Changes coming to health care in October 2013
The Affordable Health Care Act was signed into law by President Barack Obama over three years ago. Under the plan, insurers must offer a package of essential benefits and cover all who apply. But not everyone will need to.
There are 875,000 Hoosiers without insurance in Indiana, according to 2010 figures from the State Department of Insurance. Under this plan they and all the rest of us face a $95 fine or 1% of your family income, whichever is greater, if you don't have insurance next year.
Open enrollment begins October 1st but you are encouraged to begin building a profile before that.
In Indiana you will have, pending federal approval, five plans from four Indiana companies, to chose from. The catastrophic plan will be for individuals only. The Bronze Plan will cover 60% of the cost of the plan, Silver 70% and Gold 80%. The Platinum plan covers 90% of the benefit plan.
Many believe the clause preventing refusal over pre-existing conditions is the difference-maker, but Dr. Aaron Carroll says it's really for all those who don't currently have insurance.
"They are the ones who want to get insurance,, who just can't get a policy, and if they could it's way out of reach. They are the ones who need health coverage and can't get it," he said.
The State of Indiana says the cost of these plans will increase by 72% on average in 2014. However, subsequent reports dispelled that as a blended average of all offered plans.
"Reality is we don't know what the premiums will be, but we do know they will vary by type and location in the state," said Dr. Carroll, who is a professor of pediatrics and Assistant Dean for Research Mentoring at IU School of Medicine.
The health law does expand Medicaid to all who earn less than $14,856 in 2012, but Indiana chose the option offered by the US Supreme Court and opted out of Medicaid expansion.
Governor Mike Pence says there is no need to expand a program that is broke and broken. He's asking the federal government for permission to expand the Healthy Indiana Plan which currently serves just less than 400,000 Hoosiers. Health and Human Services has yet to respond. The state is not saying whether it has a backup plan.
"I don't doubt there is a population of sick and uninsured people who are counting the seconds to October 1st so they can sign up for that plan. I don't think there are as many healthy people doing so and that could be the real problem," said Dr. Carroll.
The Affordable Health Care Act needs the young and healthy Americans to sign up or the plan may not be so affordable.
There are some delays that are fueling the fire of those opposed to the plan. The cap or limit on out-of-pocket expenses, including deductibles and co-payments, has been delayed by one year. That means your costs could greatly exceed the $6,350 for individual or $12,700 for a family. Insurance Companies say they needed more time to set up their computer systems.
Dr. Carroll cautions against making too big a deal of that delay.
"You wish it would get done now but it will still affect a small number of people and for most people this is not something that will hurt them next year," he said.
The White House also instituted a one-year delay on a requirement that larger employers offer health coverage to full-time employees while a debate over the definition of a full-time employee plays out on Capitol Hill.
WTHR will attempt to address your questions before Open Enrollment begins. If you have difficulty, Indiana navigators will be coming online in the next few weeks to assist. We will let you know all these deadlines as they approach in Your Health, Your Choice.