Couples facing divorce should familiarize themselves with our new health insurance system. It is likely that at least one or possibly both spouses will have to find health insurance coverage for themselves and/or their children after the divorce.
One factor to be aware of immediately is that open enrollment for securing new health insurance for this year closed on March 31, 2014. (And Open Enrollment for health coverage for 2015 does not begin until November 15, 2014; it closes February 15, 2015). However, if you reside in Texas, divorce is a life event that may qualify you for a Special Enrollment Period so you can buy health insurance coverage through the Marketplace after divorce, even if open enrollment is closed. (Visit healthcare.gov for details.)
Consumers now have new rights and protections designed to make health coverage fairer and easier to understand. Children, especially, have new important coverage to protect not only their health, but their dental care and vision. So, divorcing couples may wish to consider and compare this new option for health insurance coverage going forward.
As stated earlier, one or both individuals in a divorce will likely have to replace employer provided health insurance following divorce. Here are a number of provisions to be aware of in the new health insurance system:
- In spite of any medical condition, plan providers must issue insurance coverage at the same premium to all individuals of the same age, sex and geographical location. However, individuals who use tobacco are required to pay higher premiums.
- All individuals not covered by an employer plan or Medicare are required to secure coverage or pay a penalty. Penalties are waived in cases of financial hardship. There also are subsidies for those with low incomes.
- Minimum standards for health insurance policies have been established. Some of the new requirements include:
- Individuals no longer have to secure preauthorization for emergency care.
- Mental health services are now covered.
- Insurance providers now cover services that are rehabilitative in nature, or include therapies to help overcome long-term disabilities like Multiple Sclerosis.
- Insurers now provide all of the 50 preventive services recommended by the U. S. Preventive Services Task Force at no extra cost.
- Insurance plans cover basic dental healthcare for children under age 19, such as teeth cleaning twice a year, X-rays and necessary fillings.
- Children in this age group are also entitled to an eye exam and one pair of glasses or contact lenses each year.
- Prenatal care is now provided at no extra cost, and is considered “preventive care.”
- The new health insurance system eliminates lifetime limits on medical expenses that in the past forced many individuals into bankruptcy.
- Insurance providers are prohibited from dropping an individual's coverage or raising premiums in the event of illness.
- Annual out-of-pocket medical expenses are now capped at $6,400 for individuals and $12,800 for families. It is estimated that this will eliminate more than 600,000 bankruptcies in the U. S. each year due to medical expenses.
- Four tiers of healthcare coverage are now offered: bronze, silver, gold and platinum. All offer the same set of essential benefits. But, the out-of-pocket costs differ, with bronze plans having the lowest monthly premiums and higher-out-of-pocket costs and vice-versa for the platinum plans.The percentage of care that plans cover on average are: 60% Bronze,70% Silver, 80% Gold, and 90% Platinum.
For more specific information about the new health insurance system, visit www.healthcare.gov.
Join Patricia Barrett at upcoming Houston Leisure Learning classes on Aug. 25 and Oct. 27. She will also be presenting at the Guide to Good Divorce seminars in Houston on July 26, 2014 and Sept. 27, 2014. For more information on divorce financial planning or divorce mediation, visit Patricia's website, Lifetime Planning.
The information in this column is provided as a guideline and offers a general overview. Please visit www.healthcare.gov for more specific details, to explore the plans and to sign up for coverage.