SOUTH SAN FRANCISCO—With the Affordable Healthcare Act, or Obamacare, about to go into effect, the Philippine American Press Club’s quarterly Kapihan collaborated with AARP to brief the Fil-Am media on the law’s intricacies.
On hand to discuss the merits of the healthcare plan was Ahnileen Martinez, associate state director, AARP California State Office. Carla Saporta, health policy director of Greenlining Institute was resource person in clarifying issues related to the plan.
According to Martinez, the key points to remember about Obamacare are that it increases consumer protection, makes it easier to find health insurance and improves Medicare-covered benefits (www.healthlawanswers.org). Martinez is a Filipino-American whose mother was a nurse when she immigrated to the US.
Carla Saporta clarified employee/employer responsibilities on individual and family health coverage, and the difference between companies with more than 50 employees and small companies with less than 50. On this aspect, the health coverage becomes a bit more complicated, but nothing that can’t be clarified through more information and education in the coming months and days.
Open enrollment starts Oct. 1, 2013, till March 31, 2014. Uninsured individuals, families or those who buy their own health insurance (not through an employer) must apply for Obamacare coverage. Those who fail to apply will be fined through the Internal Revenue Service. Coverage will start Jan. 1, 2014. http://www.healthlawanswers.org/
First and foremost, Obamacare will affect people with healthcare insurance, those who are uninsured or buy their own coverage, and people with Medicare.
For those insured now: Insurance companies can’t drop coverage if you get sick. Insurance companies must justify increases to premiums and spend more on health care over administrative costs. No one can be denied coverage for a pre‐existing condition (2014). There will be no lifetime and annual coverage limits, and insurance companies can’t place annual limits to your coverage. It requires coverage for more preventive services like mammograms, immunizations, and screening for cancer or diabetes.
People who are uninsured or buy their own coverage: Applicants can choose their health policy through the Health Insurance Marketplace or Exchanges, which can be found online. The Marketplace or Exchange is supposed to make it easier to buy health Insurance/plans by 2014. One can compare rates and coverage for different levels from different agencies. There are several levels of coverage from 60-40 (Bronze) to 90-10 (Platinum) co-pays (in addition to monthly premium.)
Core set of benefits are: doctor visits, emergency services, hospital care, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services, including oral and vision care.
Coverage extended to young adults and parents: Adult children can stay on family policy until age 26 even if they are no longer living with parents, are married and/or are no longer in school. On the other hand, children can claim their parents under their health plan regardless of whether they live together or not as long as the parents are also claimed in their child’s income tax return.
Options for states to expand Medicaid: Each state has the option to expand coverage to more people. The Affordable Healthcare will provide help paying for insurance starting 2014 for health insurance purchased through the marketplace, but applicants must meet income limits to be eligible.
People with Medicare: Obamacare protects guaranteed Medicare benefits and improves those benefits. It lowers out of pocket costs for prescription drugs and expands coverage for preventive care. No copayments for deductibles for Medicare-approved preventive care.
Lowered drug costs: 2013 – 52.5 percent discount on branded drugs and 21 percent discount on generics. By 2020 coverage gap will disappear, although Part D cost sharing will remain.
Initial benefit: Deductible and 25 percent of drug costs; catastrophic benefit – you pay 5 percent drug costs (www.aarp.org/doughnuthole has doughnut hole calculator). Call Medicare at 1-800 633 4227. Log on to www.medicare.gov.