Keeping Up: A New World of Health Care

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Health insurance. You love to hate it. You love to have it. But as a self-employed 20- or 30-something married female getting decent coverage in Texas has been quite challenging.

I recently had the opportunity to attend a Meetup from the Refresh Austin group about the new health laws, aka Obamacare. Amanda Fredriksen from AARP Texas did a great job breaking it down.

Since I don’t know your situation, I thought I would share what I learned at this meeting and tell you about how these new laws are affecting me as someone who does not currently have health insurance.

Disclaimer: Please note and take into consideration that these laws are constantly changing and that I am absolutely not an expert on this. I am just sharing what I learned in hopes that it may be helpful to you. Also, please note that this is from the perspective of a self-employed person with no employees that does not currently have health insurance. If your current employer provides health insurance coverage or you already have health insurance these new laws may not directly affect you (or you may not notice how they affect you).

Logistics

In order to start getting health insurance coverage by January 1st you need to sign up by December 15.

There are basically two ways you can sign up—healthcare.gov or directly through a provider like Blue Cross Blue Shield.

From my understanding, the main reason you should battle the ever-failing healthcare.gov website is because it is the only place where you can qualify for a tax credit if you meet certain requirements such as your income falling below a certain amount. I think for individuals it is $46k, for couples it is $62k, and for a family of four it is $94k a year. (Again, please do your research as I could have some of these facts wrong).

A quick Google search will bring up several calculators that could help give you an idea if you would qualify for the tax credit. I thought this one was quite helpful – Subsidy Calculator (it also happens to be the one healthcare.gov recommends).

If you don’t meet the requirements to get a tax credit then you are free to pick whatever health insurance plan you want. eHealth is a great website to do a little browsing and to check out your options.

One of the biggest things to note is that you have to be signed up for some sort of health insurance by March (not sure the exact date) or you get a fine and you have to wait again until the next window of enrollment to sign up again.

Coverage

There is now an essential set of benefits that each insurance policy has to cover. According to the healthcare.gov website they are:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Then there are levels of plans—Bronze, Silver, Gold, and Platinum. To be honest I am not sure what the differences in these plans are, I just know the premium goes up as you move to a higher plan. Click here for an article by Web MD that does a pretty good job explaining the different plans.

Positives

For me personally, it is the coverage. For the past two years, we have thankfully received health insurance through my husband’s company. However, recently he started working for himself again so our health coverage has gone out the door.

So why haven’t we just gotten a new individual health insurance plan? In Texas the health insurance coverage for women has been almost a joke. We pay a significant amount more than men, with the claim that we need more coverage because we could get pregnant. But get this—no individual insurance plan in Texas (that we could find) covers maternity.

For example, I have a friend whose husband owns his own (and quite successful) business. She is a stay at home mom and they wanted to grow their family even more. They searched and searched but no matter how much they paid, they could not find a health plan that would cover maternity. So they basically had to save $30,000 (she needed a c-section) in order to have their second kid. To them, buying an individual health insurance plan wasn’t worth it.

As a 20- to 30-something female (no I’m not giving up my age that easily) maternity coverage is pretty important to me. So I am glad that it is now required to be covered on all health insurance plans.

Negatives

I am sure a quick Google search will bring up lots of reasons why Obamacare is bad. And while I can’t speak to these claims (I’m not posting this to stir up any debates), I do know that the thing I don’t like the most is that is required for me to buy health insurance. And if I don’t I get a big fat fine.

This requirement will be challenging for some young freelancers and entrepreneurs, especially if your income falls just above the income requirements for the tax credit. While being self-employed has its perks, you don’t always know when your next paycheck is coming in and adding another thing that you are required to pay for, whether or not you use it, is never easy.

I hope this information was helpful to you. Please feel free to send me a note if you notice any information that may not be correct, I definitely want to provide accurate information. Also, I recommend checking out the resources below as they may be quite helpful to you as you figure out how these new laws will affect you.

Resources

Healthcare.gov or you can call 1-800-318-2596
HealthLawAnswers.org
eHealth
WebMD
Kaiser Family Foundation

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