10 Essential Health Benefits
As a Health Insurance Industry professional, my clients often confess their bad experiences. These range from their Company’s Health Insurance Plan, maybe implementation or strategy. Most grievances are about the misunderstandings on the functionality of their plans. I want to discuss the importance of the provisions of the Affordable Care Act. I don’t want to delve into any elaborate concepts or any of the politics that exist behind them. Truth is, at the end of the day, whether you agree with it or not, it is in existence and a reality for a lot of people.
3 Main Principles exist with the Patient Protection and Affordable Care Act (PPACA). Commonly called the Affordable Care Act (ACA) or, colloquially, Obamacare. They are:
- Every Plan must contain 10 Essential Health Benefits (Federally and State mandated)
- All Plan offerings must meet Actuarial Tables within the Metallic Tiering Structure
- The MEDICAID thresholds/limits have expanded to meet more demands of affordability
So to not BORE everyone to death, this article will only focus on the first Main Aspect. So YES, your physicals are free! That includes:
- Child wellness visits to age 21
- free annual feminine exams
- when you’re old enough (50), free colonoscopy
- and more free services
But let’s face it, there is no such thing as free. The cost of embedding 10 Essential “unused” Health Benefits is everyone’s burden. Everyone participating in health plans (between non-groups and groups with fewer than 100 employees). It means that insurers can cost contain premiums by sharing a much larger risk pool. This offsets costs for sicker populations because most people on the spectrum are healthier. Additionally, age factors are part of premium calculation. It means that the younger may pay proportionally as much as the older. The rationale being that the older have more health issues.
Any time I provide Health Quotes to families and Individuals, I share the magic formula. This magic formula is simple, take your age, add a ‘zero’ to the end of it, then subtract by a hundred. E.G. 30 Yrs Old + Zero = $300 – $100 = Bronze Plan (Left Limit). The other part of the formula predicts the Platinum Plan Cost (Right Limit). Take your age, add a ‘zero’, then multiply by 2. So, 30 + Zero at the end = $300 * 2 = $600 = Platinum Plan. So your cost effective plan can range from $200 all the way up to an awesome expensive $600. For a 60-year-old, the math is the same, left limit is $600 and right limit is $1,200.
For a long time in my life I’ve always contended with the thought of paying for other people’s way. Whether education, low-income housing, even Senior housing. All for the greater good, the Social Contract. I have never abstained from the idea of taking care of our children. The one fundamental fact the ACA makes clear, is children are at the forefront of our endeavors! Something else monumentally true, the ACA aims to keep people healthy. With low cost visits to the doctors should you so choose as the remedy to high premiums. The preventative aspects alone indicate early prevention and detection is what will save lives.
Will people use their free visits or frequently go to the doctor for early detection and tests? Probably not, which is why people argue freedom of choice against ACA. THANKFULLY, catastrophic plans still exist for the 30 and under population. For everyone else, just have hope your Employer offers a plan with premium contribution. This mandate is the Fair-Share Employer Contribution Act. The mandates are contribution rates for individuals at 50% and all Else 33%. There is a takeaway thankfully. Due to common sense in the Health Industry, Insurance Companies make certain products affordable. This compromise we know as Health Care Supplements.
What are Health Care Supplements and why do I want or need them? Well, there are two trains of thought on the matter of what kind of Health Plan you should get. Most folks are healthy and don’t worry about major life altering events. Examples include Heart Attacks, Stroke, Cancers, other diseases or injury. Then exist the smaller yet sick populations that need more robust health insurance plans. Through years of experience we have deduced some facts! We maintain that the best option is to craft a suite of benefits that compliments your Plan. Not just employing the cheapest options. Insulating yourself and family. We always hear the dumbest excuses too:
“Well, if it’s extra I don’t need it, I’ll just be dumping money down the drain if I don’t use it”…
As if the same were untrue about health insurance, Gym memberships, or magazine subscriptions.
It’s simple. Option one: Find the Cheapest health plan available for your age. If your Doctor accepts the plan, cool. Then, insulate your Health Insurance Plan’s exposure (like deductibles and higher co-pays). Insulate from loss with Health Insurance Supplements. Health Insurance Supplements do NOT replace your Health Insurance Plans and are completely OPTIONAL. But do yourself a favor, get benefits that pay you back, in cash, in case you have to use your plan. What does that mean? Well case in point, if I’m painting my house and I fall off the ladder, what happens next? Depending on the severity of the injury I may have to go to the hospital. If I told you there was a benefit that paid you money when you went to the ER. A benefit that offsets your ER co-pay, would you at least want to hear about it? How could that save your financial future from hospital bills? “Loss of work/income the auto/home/utility bills still exist bills”, or even child care bills? The best choice you can make, find a cost affordable plan and insulate yourself from exposure. Or just find the most expensive plan and pray you aren’t absent from an extended period of time from work. One fact will always remain. Even with the most expensive plan, a Health Plan will NEVER put money back into your wallet. Offset medical expenses the smart way.
Contact us today. Let us show you how to save dollars investing in a Program that pays you and your Family!