Questions remain about the Affordable Care Act

By: Jenny You Email
By: Jenny You Email

What are the major changes I need to know about?
There are a number of major changes for comprehensive health insurance plans
effective January 1, 2014. These include the following:

  •  Insurers must sell a health insurance policy to any person who applies for coverage, except in cases where fraudulent information is provided by theapplicant. This is called guaranteed issue.
  • Insurers are prohibited from excluding or limiting coverage for a preexistingcondition. A preexisting condition is a health condition an individual has before purchasing a health insurance plan.
  • Insurers may only take four items into account when pricing their products. These are: (1) whether the policy provides individual or family coverage;
    (2) the area of the state the policy is sold; (3) age; and (4) tobacco use.
  •  Plans will be required to offer “essential health benefits.” See the “Glossary
    of Terms” section for more detail.
  •  Plans will be categorized into one of four different levels, which the federal
    government calls “metal tiers.” Consumers will know the level of coverage
    expected by a plan based on the metal tier assigned to it. The percentages
    attached to each metal tier represent the average portion of expected costs a
    plan will cover for the average individual. The metal tiers include: bronze
    plans covering 60%; silver plans covering 70%; gold plans covering 80%; and
    platinum plans covering 90%.
  • All plans will limit in-network out-of-pocket expenses to $6,250, for self-only
  • Insurers will have the option to sell their plans through the federal health
    insurance Exchange, in addition to selling their plans in the marketplace
    like they do today.

    (Information from the OCI -

EAU CLAIRE, Wis. (WEAU) – A week of public hearings on health care reform has begun and one of the first stops was in Eau Claire. According to the Office of the Commissioner of Insurance, the hearing is designed to educate people about the Affordable Care Act.

In Wisconsin, there’s less than a month to go before open enrollment starts and consumers say many questions still remain unanswered. The law requires everyone to have insurance and among the most noticeable changes, a new online marketplace where you can shop for your health plan.

Wisconsin is among the states that are not taking the option to expand Medicaid. Now questions remain for those who were previously covered under Badgercare.

Elizabeth Spencer of Eau Claire said this is her second session on health care reform that she has been to so far.

“Exactly how is it all going to take place? How are those thousands of people who are going to be eligible for Badgercare going to get to the right place at the right time in order to get enrolled into Badgercare. And also those people who are eligible for Marketplace, how are they going to get there?” said Spencer who worked as a provider for 25+ years.

Mollie Zito is the chief legal counsel for the OCI. She said one of the messages the OCI wanted to inform the public about is the deadline. The initial period for open enrollment begins October 1st and ends March 31st. But if you need your coverage to be effective January 1st, you must be enrolled by December 15th.

“There’s a lot of confusion out there and they're looking for answers and they want to know where to get them,” said Zito. “This has been the biggest change in health care since Medicare in 1965 so really it’s new to everybody. We're working with other state agencies and the governor to really get all the information out there.”

Zito said the OCI's job is to point people towards the right direction. She said the OCI is among the resources people can reach out to for enrolling. There’s also the U.S. Dept. of Human Health and Services, the IRS and the Dept. of Labor.

(Link to resources at the bottom)

“It is complicated. People with low literacy, people who are just not paying attention who are realizing how much it’s going to impact them are going to have sticker shock. I don’t mean price wise but just information shock,” said Spencer.

If you don’t have access to the internet or need extra help and guidance when enrolling, Zito said you can turn to insurance agents and brokers or the Dept. of Health and Human Services who have Navigators and Counselors to help.

The Alliance and Rep. Ron Kind's Office will also present "The Affordable Care Act: Information for Small Businesses and the Chippewa Valley Community" on Wednesday, Sept. 4th from 12 p.m. - 1:30 p.m. at CVTC Gateway Campus (2320 Alpine Road, Eau Claire) in the Commons Room.

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