San Luis Obispo health insurance expert Susan Polk updates locals on new changes coming with the Affordable Care Act, the landmark health care reform law

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Sweeping changes to health care will occur on January 1, 2014 and Americans need to prepare, says Susan Polk, a San Luis Obispo health insurance expert. The Patient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act (ACA), ObamaCare, and health care reform, was passed on March 23, 2010, and will be implemented over a ten-year period.

San Luis Obispo health insurance expert Susan Polk

Susan Polk, a San Luis Obispo health insurance expert

“Some people think that come January 2014, a new insurance card will magically appear in their mailbox,” says health insurance expert Susan Polk. “This is most certainly not true."

Susan Polk, an expert in San Luis Obispo health insurance, recently issued an advisory to her clients to help them sort out the changes coming from U.S. health care reform called the Patient Protection and Affordable Care Act and commonly referred to as ObamaCare.

The Patient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act (ACA), ObamaCare, and health care reform, was passed on March 23, 2010, and will be implemented over a ten-year period. The most sweeping changes will occur on January 1, 2014, and will affect everyone, whether covered by health insurance, seeking coverage in health insurance, enrolled in Medicare, or needing health care.

“Some people think that come January 2014, a new insurance card will magically appear in their mailbox,” Polk says. “This is most certainly not true. Enrollment will not be automatic, except in certain circumstances when you participate in an employer group plan of more than 200 employees, and you must make choices among various options, choose a plan, and enroll yourself and family members."

Key points of ObamaCare, explained by Susan Polk, expert in San Luis Obispo health insurance:

The Individual Market and Health Benefit Exchanges

Individual health insurance
All insurance is guaranteed issue, meaning you are guaranteed to get coverage. There are no waiting periods for pre-existing conditions. Higher premiums cannot be charged for any health conditions, although an individual can be charged up to 50% more for smoking. California has decided not to implement this option.

Free or low-cost health insurance
Individuals and families making less than 138% of the Federal Poverty Level (also known as the Federal Income Guidelines) will be eligible for MediCal in California (133% will be eligible for MedicAid in most other states). There is no longer an asset test, so people can now hold onto their retirement plans and other property and still qualify for free or greatly reduced medical care.

Health Plans Offered
Insurance companies can offer four plans of insurance. Copper plans must provide at least 60% coverage. Silver plans must provide at least 70% of coverage. Gold plans must provide at least 80% of coverage, and Platinum plans must provide at least 90% coverage. Deductibles and co-pays may very from company to company. The only requirement is that they can prove that the actuarial value of the coverage meets the minimum percentages.

Premium subsidies
Individuals and families making between 138% and 400% of the Federal Poverty Level will be eligible for premium subsidies. Your eligibility in 2014 will depend on your income in 2012. Each subsequent year, the eligibility will be based on your income in the calendar year two years prior, for example, in 2015 your subsidy would be based on your 2013 income. By purchasing insurance through the Health Benefit Exchange, they will be subsidized for the difference between the second lowest cost Silver Plan and the amount they are expected to pay, which varies from 2% to 9.5% of the Modified Adjusted Gross Income.

For folks who make over 400% of the Federal Poverty Level, there is no subsidy. However, they will be able to purchase any of the same products outside of the Exchange with no underwriting.

Individual Mandate
Individuals will be required to purchase medical insurance starting in January 1, 2014. This is called the Individual Mandate. Those not enrolling will pay a penalty along with their income taxes annually to the Internal Revenue Service, beginning in 2015. The penalty for not participating in 2014 will be the greater of 1% of Modified Adjusted Gross Income or $95, whichever is greater. This will increase each year, until it is the greater of 2% or $295.

When to Enroll
The first Open Enrollment will start on October 1, 2013, and will continue until March 31, 2014. After that, Open Enrollments will occur each fall between October 15th and December 7th. There will be no enrollment into individual insurance outside of Open Enrollment except for certain qualifying events, including losing other coverage, birth, divorce, death, and a few other life events.

Grandfathered Plans
If you have present individual insurance, you may be able to keep it, if your original effective date was before March 23, 2010, and you have not made substantial changes to your policy. In this case, your plan is said to be “grandfathered” and you can keep the plan even after ObamaCare is fully implemented. President Obama’s message to Americans in January of 2010 was that if we liked our health plans, that we would be able to keep it. He makes good on that promise if your plan is grandfathered.

If your plan is not grandfathered, it will go away on December 31, 2013. You will then have a choice of any health plan offered by any health insurer in your county.

How will you enroll?
With up to half the population expected to enroll during the first six months, there will be many options to enroll. Enrollment can be:

  • Personal help with insurance brokers
  • Paper applications by mail
  • Applications by phone
  • Personal help through Navigators
  • Online

Why enroll through a broker?
Private insurance brokers will go through a formal training process to be eligible to enroll folks in the Health Insurance Exchange (in California, this is known as Covered California). Health insurance brokers are uniquely qualified to assist people. Their training and experience with health insurers will make them the optimal choice for your enrollment needs. They can help you choose the best plan for your circumstances and help you with the tools you’ll need to find a doctor and access care. Here at Susan Polk Insurance, we will be seeing individuals enrolling in the Exchange on Tuesdays, Thursdays, and Saturdays, beginning October 1, 2013.

Susan Polk’s advice for 2013

“Our advice for 2013 is to be prepared for 2014,” she says.
Here are the best strategies:

  • Know your income and optimize the results. Falling above the 400% threshold will mean paying 100% of the cost of your health insurance with no subsidy. Some individuals may not want to fall below the 138% (in California, 133% in other States), as that would mean eligibility in MediCal or MedicAid and could restrict access to personal physicians.
  • If your plan is grandfathered, don’t make any changes until after the summer or fall. A synopsis of plans will be available later in 2013. At that time, you will be able to preview plans and see how the premiums compare to your present plan. It is expected that once the Affordable Care Act is fully implemented, grandfathered plans will see much lower premium increases.
  • Make your appointment early. We will begin making appointments in August for the October enrollment.
  • Keep your records handy. You may be asked to bring your 2012 tax return to your appointment, as well as other important records. This information will help insurance agents quickly determine your eligibility for subsidies and help you get the best result. All personal information is kept strictly confidential.

About Susan Polk Insurance Agency
Susan Polk Insurance Agency, Inc. has been serving San Luis Obispo County since 1988 in providing access to affordable health insurance for individuals, families and businesses. Agents are knowledgeable and kept informed on the latest health care issues and legislation, as well as products and services. Susan Polk and her Medicare and Health Insurance Specialists serve people in California, Alaska, Arizona, Colorado, Idaho, Nevada, Oregon and Texas. Medical, dental, disability, life, long-term care insurance, coupled with Medicare and supplements and travel insurance are offered while providing superior service. All services are free.

Susan received a B.A. in Economics from Pitzer College in Claremont, CA. She has worked in health and life insurance for over 40 years and opened her own agency in 1988. Susan has been a featured speaker as a health specialist to community groups, a panel member on health care reform presentations, and as a radio talk show guest dealing with health care issues. She has read and is educated on the Patient Protection and Affordable Care Act. She also serves as a California Health Benefits advisor for Covered California. She holds Chartered Life Underwriter, Charted Financial Consultant, and Registered Health Underwriter designations.

Susan Polk Insurance Agency
1443 Marsh Street
San Luis Obispo, CA 93401
(805) 544-6454

Press release prepared by San Luis Obispo marketing firm Access Publishing, 806 9th St. #2D, Paso Robles, CA 93446. (805) 226-9890.

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