenses. At the moment, plans under the Maryland Health Connection are not required to cover out-of-network health expenses.

However, some practitioners are wary about how “Obamacare” will pan out. “We’re already starting to see insurance companies try to dictate treatment,” said Dr. Maria Hayes of Alluring Smiles. “They’re ramping up for when the Affordable Care Act will kick in … and it’s the epitome of managed care.” Hayes is worried that, in an effort to counteract the money they may lose from the Affordable Care Act, insurance companies will increasingly dictate what diagnoses and treatment medical care professionals should be providing.

For those that want one-on-one assistance to determine what insurance plan works best for them, the Health Insurance Commission has trained several “Assistors” and “Navigators” who will be traveling the area, providing help and guidance. To find out when they will be in the Kentlands/Lakelands area, visit http://capitalhealthconnection.org/calendar.