Surviving the Health Reform Gap Year
By Carrie McLean for the eHealth Insurance Blog
Here’s a question for you: What big changes can you expect from health reform in 2013? The answer is: Not much! 2013 is what we’re calling the “gap year” in the roll-out of health reform. What do I mean by “gap year”? Well, in the first two years after the Affordable Care Act was signed into law, a number of provisions came into effect. Some of these provisions made it easier for children to qualify for coverage and allowed adult children under age 26 to stay on their parents’ plan. Others expanded coverage for preventive care and did away with lifetime coverage limits for most covered medical services. All of these provisions came into effect between 2010 and 2012. The last major provisions of the law, however, don’t come into effect until January of 2014. These include provisions requiring most people to have health insurance, making subsidies available to help people afford it, and the rule making it impossible for health insurance companies to decline applicants based on pre-existing medical conditions. Which brings us back to the in-between gap year. What should you do if you’re in need of health insurance coverage in 2013? And what should you do to prepare yourself for the whirlwind of change that 2014 is likely to bring?
Here are a few tips:
- If you’re uninsured, don’t just wait for 2014 to arrive. It might be tempting to wait out the next several months until subsidies are available to help you afford coverage, and when you can no longer be declined due to pre-existing medical conditions. But going uninsured, even for a few months, can be a big mistake. A single visit to the emergency room or an overnight stay in the hospital can cost you tens of thousands of dollars. Find coverage today, if you can, because health insurance purchased in 2014 will not help you pay for medical bills incurred in 2013.
- Get to know your 2013 coverage options. If employer-based coverage isn’t an option for you, look into buying individual or family coverage on your own. Work with a licensed agent online or in your area to find the best match for your needs and budget. It doesn’t cost anything extra to work with an agent. Individual and family plans are paid for on a month-to-month basis and may be canceled at any time. If you find that you don’t qualify for coverage due to a pre-existing medical condition, look into government-sponsored pre-existing condition plans or high-risk pools. You can learn more about these through your state department of insurance or pcip.gov. If even these aren’t options for you, look into short-term health insurance, accident or critical illness coverage. These products don’t provide comprehensive benefits, but they can give you at least some protection in case of serious illness or hospitalization. Anyone who’s uninsured, especially Baby Boomers who haven’t yet aged into Medicare, should also look into prescription drug discount cards, like the free eBestRx card available through eHealthInsurance.com.
- Expect more benefits, and potentially higher prices to come. As a result of the Affordable Care Act, you can expect plan benefits to improve in the next year as coverage for things like maternity care becomes standard, but keep in mind that higher benefits may also mean higher monthly premiums. No one can say exactly what your health insurance costs will look like in 2014. If you don’t qualify for subsidies, you may face an increase in your monthly premiums. You may want to start budgeting for that possibility now.
- Find out if you’ll qualify for subsidies in 2014. If you buy your own insurance today, or there is a chance you could lose your employer-based coverage next year, it’s a good idea to know if you will qualify for government subsidies to help you pay for your own health insurance. Beginning in 2014, federal subsidies will be made available to individuals and families earning less than 400% of the federal poverty level (about $45,000 per year for a single person, or $92,000 for a family of four, in 2012 dollars). Depending on how much you earn, these subsidies will limit your health insurance premiums to between 3% and 9.5% of your annual income.
About Carrie McLeanCarrie McLean has been in the health insurance field for 7 years and is licensed in all 50 states. She is often seen in the media discussing health insurance trends and issues from an insider’s perspective and as a consumer advocate, having personally helped thousands of individuals and families search for and find affordable health insurance.
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