Texas Agents Counter ACA Misinformation

Consumer confusion and frustration don’t appear to be subsiding one month into the roll-out of the Affordable Care Act’s health information exchanges. Mark Bellman, president of the Texas Association of Health Underwriters says that polls reflect a broad lack of understanding about the new law, confusion about the enrollment process and choices, and frustration with glitches that have plagued the rollout of the health exchanges. Increasing misinformation adds to these complexities. Bellman says that health agents hear from hundreds of Texans each day with questions that highlight the confusion. The good news is that many consumers are reaching out to a professional benefit advisor to get answers and avoid making costly mistakes, he said.

The Texas Association of Health Underwriters says these 10 areas generate the most confusion:

• Can I keep my existing coverage? Many plans will not be in compliance and will be eliminated because the ACA contains new requirements for coverage. For example, the ACA requires all policies to cover 10 essential benefits. An individual with a non-compliant plan will be forced to change coverage. Employers offering health insurance could have grandfathered their plans to avoid being forced to change their employees’ coverage. If an employer did not grandfather its plan, employee benefits change. These benefits could improve or erode depending on the employer’s ability to absorb cost changes resulting from the Affordable Care Act.
• Am I required to purchase insurance coverage through the health insurance exchange?Consumers are not required to purchase coverage through the Exchange. Most Americans will be required to carry health insurance, which can be purchased outside of the Exchange in the commercial market.

• Will insurance coverage purchased through the Exchange cost less because it provides Americans with a government subsidy? There is no guarantee that insurance purchased through the Exchange will be more affordable than coverage in the commercial market. Subsides available in the Exchange may reduce the cost. People with incomes from 100% of the poverty line (or about $23,550 for a family of four) to 400% of poverty ($94,200 for a family of four) may be eligible for a subsidy. All consumers should compare benefits, rates, as well as physician and hospital networks in the commercial market with those in the Exchange. This comparison will be particularly important for consumers who want to keep their doctor.

• Are individuals required to contact a navigator to purchase coverage in the Exchange? There is no requirement to contact a navigator. Navigators will have limited, if any, knowledge about rates outside the Exchange and are likely to have only a basic understanding of coverage benefits. Consumers who have questions about finding the best coverage for themselves and their family would be wise to contact a professional benefit adviser.

• Do the Obamacare insurance options compete with coverage from plans offered by Blue Cross Blue Shield, Aetna and United Healthcare? Obamacare refers to the entirety of the federal health care reforms or the Affordable Care Act, therefore it is not a health plan. It includes such things as the types of coverage that can be offered, rules for pricing and penalties for those who don’t purchase coverage.

• Are all employers required to provide health insurance coverage? Beginning in 2015, the federal rule is that employers with 50 full-time equivalents will have a responsibility to offer health coverage or face penalties depending on where their employees get coverage and if they get subsidies. Employers with less than 50 full-time equivalents will not face any coverage requirements.

• Am I better off letting my employees purchase their own coverage rather than purchasing a group plan for my business? This is a subject of considerable complexity. An employer must weigh a number of issues including number of employees, wages, and other financial considerations to determine what fits it’s situation. A health insurance professional will be able to guide an employer through the maze of considerations.

• Am I required to cover my children, under 26, on my insurance policy? There is no requirement that parents cover their children through age 26. Parents have the option of carrying their adult children on their health insurance plan. If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old.

• Has the Affordable Care Act has been postponed? Portions of the bill that involve certain types of employers have been postponed, but the individual health insurance requirement goes into effect in early 2014. The open enrollment phase for individual insurance plans is underway, and the deadline to enroll remains March 31. The date to enroll and avoid a penalty has been extended from February 15 to March 31.

• Will the Exchange allow me to compare rates of policies inside and outside the Exchange?The Exchange does not provide a comparison of rates within and outside of the Exchange. For rate comparisons, consumer should seek professional guidance. Attempts to defraud consumers have already been reported as scam artists attempt to exploit the confusion and misinformation about the law and gain access to social security numbers, credit cards, bank accounts, and other personal information. Consumers should be wary about providing personal information in the process of purchasing health coverage to comply with the new law.

Last Updated 08/10/2022

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