Couples facing divorce should familiarize themselves with the Affordable Care Act (ACA). It is likely that at least one or possibly both of the parties will face the prospect of having to find healthcare insurance for themselves and/or their children after the divorce. Since the ACA offers a variety of benefits, such as free preventive care, couples also may wish to consider this new option for healthcare coverage going forward, even if they have a separate plan.
According to the federal government enrollment website (www.healthcare.gov), the ACA offers new rights and protections designed to make healthcare coverage more fair and easier to understand. It establishes a Health Insurance Marketplace where individuals, families and small businesses can chose to purchase health insurance coverage from a variety of competing providers who offer a number of plan choices.
According to the Kaiser Family Foundation, most people will pay less for healthcare than before the Act. Even with changes in health, plan premiums are expected to stabilize and be transparent.
The first open enrollment for the Affordable Healthcare Act began on Oct. 1, 2013. The law takes effect on January 1, 2014. The first open enrollment period will last through March 31, 2014. In future years, open enrollment will last from October 1 to December 7.
Here are a number of important provisions in the ACA:
- 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 will be 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. This means that coverage will be far better than before. Some of the new requirements include:
- Individuals will no longer have to secure preauthorization for emergency care.
- Mental health services must be covered.
- Insurance providers must cover services that are rehabilitative in nature, or include therapies to help overcome long-term disabilities like Multiple Sclerosis.
- The law instructs insurers to provide all of the 50 preventive services recommended by the U. S. Preventive Services Task Force at no extra cost.
- Insurance plans must 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 will also be entitled to an eye exam and one pair of glasses or contact lenses each year.
- Prenatal care must be provided at no extra cost, and will be considered “preventive care.”
- The ACA 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.
- The ACA caps annual out-of-pocket medical expenses up to $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.
- Insurance exchanges must be set up in every state. If a state refuses to set one up, then the U. S. Department of Health and Human Services will do so. These exchanges allow individuals to easily compare prices and plans. Only approved plans that meet the minimum standards will be included in these virtual marketplaces. This will reduce prices because of competition among the providers, since consumers can readily compare prices.
- Four tiers of healthcare coverage will be offered: bronze, silver, gold and platinum. All offer the same set of essential benefits. But, the out-of-pocket costs will 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 will cover average:
- 60% Bronze
- 70% Silver
- 80% Gold
- 90% Platinum
- Congress is not exempt and must also participate in the ACA. Instead of the current government program (Federal Employees Health Benefits Program), federal government employees will contribute to the new health insurance plans.
- There are no “death panels” to decide if the sick and elderly are worthy of medical care.
- The law explicitly denies insurance subsidies to non-citizens of the United States.
The bottom line is that most Americans will benefit from the Affordable Care Act, giving them better coverage than before. Children, especially, will have new important coverage to protect not only their health, but their dental care and vision.
For more specific information about the Affordable Healthcare Act, visit www.healthcare.gov.
The information in this column is only a guideline to the ACA and offers a general overview. Please visit www.healthcare.gov for more specific details, to explore the plans and to sign up for coverage.
Join Patricia Barrett at her upcoming 2013 Houston Leisure Learning classes November 11. She will also be presenting at the Guide to Good Divorce seminars in Houston throughout 2014. For more information on divorce financial planning or divorce mediation, visit Patricia's website, Lifetime Planning.