Localizing Obamacare: What does it mean for me?

Localizing Obamacare: What does it mean for me?
Source: HealthCare.gov
Source: HealthCare.gov
Source: HealthCare.gov
Source: HealthCare.gov
Source: HealthCare.gov
Source: HealthCare.gov

AMARILLO, TX (KFDA) - Many have heard about the price hike to the Affordable Care Act coming in 2017. But, how will this effect us locally throughout the panhandle? NewsChannel 10 took an in depth look at how you and your family will be effected by the hikes and how you are able to avoid paying higher premiums next year.

Open enrollment for 2017 is underway. But, signing up might be a bit confusing. Those who need to enroll can either head to the marketplace online at healthcare.gov or to a local health insurance agent. Both will help you to figure out what you are eligible to receive from the government and what each plan can offer to the customer.

There is no difference in cost if you use the marketplace or see an agent. But, it is recommended that you do go to a representative in your area. They are able to help you find the best plan for where you live.

"What we suggest is use a very good well known agency that is going to give you that information," says, Professional Insurance CEO Julie Hulsey. "But, using that local representation really helps. This is because we can help you find what doctors are in the network and what actually works best for your pocketbook."

Some of the plans you can choose from on the Affordable Care Act are not accepted by doctors in our area. By choosing to use an agent when making the decision will help you find the plan which gets you the coverage you need.

Premiums for the Affordable Care Act are expected to hike in 2017. But why is the increased expected to be so much?

The Affordable Care Act works like a pot, if as many people are paying into it as are taking out, the system works. However, there are more people sick that what was expected. This means more people are taking more from the pot than are putting into it.

Local agencies are seeing people buying policies then having expensive surgeries or buying high priced drugs then canceling their insurance. This leaves insurance companies paying for these procedures without people paying into the Affordable Care Act.

Also, less young, healthy patients are buying insurance which adds to the pool. It was expected that the younger generation was going to pay into the pool and not use the money because they are relatively healthy. However, not many are buying into the plan because they can stay on their parents plan until they are 26.

"Well, you know when you suddenly see the new technology and everything that is covered they [insurance companies] can't absorb it," says Hulsey. "We are also not getting the younger people that were supposed to be going in and buying this to help even it out. So, we are actually seeing the result of the sicker older people that are on there that are using it but not enough money coming in to justify that."

According to Hulsey, the premise of insurance is pooling the risk. Meaning, if you have everyone putting money into the Affordable Care Act, it is there for those who need it. However, instead of everyone adding to the pool, there has only been a portion adding to it causing insurance companies to hike everyone's rates to cover the sick pulling from the pool.

The Hike in premiums is going to effect everyone, but how can I help to reduce my cost?

Some families are worried about how they will afford doctors visits or medicines. We have now three insurance company plans in Amarillo and the hike in premiums for the plans went up between 48 and 59 percent. This is a huge increase and leaves customers wondering what to do.

Your price of your policy is based on your age, geographic location and surprisingly tobacco usage. If you are a smoker it increased the price of your plan by 50%. So, one way to help offset the cost of the plan is to quit smoking. But there is not a lot that can be done to avoid the price hike. Everyone in the U.S. must be covered to avoid being penalized over $600.

"You know the loop holes, and this is the worst thing, it kills family values," says Hulsey. " But I have actually had people in my office say well we are getting married next month so we need to get our quote for our insurance, we need to figure it. Because they are getting married, they couldn't qualify for a subsidy but if they don't get married then they both got a subsidy. That is a sad situation. That is a loop hole but not one that I cannot condone."

Another problem is that when someone tries to get family coverage or add a dependent, the employer stops subsidizing the insurance premiums. Meaning, a large increase in your month to month payments which some cannot afford. A subsidy is assistance from either your employer or the government to help off set the cost of insurance premiums.

One way to help lower the cost is to stay on your own separate plans. But, this may not help or even be an option. If you or your spouse is not working or you have children you will not be able to qualify for government assistance.

This is what they call the Family Gap. If you are offered coverage by your spouses insurance plan, you cannot be provided coverage under the affordable care act. So this means, you will either have to pay the amount to have coverage under your spouses plan or be penalized for not having insurance.

For more information visit healthcare.gov

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