Greater Peoria Metro Area, IL

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Health Insurance Marketplace – Part 1 of 2

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By Pamela Camey, CLTC, Healthcare Solutions Team

You can’t live with it and you can’t live without it. There is something irresistible and bullish about it. We grin and bear it and we make sure we have it. What is it? Health insurance…and we hope something better comes along!

50 years ago, on July 30, 1965, President Lyndon B. Johnson signed the Medicaid and Medicare Bill into law. Our senators and congressional representatives launched attacks against the system and have been consistent ever since with their attacks. Have there been changes to the Medicare system? Absolutely. But Medicare just celebrated its 50th Anniversary. Those retired depend on it, and some seniors still struggle with medical bills, but their situation is far better than 50 years ago.

The Patient Protection and Affordable Care Act (commonly referred to as ACA, or Obamacare) is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Our Senators and Congressmen’s attacks against the system have been consistent ever since.

Are you seeing a familiar pattern? 
In the past 50 years, Medicaid and Medicare have gone through some massive changes. What will be the future of ACA? That is hard to predict. ACA has set one precedent that is likely to continue to exist: people should be allowed access to healthcare, even if they cannot afford it. It is here to stay. To eliminate the ACA, Medicare, and social insurance programs like these would actually weaken us as people.

However, there are bound to be some changes. The current system is bizarre, to say the least. Higher income people get generous tax subsidies for employment-related coverage. Low-income people get tax credits and/or cost-sharing opportunities.

The middle-income people get nothing. That is unsustainable. The nation does need a system where everyone gets the level of help they need for coverage and cost sharing.

Insurers will continue their attempts to provide plans with attractive premium options for controlling pricing.

The Kaiser Foundation estimated that 28.6 million U.S. residents were able to buy health insurance via the marketplace. 8 million purchased year one, and 11.7 million purchased in year two. Of the 11.7 million that purchased in year two, 86 percent of all health plans purchased in the 2015 Open Enrollment period through the marketplace included financial assistance for the customer. It is projected that 15 million people will purchase plans during the 2016 Open enrollment Period.

Health Plans That Qualify As Minimum Essential Coverage
If you are covered by any of the following types of plans, you are considered covered under the health care law, and do not have to pay a penalty or get a health coverage exemption:

  • Any marketplace plan, or any individual insurance plan you already have
  • Any job-based plan, including retiree plans and COBRA coverage
  • Medicare Part A or Part C
  • Most Medicaid coverage
  • The Children’s Health Insurance Program (CHIP)
  • Most individual health plans you bought outside the marketplace, including “grandfathered” plans (not all plans sold outside the marketplace qualify as minimum essential coverage).
  • Coverage under a parent’s plan (if you are under 26)
  • Self-funded health coverage offered to students by universities for plan or policy years that started on or before Dec. 31, 2014 (check with your university to see if the plan counts as minimum essential coverage)
  • Health coverage for Peace Corps volunteers
  • Certain types of veterans’ health coverage through the Department of Veterans Affairs
  • Most TRICARE plans
  • Department of Defense Non-appropriated Fund Health Benefits Programs
  • Refugee Medical Assistance
  • State high-risk pools for plan or policy years that started on or before December 31, 2014 (check with your high-risk pool plan to see if it qualifies as minimum essential coverage)

See a more detailed list of types of plans that do and do not count as minimum essential coverage from the IRS.

Be sure to read upcoming segments on the market place. For more information, contact Pamela Camey, CLTC, and Licensed Insurance Agent for Healthcare Solutions Team at 815-579-2266 or 309-761-8090. Email: pcamey@myhst.com; website: www.healthcaresolutionsteam.com, or http:healthcaresolutions.com/agent/pamela-camey/. Pamela has a master designation and is certified in Long Term Care. She is FFM and AHIPP certified through the Centers of Medicare and Medicaid, and licensed in Illinois, Iowa, Indiana, Michigan, Ohio, and Kentucky.

Sources available upon request.