It’s Open Enrollment Season for Obamacare

If you have an inadequate health insurance plan or you have changed your situation and need new insurance, now’s the time to go out on the exchange and look around. Open enrollment is from November 1st to December 15th. Today’s NY Times has an in-depth discussion of what’s out there. Take a look also at this very recent NY Daily News article.

The American health insurance system is a frustrating  tangle which is hard to navigate and requires a lot of time to deal with, from selecting policies to figuring out how to afford insurance to changing prescription plans based on their formularies to coping with absurd denials of coverage for drugs or treatment that the patient’s doctor recommends. Unbelievable amounts of hours are spent by patients and their advocates every year, often during their workday when those hours might be better spent getting the work done. Before the affordable care act, our small-company plan’s premiums were rising by double digits every year. The ACA was designed to greatly broaden the pool of healthy, premium-paying plan participants as a way to bring those premiums down. With the rollbacks of certain protections that were built into the Affordable Care Act (“Obamacare”), in the free-market economy, that critical aspect of the program has been removed, and companies are allowed to offer policies that provide minimal coverage and are still costly to pay for. People are spending as much on their insurance as they are on housing. It’s absurd.

I’d like to see a system where coverage isn’t linked to employment and instead is just based on something simple, like geography … for example, everyone who resides in a county which has population in excess of X people enrolls in that county’s plan, and very small counties just combine into a regional plan of an adequate and defined size. You’d only have to change plans if you moved out of county. No more worries that your smaller employer won’t have an insurance plan.  Let the insurance companies compete behind the scenes to be the plan administrator. Have all practitioners in a given county accept that insurance plan as well as others. Let the plans negotiate drug prices or treatment prices like the Veterans Administration does (for drugs) or Medicare (treatment). Control the price of premiums and subsidize premiums through tax returns (as is done under the ACA) so that no participant has to pay more than a certain nation-wide percentage of their modified adjusted gross income. It’s absurd that an employee in a company which has a health plan should have to pay $12,000 a year for their share of the premium to have coverage for their family. The cost of insurance may not make too big of a dent in the budget of someone earning $180,000 a year, but the premium cost is the same for the person earning $60,000 a year.

By the way, if you are at that age to enroll in Medicare (65), keep an eye on your deadlines as well, and be sure to be mindful of the potential lifetime penalties for failure to enroll in Part B when you sign up, even if you are still employed.

For advice and representation on senior care legal planning, call us at 732-382-6070


Affordable Care Act (Obamacare) Coverage – Automatic Renewal Available

More than 5.4 million people enrolled in health insurance plans through the federally subsidized health insurance exchanges that were established by the Affordable Care Act (ACA), and 86% of them were eligible for subsidies, according to the NY Times on June 27th. The Department of Health and Human Services has issued regulations that enable most ACA enrollees to have their policies automatically renewed without a need to reapply. If there has been a material change in income or the person wants their premium and subsidy to be recalculated, they would need to re-apply through

The next open enrollment period begins November 15th, and anyone who isn’t presently insured should certainly make plans to enroll in either an ACA insurance plan or the expanded Medicaid plan if their state is participating. This is especially useful if you are awaiting a decision on your Social Security Disability claim or have been approved  but cannot yet receive Medicare benefits (because there is a 2-year waiting period from the start date of your disability benefit). ACA Subsidies are based on the Modified Adjusted Gross Income (MAGI) reported on the most recent federal income tax return, and are available if household income is up to 4x the poverty level — i.e., if your income is up to $45,960 in 2014 you may qualify for a subsidy to keep your premiums affordable. The Times reports that “The Congressional Budget Office estimates that subsidies this year will average $4,400 for each person who receives a subsidy.” This may amount to 50% of the cost of the insurance, depending on where you live.

In keeping with my recent comments about the need to continue treatment or health care monitoring to maintain documentation of your ongoing disabling conditions, it is critically important to do whatever you can to maintain some kind of health insurance coverage.

For representation on Social Security Disability Appeals, contact us at 732-382-6070