East TN News
East TN News

The Truth About Obamacare Q&A
By John M Disque


Every 20 minutes an American dies from a curable issue because they don’t have health insurance.

Q - If you have existing health insurance will the provider still be able to dump you or charge more for pre-existing conditions?


A - As of Jan 1, 2014 – No… they will not be able to dump you or charge you more for your plan. That’s why they’re dumping people before Jan 1 and offering new plans that abide by the new laws.

Q - If you have a current policy can you still shop for better rates on the exchange?


A - Yes

Q - Will Medicare work the same way it always has?


A - Yes

Q - Can Americans living outside the US participate?


A - This is discouraged because the medical industries outside the US are unlikely to participate or accept ACA.

Q - Can I shop for plans without signing up or giving my name and address?


A - Yes – but to check out your potential subsidies and final prices you will have to include more detailed information.

Q - Is dental care and mental health care included?


A - The plans cover 10 health benefits, which include medical care, rehab and mental health services and dental care for children. Dental coverage for adults is not covered. (Only children)

Q - I’ve been paying $400 a month for 10 years. That’s $50,000 and I’ve seen a doctor 5 times. My cost has been $10,000 per doctor visit. Even if ACA can get me a much better deal isn’t all insurance just a big scam? Now we’re being mandated to let ourselves be scammed.


A - Is this an individual plan? If it is – you’re being raped.


You’ve stayed relatively healthy for the past 10 years. Imagine for a moment that you were diagnosed with a brain tumor or cancer in the past 10 years. Or if you had a heart attack or you had several trips to the emergency room.


ACA is offering the assurance that you won’t lose everything if you get extremely ill.

Q - What if my employer doesn’t offer insurance and I refuse to sign up?


A - You will be fined and charged on your tax return. $95.00 or 1% of your income… whichever is higher. I’m hearing that some employers are offering to pay the fines for the employees but it’s unconfirmed and no one is giving me the names of these companies.

Q - The fine is much less than the cost of the plans so why would I sign up?


A- You have to factor the cost of getting seriously sick without having insurance.

Q - There’s rumors that people who oppose Obamacare are hacking the site and the site may’ve been bugged when it was built. Is this true?


A - I have asked for this information under the “Freedom of Information Act” and they won’t share it with me but they’re not denying it.


If a case is under investigation and releasing the information will result in disturbing the investigation they are not legally required to share it with the media. 

Q - Can illegal immigrants sign up?


A - No

Q - I’m being told that some businesses are cutting their workers down to part-time and some are just refusing to sign up their employees because the fines are much cheaper. Is this true?


A - There’s been a lot of talk and threats of businesses cutting their employees hours but I haven't seen it yet. Most business people understand that this would kill the morale of their company and employees will leave to find better companies. 


As for not signing employees and paying the fines, not only is this illegal – it’s unethical and I would recommend finding a better employer if this is your case.

Q - My credit report is not good. Will this affect the cost of my plan?


A - No – There’s no credit check and the cost of your plan and available discounts (subsidies) are based on your projected income (the amount you’re estimated to make in 2014).

When the government processes your taxes each year they will determine if you’re still eligible for those discounts and if you’re eligible for more discounts.

Q - What are the main factors that determine my cost?


A - Your age, where you live and your projected income. (Not your current or past health, not your credit, not your gender and not your race).

Q - Many people are screaming that the Obamacare rates are higher than they’re currently paying. Is this true?


A – This is extremely misleading. Most of these people are choosing the most expensive plans without checking the availability of their subsidies. They’re then taking this to social media without telling people “the whole story.”


If they go through the entire enrollment process they’ll see their plans, with their subsidies, are much cheaper than they’re reporting. Also - in most cases (unless they're extremely sick) they don't need the most expensive plans.

Q - I have a son not living at home and going to college. He’s 23. When is he no longer covered on my plan and what does he need to do?


A - On his 26th birthday he will no longer be covered on your plan and he needs to get his own individual coverage. 

Q – What if my state has not set up their own exchange program?


A – Then you have to use the federal government who are trying to pick up the slack of state-neglect. 

Q - Are there companies that can privately walk me through the process of enrolling and help me find the best options?


A – I would not use a pay-for company. The enrollment process is not complicated and people have that misconception because the subject of insurance IS somewhat complicated. I personally believe the insurance companies did this to confuse people so they really don’t know what they’re buying. These people often find out too late and when they need their insurance the most.


There’s nothing to fear and there are many non-profit groups willing to help you. There’s also a toll-free federal hotline that will be happy to assist you.

Q - If I sign up right now am I covered right now?


A – No. Coverage doesn’t begin until Jan 1. You have the option of enrolling now, and you’ll continue to have that option whenever you’re ready, but you will not be covered until Jan 1.

Q - I have a healthcare provider and I’m happy with my plan. Do I have to change anything or enroll in ACA?


A – No. You don’t have to do anything but I would recommend reading your current plan (every letter, every word) and making sure it’s still legal.

Q – I’m in sales and my income varies greatly from year to year. It’s almost impossible to project my income for 2014. What should I do?


A – That’s a great question and you’re not alone.


I would use an average of your past 5 years and start with that number. Your projected income does not have to be exact and the government understands that many people have this issue.


If you go about the year and see your projected income is going to be much higher or much lower than you anticipated contact ACA and they’ll make the adjustment – Otherwise you’ll be paying too high a price if it’s lower than expected and too low a price if it’s higher than expected and they’ll find out the bottom line when you do your taxes in 2015.

Q – I have an adult daughter living at home who is not working. I want to get her covered but don’t understand how it will affect the subsidies and what I need to do.


A – Covering her, yourself and anyone else living in your house will be based on your household income. It won’t be individual plans because she lives in your home.

Q – Is it true that you have a 90-day grace period to pay the premiums and will still be covered if your 89 days late?


A – This would depend on your state exchange if you have one. While the federal government might be lenient on this – it would only be until they get the paperwork nightmare straightened out.


The states are in a much better position to be more organized and most want the premiums paid 15 days upfront. So – to be covered by Jan 1 … you’d have to make your first payment by Dec 15. Your next payment would be due Jan 15 and you’d be covered through February, etc… 

Q – Are senior citizens eligible to enroll in Obamcare?


A – Absolutely

Q – Can doctors deny participation in ACA?


A – Yes, but doctors can and do deny all sorts of insurance providers depending on their relationship with the company. It would not be wise for a medical professional to do this because they’re guaranteed payment and they don’t have to wrestle with insurance companies who often don’t want to pay their bills or are chronically late paying their bills.

Published (11/4/13)
Author: John M Disque




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