Local presentation on health care reform Nov. 13
The Downtown Paso Robles Main Street association is sponsoring a presentation on health care reform. “Affordable Care Act, Obamacare, , Health Care Reform, Patient Protection and or the Affordable Care Act (ACA) – it doesn’t matter what you call it… What does it mean for you?” asks the group’s Economic Restructuring Committee.
The public is invited to come hear about the new health exchange and other options available for health insurance. It will be Nov. 13 from 8 a.m. to 9 a.m. at Park Cinemas, 1100 Pine Street, Paso Robles, CA. The featured speakers are insurance agents from HFG Coastal Insurance in Paso Robles.
Q&A on Health Care Reform with HFG Coastal Insurance
Answers to questions regarding the Patient Protection and Affordable Care Act
Like it or not, it’s happening – the Patient Protection and Affordable Care Act (PPACA) was passed into law on March, 23, 2010 and California residents, including those in San Luis Obispo County, need to keep up-to-date on some of the changes coming their way. Whether referenced as the Affordable Care Act (ACA), ObamaCare or Health Care Reform, one thing is certain – it’s the law. Recently, Simon Lebo and Sarah Hinds of the Hinds Financial Group in Paso Robles took some time away from their busy schedules to provide answers to some of the most commonly asked questions concerning changes involving health insurance.
This whole Health Care Reform isn’t really the law, is it?
Sarah: A recent study revealed that 40 percent of those interviewed think the Patient Protection and Affordable Care Act is a bill that has been repealed already. It’s not – it’s the law. Even if the federal law went away, California will still move forward.
Simon: Like it or not, it is here, and there are different ways of getting information about the Affordable Care Act; coming in to talk with a broker will help a person understand it better. We can show you how to make it an easy transition.
I keep seeing ads for Covered California – what is this?
Sarah: Covered California is an exchange or marketplace on the website www.coveredca.com. On the site, a person can find a lot of information concerning the PPACA. We encourage people to go to the site, see where they fit in as far as coverage options and subsidized income requirements, and then give us a call for more details.
I do not currently have health insurance and have questions – what should I do?
Sarah: Contact an insurance broker such as those at the Hinds Financial Group in Paso Robles. I can sit down with someone for 15 minutes and walk them everything instead as opposed to a person researching online for a couple of hours and still being confused. It’s so much better to have a face-to-face or over the phone consultation; it is so much more beneficial.
Simon: We do the reading, so they don’t have to. It can be pretty daunting, and there’s a lot to it. Our hope is to inform people.
I am self-employed and have an individual insurance plan – will I be affected?
Sarah: If your plan was written before March 23, 2010, you will be able to keep your individual health plan; that’s what being ‘grandfathered’ in is about. If it was written after that date, you are no longer allowed to keep it because it is no longer compliant with the PPACA.
Simon: If you have an individual policy, give us a call and talk to us first before making any decisions. A lot of people are under the impression that they have to go to the exchange (coveredca.com) and get information there, even if they’ve had insurance before the 2010 date. If they’ve had something long enough, they can keep it. It’s their choice.
Sarah: A lot of grandfathered plans are better than what’s coming out so you have to be careful not to just change your plan thinking you have to comply with PPACA; it depends on when the plan was written.
I have Medicare, my neighbor has coverage through his employer – does this affect us?
Sarah: Those on Medicare will not be affected at this point. If you are employed by the government, city, county or state, you are not affected. Large group employers, those with over 50 employees, have one year before deciding if they will continue to provide health insurance coverage for their employees. If they decide not to, their employees still need to have insurance get health insurance because the individual mandate is still in place. All employees should have received a Department of Labor notice from their employer by October 1 explaining if they will offer health insurance or not.
What, if anything, may be different about my previous coverage?
Sarah: Some changes are already in place, such as children on their parents’ health plan can remain so until their 26th birthday. Some companies will look at the costs involved with insuring their employees and may not offer the same benefits. Most will see a cost increase of 40-60 percent. The people I’m talking to the most are the ones who currently have health insurance and are worried about what’s going to happen and business owners are wondering what they should do for their employees. It’s a good idea to sit down with a professional and review your coverage options.
Simon: It’s all about educating people right now. Talk with us and we can let you know more about the changes and how they may affect you.
What is guaranteed issue?
Sarah: Small groups (companies with 50 or less employees) and individuals are now guaranteed issue, which means it doesn’t matter about health questions or pre-existing conditions.
Simon: We used to hear a lot about pre-existing conditions for individuals, not for the group.
Sarah: Starting January 1, pre-existing conditions will not disqualify anyone. With that being said, individual rates are going to go up about 60 percent. In the past, insurance companies were allowed to turn you down based on pre-existing conditions. Now they must take you and they are not allowed to ask about your health conditions so the rates will be going up.
So now I can see a doctor whenever I need to, correct?
Sarah: The positive is everybody will have access to health insurance. If a person does not have a relationship with a doctor, they need to go get one. A lot of people will be added into the system, which is a good thing, but we have not added any doctors to the county and this can mean a narrow network of providers.
Simon: If a person has an established relationship with a doctor, it is a good idea to check in with their office staff to see if there’s any changes that may affect them.
What if I need financial assistance? What is a subsidy?
Sarah: Call us or check the calculator at coveredca.com and find out if you qualify for a subsidy based on how your income compares to the federal poverty level; if you qualify you will receive a subsidy. A subsidy is actually an advanced tax credit. If your circumstances change, for example you get a raise, that changes what you should be getting for your subsidy and you may have to pay that back to the IRS. An employee who is offered an employer-sponsored health plan will not get a subsidy because they have insurance through their employer.
Simon: If you are insured through your employer, technically you are already getting a subsidy.
If I don’t have insurance or want to change plans, when should I sign up?
Sarah: There is a six month window for people to sign up from October 1, 2013 through March 31, 2014.
What if I ignore the law and just don’t sign up for health insurance?
Sarah: The first year, there is a penalty of $95 per person, or 1 percent of household income – whichever is higher, and it goes up every year. At this point, if you receive a tax refund the money for the penalty will be taken out of that refund.
There’s a lot of information out there. Why should our readers go to a certified licensed, trained insurance consultant?
Simon: I think you just listed the reason right there – it’s because there is a lot of information out there
Sarah: They will not pay more by coming to us; it’s the same cost. Would you rather come in and see us face-to-face or call somebody that you don’t know over the phone? We are licensed through the state by the Department of Insurance, we take classes, undergo tests, go to seminars and take continuing education. We are up-to-date and have the current information.
Simon: For someone who has never had insurance, especially, it would be very helpful for them to call a broker to find out more information.
Anything else I should know about this process?
Sarah: If you want a January 1 effective date for health insurance, the application cutoff date for forms to be submitted to insurance carriers is December 15; be sure to plan ahead.
Simon: This is an evolving process. Use the resources on coveredca.com, but use us as a resource as well As of the publication date of this magazine, all information is current for updates and changes associated with the health care law, give us a call and find out what’s been changed.
For more information or to schedule an appointment with a licensed insurance broker for health and other insurance coverage options, contact the friendly folks at Hinds Financial & Insurance Services, Inc. at call (805) 239-7443 or stop by 1818 Spring St. in Paso Robles.