President Obama’s Health Care Overhaul: What Does it Mean for You?

Three years ago, Congress wrote the law known as the Affordable Care Act (ACA), to maintain Americans’ current health coverage as much as possible, to boost consumer protections in the health insurance market for individuals, and to cover the uninsured.

Today, October 1, the U.S. government launched the centerpiece of the ACA, opening new insurance marketplaces across the country for millions of uninsured Americans.

When it comes to the ACA and the Open Enrollment Period, fewer than half of Americans think they know enough about the law to understand how it affects them. Therefore, for many Americans including seniors, the most important question is: what do I have to do?

If you’re one of the 80% of Americans who already has health insurance through an employer or if you are enrolled in a government program, such as Medicare, the answer is: probably nothing. Seven million people, however, will purchase private health insurance on the exchanges for 2014. An additional nine million will use the exchanges to enroll in Medicaid or the Children’s Health Insurance Program, two joint federal-state health programs for low-income people. By 2016, 25 million fewer people will be uninsured than would have been without the ACA, the Congressional Budget Office projects.

For the uninsured, how does it work?

  • Visitors can go to healthcare.gov, the federal government’s health care website, and can  navigate how to shop for and buy health insurance. The sites are open even if Congress and the White House can’t agree on a government spending plan.
  • The open enrollment period for 2014 health plans bought on the exchanges begins today, Oct. 1, and runs through the end of March.
  • People will use the exchanges in their home states to compare the price and benefits of various insurance plans.
  • The exchanges also are the only way to get the financial assistance available to those who earn less than four times the federal poverty level, which amounts to $45,960 for a single person this year.
  • People who don’t get health insurance will have to pay $95 dollars or 1 percent of their annual income — whichever is higher. That amount will rise each year until it hits $695 or 2.5 percent by 2016. 
  •  More than half of the uninsured will be able to get coverage for less than $100 a month, according to the Department of Health and Human Services. Prices will vary widely from community to community and from household to household.
  • Some younger and healthier people may see higher premiums, guaranteeing coverage to people with pre-existing conditions and limiting how much more older people can be charged than younger consumers.
  • Customers will not have to give up any personal medical information.

What if you are on Medicare?

Express Scripts, which manages prescription drug benefits for health insurance plans, surveyed Medicare enrollees and discovered many misperceptions — including 17% who think they have to buy coverage on the exchanges. It’s illegal for a health insurer to sell a plan through the exchange to someone on Medicare.

“People on Medicare don’t need to do anything different this year than they have in the past,” said Lynn Quincy, a senior policy analyst at Consumers Union in Washington who specializes in health care issues. “The main message is: Nothing has changed for you. You’re good to go.”

In other words, if you’re on Medicare now, no matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now, and you won’t have to make any changes.

If you want to make changes, however, keep in mind that Medicare’s Open Enrollment isn’t part of the new Health Insurance Marketplace. To reiterate, it’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan. Medicare Open Enrollment (October 15 – December 7, 2013) is the time when all people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year. If you want to change your coverage for next year, this is the time to do it. If you’re satisfied that your current coverage will continue to meet your needs for next year, you don’t need to do anything.

The Health Insurance Marketplace Open Enrollment period (October 1, 2013 to March 31, 2014) overlaps with the Medicare Open Enrollment period (October 15 – December 7, 2013). Therefore, people with Medicare who are looking to make Medicare coverage changes should make sure that they are reviewing Medicare plans and not Marketplace options.

Be aware that the Medicare open enrollment period is a time when there’s a higher risk for fraudulent activities. DO NOT share your Medicare number or other personal information with anyone who knocks on your door or contacts you uninvited to sell you a health plan.

To learn more about health care fraud and ways to protect against it, visit StopMedicareFraud.gov or the Senior Medicare Patrol (SMP) program in your area.

Just as you are planning for the Open Enrollment Period, you should plan for your future and for your loved ones. If you have a loved one who is nearing the need for nursing home care, call The Fairfax and Fredericksburg Medicaid Asset Protection Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a no-cost consultation.

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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