A group of
nonpartisan East Nashville healthcare advocates, "You're Covered Nashville," decided to share the
facts on the Affordable Care Act, otherwise known as the much demonized "Obamacare." They've spoken at churches, neighborhood association meetings and other gatherings
helping their friends and neighbors understand some of the basics of this big,
broad complicated law. I was fortunate to attend such a gathering at a friend's home. I was much impressed with the fact that a group of individuals would care enough to educate themselves and others. And, I was appreciative to come to a greater understanding of the Act. So, I asked "You're Covered" member Debbie Meredith, an accountant by trade, to author this guest post so that more people could learn the facts. Note that the basics here apply throughout the country.

What is
Obamacare and how will it help people? 

"After
years of debates about Obamacare, it’s finally time for implementation.  With tons of misinformation abounding, You're Covered Nashville, decided to  clarify the basic facts and debunk a few of the myths
surrounding this historic legislation.  We've made it really simple for everyone.  There are three things everyone should know about
Obamacare.  First, everyone is required
to have coverage in 2014.  Secondly, by
law, health insurance has to be affordable. 
Finally, all insurance plans must offer quality coverage.  It’s really that simple.  There are no death panels, no one is taking
away anyone's current plan and the government won’t pick anyone's doctor.  Let’s take each of these items and break
them down." 

Coverage for
all with freedom of choice

"Even
though the law requires everyone to have insurance coverage in 2014, the law
allows individuals the freedom to choose their coverage. 
If a person has coverage now, either through their employer or private
insurance, and they like it, they can keep it.  If they want to shop around for another plan, they  can log onto www.healthcare.gov and take a look at the insurance
marketplace.  There, one will find plans
offered by private companies that meet the standards of a qualified health
plan.  The marketplace format looks much
like a travel website and, by law, the plans must be easily comparable with no
fine print, no fancy jargon, and no insurance company trickery.  The marketplace opened for business October 1 and coverage will begin January 1, 2014.  In Tennessee, the marketplace will include plans from BlueCross/BlueShield,
Cigna, Humana, Coventry Health & Life and Community Health Alliance.  As previously stated, individuals can keep what they
have or purchase insurance from other companies through their employer or an
insurance broker, they just won’t be listed on the marketplace." 

It isn’t
called the Affordable Care Act for nothing

"The law states that health
insurance must be affordable.  No longer
can insurance companies charge more for pre-existing conditions or raise premiums for high claims experience. 
In addition, the health care law says that if an individual can’t find a plan that
costs less than 8% of their income, they're exempt from the requirement to
purchase health insurance. To make premiums affordable to low and moderate
income Americans who are not eligible for Medicaid and are not offered
employer-paid insurance, premium assistance is available in the form of tax
credits.  That means middle-class folks
with income between 133% – 400% of the federal poverty level can get help
paying for their insurance.  So if an individual's
projected 2014 earnings are less than about $46,000 or less
than about $94,000 for a family of 4, they may qualify for assistance paying for their insurance premium through tax credits."

"In addition to the premium
assistance, those making less than 250% of federal poverty level (about $23,000
for individual or $80,000 for family of four) may receive out-of-pocket subsidies.
These subsidies are designed to keep the dreaded co-pays, co-insurance and
deductibles down to an affordable level. 
Speaking of out-of-pocket expenses, the law mandates the maximum
out-of-pocket expense to be less than $6,350 for an individual and $12,700 for
a family of four.  Because of The Affordable
Care Act, medical bankruptcies are a thing of the past."

Quality care means new rules for
insurance companies

"The
Affordable Care Act requires health insurance plans to include basic coverage
or "essential health benefits." These benefits include an extensive
list of services from doctor visits, prescription drugs and lab tests to emergency
room services and hospital stays.  Free preventive
care, such as cancer screening and annual physicals, are on the list, as are rehabilitative
services and mental health therapy.   Plans will also include coverage for pregnancy
and baby care and dental and eye care for children under 18.  By law, the insurance companies can no longer
limit the amount of coverage or place lifetime caps on an individual's plan.  In fact, insurance companies now have to
actually pay 80% of premiums they charge on healthcare, not on “overhead” such
as corporate jets and CEO salaries. 
Should they fail to meet these requirements, the law requires them to refund
a portion of the premiums back to the individual."

"Insurers
will bundle their plans at five different pricing levels, and individuals have the
freedom to choose whether they pay now (higher premium & lower deductible)
or pay later (lower premiums & higher deductible).  The most expensive of the plans offered is
called platinum level, which will pay 90% of medical costs.  Gold plans will pay 80% of the costs, while
the silver coverage will pay 70% of the medical costs. Bronze carries the
lowest monthly premiums but also only pays 60% of costs. There are also catastrophic plans
available.  As these plans are designed
for 'young invincibles' and working poor, they are only available to those
under age 30 or those over 30 who cannot find a plan for less than 8% of their
income.  Premiums for catastrophic plans
will be cheaper and they will cover all the essential health benefits and 3
primary care visits per year, however deductible and co-pays are likely to be
higher for these plans.  Again, individuals have
the freedom to choose which plan works for their budget and their healthcare needs." 

Bottom Line

"The uninsured have a dramatic
effect on our nation’s healthcare.  They
affect the finances, quality and availability of care for everyone.  But more importantly, access to affordable
healthcare for all is just the right thing to do.  A community full of healthy individuals is beneficial to us all. Yes, the opening days of
enrollment have been rocky and fraught with website glitches, but don’t let
that deter you.  Access to affordable,
quality health insurance can change lives. 
So, Go Get Covered!"

How can you get more information?

Check out You're Covered Nashville's Facebook page at www.facebook.com/yourecoverednashville or follow them on twitter @ycnashville. In addition, you can find local help at www.getcoverednashville.org. Of course, don’t forget
to log onto www.healthcare.gov and get covered!