Readers of my message, listeners to my comments can understand now what I have thought: there was almost no chance for opponents of Obamacare to win. If you are an ardent member of the GOP, your most optimistic spin, at best, is “we raised the issue.” Meh. The pertinent question now: what am I supposed to do?
Implementation, and the participation rate of the young and healthy were, and remain, the biggest question marks. Here is what you need to know. And here is what to do.
Pre-Existing Condition? Obamacare is a Huge Plus
If you have a pre-existing condition, particularly if you require immediate attention (including prescriptions), then you are well-served by Obamacare. No insurance company can deny you, and there is no concept of waiting period. Diagnosed with cancer on Decmeber 31st? No problem: if you have enrolled effective on Jan 1, 2014, you are covered.
The question is now affordability and plan design. That is a matter of calculation, depending on the anticipated total costs. Rule of thumb: if you take a large number of expensive prescriptions, then your plan should include prescription benefits. It will not be cheap, but the insurance will more than pay for itself. Note: prescription benefits ALONE will raise the premium by more than $100/month, so you need to be careful.
Here is the problem with those that support Obamacare: they are reporting that health insurance is affordable. Tell that to someone who needs a “Gold” plan in their 60s. $1000 a month. Now you know why Medicare is a screaming bargain and why correctly configured, Medicare & a private plan can save you many thousands of dollars, a year.
Exchange Plans Pros and Cons
Leave your politics at the doorstep. Here are the pros: transparency. You can compare prices among within tiers. Someone has calculated it for you. Cons: coverage within tiers varies.
Here are the important points. First, HMO vs PPO. You need to know the difference. HMOs won’t pay if you don’t go to your primary care physician first. Second, prescription coverage. Some plans have prescriptions as part of the plan, and some do not. Third, the deductibles can vary widely, even within tier.
Medicaid expansion? Maybe, but the problem here is that you need to speak with the government, and it isn’t clear that they have the right information or that they are correctly transferring it to insurance companies. This is a fundamental problem with many implications (the opponents are right here).
If you do not qualify for Medicaid expansion, it is a virtual guarantee: you can find a plan that almost identical, and with superior benefits (hmo v ppo, prescriptions, deductible) off the Marketplace. You can contact an expert to help identify these alternatives, and one other thing: no dealing with 1-800-Government.
Young and Healthy? Get Ready to Pay
Due to the way that Obamacare is structured, the net payers are over 30 with families. If you are employed and your employer offers health insurance benefits, you will need to take it. That may or may NOT include your spouse or children. Your spouse, if also employed, should individually check his/her available benefits from his/her employer. Children may be able to purchase separate policies in the private market. Families, as a unit, are frequently more expensive in a group plan than the individual parts added together, unless there is a subsidy from the employer.
If everyone is healthy, then you may be able to save hundreds of dollars a month by looking into non-Obamacare compliant plans, but you must act now. Reason? Deadlines for enrollment are in early-mid November. There is no getting around this: if you starting thinking about this during Thanksgiving dinner, you are too late.
Employee with Benefits? Check Anyways
It depends. If you are healthy, then you should check the market according to the previous paragraph. Employers don’t want to say this, but your best option may be to take 2014 using a private plan, and then opt back in for 2015. Why? You may be able to save money in 2014, but won’t be able to in 2015, when all new plans must be Obamacare compliant, which will be much more expensive.
If you have a pre-existing condition or require extensive medical attention, it is most likely that your group plan is superior to the Obamacare alternative. In addition, if your employer offers health insurance, then you cannot apply for Medicaid expansion.
Small / Private Employer? Tick, tock
If you are a small employer (even with as few as 2 employees), and you have not checked the market by now, it is the bottom of the 9th inning. There are viable alternatives (too many to mention). The difference among alternatives can easily be over $300 per employee. Now multiply by employees/enrollees, and then multiply by 12.
You will see complaints in the press, but what you don’t see is this fact: many small employers are sitting on their hands without thorough thought of the implications of this paragraph. This is one of the most imprudent approaches I can possibly imagine.
If you are an employer that has been able to navigate this economy, then you can handle this. Putting it off til later? Well, you can excuse me for not being sympathetic: one hour of attention can save or cost a small employer tens of thousands of dollars. Waiting until Thanksgiving? You will be too late to consider many of these options.
Maximize Your Medicare (2014 Edition) Coming Soon
For married couples, some very, very important changes and strategies to deal with Obamacare, when are involved in employer-sponsored plans. For those of you that own the 2013 Edition (ebook), you can get a free update when you update the book. For those that own the paperback version, the strategy is unchanged, and they way to understand Medicare is also unchanged. The ebook will be part of Amazon’s Kindle Matchbook, which allows you to purchase the ebook version for $2.99 if you have previously purchased the paperback version.
One more reason for the ebook: the next revision will include ways for enrollees to directly select carriers or other service providers to receive personalized attention.
Disclaimer and Fiduciary Responsiblity
This is not individual, specific financial advice. It isn’t an offer of any financial product or contract. You can consult with a financial advisor on a private basis in order to receive individualized attention.
That said, there are certain advisors that have a fiduciary responsibility on behalf of their clients. If you require financial advice, then you can ask if they are subject to this responsibility. It is a technical term with a specific meaning. If you advisor doesn’t know what it is, then I will leave it to you to make your own conclusion on the answer to the question. It is difficult to ascertain who is an “expert” and who is not, but this standard is a very good start.
Further information can be found on the official website: https://maximizeyourmedicare.com