The Block Island Times
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ACA overview for consumers

By Dr. Peter Baute | Oct 06, 2013

This past week, on Oct. 1, the biggest innovation brought about by the new health care law, the Health Insurance Exchange, kicks off.

There is a lack of knowledge about many of the provisions of this act. This is an attempt to provide some information and guidance to those with concerns. The Affordable Care Act (ACA) is a major attempt by the Obama Administration to provide health insurance to the 48 million Americans currently un- or under-insured.

Here are some of the provisions:

1) Already in place is a requirement that commercial insurances cover young adults up to the age of 26 under their parentsʼ policies even if they are married, students, or living separate from their parents.

2) Insurance companies cannot discriminate against clients because of a pre-existing condition such as heart disease, cancer or arthritis. The premiums within a given plan will be not change because of the preexisting condition.

3) Medicaid has been expanded, so that in R.I. individuals or families with incomes of up to 138 percent of the poverty level will be eligible. That would be about $16,000 for an individual, and $32,000 for a family of four.

4) The ACA will not apply to you if you have Medicare or if you are already covered by most employers’ health plans.

Now about the Health Insurance Exchange: First, donʼt hurry to enroll. Take time to study the informational websites listed below. And be aware that there will be other unethical sources out there. You have until March 31, 2014, to make a decision; but for practical purposes, it makes sense to enroll before January, 2014, so that you and your family will be insured as of that date.

If you are not covered by Medicaid, Medicare, or an employer’s plan, you will want to look carefully at the plans available through the R.I. Health Care Exchange. There are four groups, depending on the level of coverage. “Bronze” provides the lowest levels and the highest deductibles; then comes “Silver,” “Gold” and “Platinum” in order of coverage and level of deductibles. Within each metallic group, the benefits will be very similar. There are reductions in deductibles and co-pays and lower out-of-pocket costs available to people with incomes between 100 percent and 250 percent of the poverty level when you enroll in “Silver” plans.

There are also substantial tax credits which are applied to reduce premiums for those incomes that lie between 100 percent and 400 percent of the poverty line (about $23,500 for a single taxpayer and $94,000 for a family of four). You can obtain more specific and complete information by visiting Healthsourceri.com, which includes an email question section and a phone number for even more direct access to answers to your questions. Healthcare.gov is another good source.

Be aware that the panel of hospitals and physicians participating varies with each plan. Here on Block Island that is particularly important, because South County physicians have often opted out of United Health plans. You can be assured that Block Island Health Services as a community health center will be a participant, although that decision will probably be made next month.

Dr. Baute is the former interim Medical Director of the Block Island Medical Center.

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