What is different between pre-Obamacare plans and post-Obamacare plans?
The new plans, for people who don’t have subsidies (see last month’s article), are generally more expensive; in large part that is because they cover much more.
Here are many of the key changes:
The new plans and old plans both have out-of-pocket maximum costs, but in the new plans all covered services are part of the out-of-pocket costs. This means that copays, and Rx premiums, which usually were not considered part of the out-of-pocket costs, are considered such in the new plans.
The new plans all cover maternity.
The new plans cannot discriminate against people with pre-existing conditions.
The new plans cannot discriminate against gender.
The new plans have expanded preventative coverage which not all of the old plans had.
The new plans have expanded coverage for mental treatment and physical therapy which were not as well covered or not covered under some of the old plans.
The new plans should provide dental and vision coverage as part of their baseline for children under 14.
What should I be aware of with the new plans?
The new plans may have limited hospital and doctor networks. Don’t assume that because your doctor takes Humana (as an example), that he will take the new Humana plan you may be trying to buy. Finding out if your doctors and hospitals are in the network is critically important in these new plans. We urge you not to wait until you need medical care to find out about provider networks.
Every new plan company has a different Rx formulary. You may need to investigate if your medications are in the formulary and what they may cost.
Sometimes plans differ on and off the exchange. This is especially true for Cigna, so make sure you understand the differences before you buy. This is often because of the way Children’s Dental is treated on and off the exchange.
Most of the bronze plans have deductibles which may seem high, but vary from carrier to carrier.
Most Gold and Platinum plans tend to have lower maximum out of pocket costs. In many cases, a Platinum plan may indeed be much less expensive than a Bronze plan, if you anticipate high medical and Rx costs for 2014.
Taken as a whole, the new Obamacare plans are very good for many individuals and much more expensive for others. Like in any new program, Obamacare has its benefits and its shortcomings. We believe that by combining a discussion with professionals like those at Florida Health Agency, along with your accountant or tax person, we may find a strategy which will enhance your overall position while giving you access to affordable care.
We encourage you to submit questions for us to answer either directly to us at Florida Health Agency or through the staff at the Good News.
To ask all your questions about the ACA, reach William at 954 -332-9768 or email him at firstname.lastname@example.org. We hope to provide answers both immediately and include your questions in future articles here in the Good News.