Choosing the Best ACA Health Plan When You Have Diabetes
If you have diabetes but don't get health insurance through your employer, your spouse's employer, or a parent if you're 26 or younger, the Affordable Care Act (ACA), a.k.a. "Obamacare," should make getting affordable health care easier. "Health care reform is awesome," says Katherine Woodfield, an insurance expert and author of Don't Buy THAT Health Insurance: Become an Educated Health Care Consumer. "It's the first federal oversight of a completely non-federally regulated industry in 100 years." Think of it as consumer protection.
Even though coverage under Obamacare doesn't start until January 1, 2014, now's the time to start health plan shopping. Open enrollment, the period when the federal government allows consumers to choose a health plan or to select a different health plan if they already have health insurance, started on October 1, 2013 and runs through March 31, 2014, for the first year of the ACA. The sooner you get your application in, preferably by December 15, 2013, the better, because the longer you delay, the longer you'll have to wait for your health insurance coverage to start. If you have your application completed and processed by December 15, 2013, for example, your effective date for health coverage will be January 1, 2014. But if you hold off one more day until December 16th, your effective date won't be until February 1, 2014. If you apply online, enrollment is instantaneous. If you apply through the mail, factor in mail time so it hits the enrollment date you're targeting.
Delaying can cost you, too. If you enroll between the 1st and the 15th of the month, your coverage will start the following month. But if you enroll between the 16th through the 30th of the month, your coverage won't start until the month after that. For example, if you don't enroll until February 16th, your coverage won't start until April 1, 2014. If you wait until the last day of open enrollment (March 31st), your coverage won't begin until May 1, 2014. Going three consecutive months in 2014 without health coverage, even during open enrollment, will assess a $95 per adult penalty on your taxes. Uninsured children are $47.50 each, with a max of $285 per family. (Exemptions are possible.) The penalty for going without health insurance for 90 days or more increases over time. By 2016, it will be up to $695.
While healthcare.gov is getting the kinks out for online applications, consumers should choose the "Apply by Phone" option at www.healthcare.gov. A navigator – someone hired and trained by the state or federal government to answer consumer questions – will send them a paper application, which they can complete and mail back. Right now, phone and the U.S. mail are the best options until the computer system is running smoothly.
No time allowances are being made just yet for the computer glitches.
New insurance marketplaces or "exchanges" will be available in every state. "The ACA is going to give self-employed people access to a lot more plans," Woodfield says. And small companies will be forced to offer their employees health insurance or pay a penalty. There's a lot to know about the ACA, so be sure to visit www.healthcare.gov if you're in the market for health insurance. In the meantime, Woodfield offers these tips for simplifying the health care shopping process, especially when you have a chronic condition like diabetes, which requires you to access the medical system frequently.
- Obamacare Facts. Health Insurance Exchange. http://obamacarefacts.com/obamacare-health-insurance-exchange.php. (Access 10/13)
- Healthcare.gov. https://www.healthcare.gov/. (Accessed 10/13)
- Kaiser Family Foundation. www.kff.org. (Accessed 10/13)
- Consumer Reports. www.healthlawhelper.org. (Accessed 10/13)
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...