Tag: aca

What Does the Texas Ruling Against Obamacare Mean?


By Daniel Murphy

After the December 14th ruling by a federal judge against the legality of ACA healthcaremany people are wondering whether or not they will continue to have coverage. Catchy headlines ran on news media for weeks implying all sorts of possible scenarios. Between the media war and political noise, the average person hasn’t been able to piece together exactly what to expect. Here at the office it’s been one of the most common questions for the past two weeks; “Is Obamacare still going to be around for 2019?” So as professionals in the industry, here are our thoughts down at Hummingbird.

 

This entire event needs to be put in it’s actual context. The supreme court did not strike down Obamacare – a federal judge in Texas did. Though this has powerful implications, especially in a judiciary system where establishing precedent is important for future laws, it can not bring everything to a grinding halt all by itself. There is almost always an appeal process. The ruling in Texas is important, but it will take many months ifnot several years to see precisely how it is going to pan out.

 

For some added perspective, consider that this is actually the seventieth time that the ACA has been challenged in court and/or sued by an assembly of politicians. The Supreme Court itself has even examined it once before and upheld the entire structure as legal and constitutional. There is a lot of political attention and validation in certain groups for the mere effort to bring down the Affordable Care Act. This results in many symbolic attacks against the law for the sake of bolstering one’s constituency and increasing funding for political campaigns. More often than notthese lawsuits are just tigers without teeth.

 

A majority of people want to continue to see some sort of inclusive healthcare for our country, and this is true on both sides. Laws often get empowered or diminished in a democratic system whose hallmark is a revolving door of different parties, people, and plans. Different ideologies hold power throughout any given era. Often times, however, the core laws are upheld. The ACA, I think at least, has become a core law in the United States. That doesn’t mean it won’t be transformed or even renamed as time goes on, but it does mean that some form of government-supported healthcare that accepts most pre-existing conditions is here to stay. Even President Donald Trump has voiced his support for a healthcare structure that provides this sort of coverage.

 

The Texas decision may indeed climb its way to the supreme court. A newly confirmed Republican on the seat there is a valid concern for people afraid that the Supreme Court may overturn its own earlier ruling. No matter what the outcome this is going to be a long and cumbersome process. Even if the law were repealed in totality tomorrow, there would still be at least a year involved in actually dismantling it. That means that for 2019, at least, no one should need to worry too much about their coverage. The future is harder to predict, but I’m comfortable betting that some form of inclusive healthcare will continue to exist at the federal level indefinitely, hopefully as a reliable pillar of U.S. law.

I am enrolled in a Medicare Advantage plan. Did the ACA make changes to this program?

Yes, the law did make some changes to the Medicare Advantage program.  This program is an alternative to traditional Medicare, where people on Medicare can choose a private plan, such as an HMO or PPO, to receive Medicare-covered benefits.  The law reduced federal payments to these plans to bring them closer to the average costs of traditional Medicare.  The law also provided additional payments to plans that earn high quality ratings.

In addition, the law limited how much cost sharing plans can charge enrollees for certain services, and limited how much plans can spend on administrative expenses and profits (referred to as “medical loss ratio” requirements.)

To learn more about how your coverage options under Medicare, including all of the Medicare Advantage plans, Part D drug plans, and Medigap supplemental policies available in your area, you can go to the Medicare Plan Finder on www.Medicare.gov or call 1-800-MEDICARE.

I am enrolled in a Medicare Part D drug plan. Did the ACA make changes to my Medicare drug coverage?

Yes, the law included changes that could save you money if you have very high prescription drug costs.  If you are enrolled in a Medicare Part D plan and you have very high drug costs, the law is helping to reduce the costs you pay when you reach a gap in coverage that is sometimes referred to as the “doughnut hole.”  This gap in coverage is being phased out between now and 2019 for brand-name drugs.  If your total drug costs are more than $3,820 in 2019, after that point you will pay 25% of the cost of your brand-name drugs and 37% of the cost of your generic drugs.  In 2020, you will pay 25% for both brand-name and generic drugs.

The law also included a new requirement that people on Medicare with higher incomes pay a higher premium for Part D coverage.  These higher premiums are paid by single beneficiaries enrolled in Part D plans with incomes greater than $85,000 and married couples with incomes greater than $170,000.

Are immigrants required to have health insurance coverage under the Affordable Care Act’s individual mandate?

Most immigrants who are residents lawfully present in the U.S., including “green card holders,” are subject to the ACA’s individual mandate.

However, for 2018, people who lack coverage during the year can claim an exemption from the tax penalty directly on their tax return if they experienced circumstances that prevented them from obtaining coverage.  No documentation of the hardship is required to be submitted with the tax return, though taxpayers should retain all documentation for their files.

Starting in 2019, there will be no tax penalty for failing to have health insurance coverage.

Immigrants who are not lawfully present in the U.S. will not pay a tax penalty if they do not have health insurance.

I am pregnant and plan to breastfeed my baby. How does the ACA affect breastfeeding services?

The ACA requires that all new ACA-compliant plans, including those in the employer market, individual market, and health insurance Marketplaces, cover lactation counseling and breast pump rental without any charge. Check your plan details to find out the specific number of counseling sessions and type of breast pump that it covers, or if your plan covers purchase of a breast pump. If you are nursing and work for a large employer (50 or more employees), your employer must provide access to a private room (that is not a bathroom) and break time for you to express milk.

Short-term health insurance policies do not have to provide benefits required by the ACA, including breastfeeding services.

Can I buy health insurance outside of the Marketplace that meets all ACA standards?

Yes.  Many insurers that offer policies through the Marketplace also offer identical policies outside of the Marketplace, in the individual health insurance market.  These ACA-compliant policies also will meet all ACA standards.  They will cover essential health benefits; and they won’t turn you down, charge you more, or limit coverage based on your pre-existing condition.  In addition, ACA-compliant policies will only be offered during Open Enrollment, or at other times during the year, only to people who are eligible for a special enrollment period (SEP).

Sometimes people prefer to buy outside of the Marketplace, for example, when they are sure they won’t qualify for financial assistance. However, many other policies that are not ACA-compliant are also for sale outside of the Marketplace, and this can make comparison-shopping more complicated.

Some signs that a health policy is not ACA-compliant include:

  • The application asks questions about your health status or health history
  • The policy doesn’t cover essential benefits, such as maternity care or prescription drugs
  • The policy has annual or lifetime dollar caps on covered benefits
  • The policy is offered for sale outside of Open Enrollment to people regardless of whether they’re eligible for an SEP, for example, because they recently lost other coverage

Plans that are not ACA-compliant, including short-term health insurance, may have lower premiums because they can exclude people with pre-existing conditions and offer more limited benefits.

If you are shopping outside of the Marketplace and you want an ACA-compliant policy, be sure to specify that to the insurer or broker you’re working with.

Finally, even if you think you won’t qualify for financial assistance, it still might be worthwhile to shop for coverage on the Marketplace.  All policies offered through the Marketplace will meet ACA standards; no other non-compliant products are sold there.   In addition, if you are not eligible for financial assistance now, but your circumstances change later during the year (for example, your income declines), you can begin receiving financial assistance right away if you are already covered under a Marketplace plan.  Or, when you file your tax return at year-end you can claim a premium tax credit to have some of the premium you paid for the Marketplace plan refunded to you.  However, if you bought an ACA-compliant policy outside of the Marketplace, and then you become eligible for financial assistance mid-year, you may have to wait until the next Open Enrollment to switch to a Marketplace plan and get financial assistance.

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