Monday 17 December, 2018
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10 Things You Need to Know About Obamacare in Georgia

BY RAJESH JYOTISHI

Open enrollment for Obamacare will begin on November 15th 2014 and will go to Feb 15th of 2015.  Many people have already started receiving letters from their current insurance companies letting them know their rates and benefits may be changing after January 1st.  There are many people who can benefit from the Affordable Care Act, also known as Obamacare and there will also be many people who will be having their rates increase significantly.  Here are the key items you need to be aware as we approach open enrollment here in Georgia.

  1. Open Enrollment is from Nov 15th to Feb 1th:  This is important to know as now if you want to apply for individual coverage or change your current plan, you have to apply during this time frame unless you qualify for a special enrollment period where you have lost group health benefits, moved into new area, gained new immigration status, etc.  Group Health Plans may have different enrollment periods based on their renewal rates.

  2. Pre Existing Conditions Are Covered:  Health insurance companies are now prohibited from excluding pre-existing conditions or denying coverage to individuals with health issues.  This is great news for people who have struggled to find health insurance in the past.

  3. Maternity is Now a Covered Benefit:  It used to be that many health insurance companies did not cover maternity on an individual policy or you had to purchase a rider and also have a waiting period of one year before maternity benefits were covered.  The new Affordable Care Act plans are required to cover maternity as a covered benefit without waiting periods.

  4. People Over Age 65 are Now Eligible:  Previously, people who were over age 65 and were not eligible for Medicare were pretty much out of luck as there were very few companies that offered coverage for them.  Now, most insurance companies will offer coverage to all legal residents regardless of age or health conditions.

  5. Not Everybody Needs to go to the Health Insurance Marketplace:  You only need to go to healthcare.gov also knows as the health insurance marketplace if you believe you will be eligible for tax credits and subsidies.  If your income is too low or too high, most likely you will not be eligible for the tax credits or subsidies.  You can go direct to an insurance company or better yet, your insurance broker for off exchange recommendations.  Please refer to income chart to determine subsidy eligibilities.

  6. You must have Minimum Income to Qualify for Tax Credits and Subsidies:  This has come as a big surprise to many people with zero to very little income to find that they are not eligible for the tax credits and subsidies.  The original plan was for Medicaid to take care of the people who’s  income were too low but Georgia, like many other states have chosen not to expand their Medicaid at this time leaving many people without subsidies.   Please refer to income and household member chart.

  7. You May Have to Change Health Plans:  There are some health insurance companies like Coventry who are requiring individuals to switch to the new Affordable Care Act plans starting 1st of the year.  Other companies such as Cigna are allowing their current members to keep the older policies for one more year.  If you are required to change plans, you may want to compare the different plans offered thru other companies and choose accordingly.

  8. If You Can Keep Your Old Plan, Do it!  If you are not eligible for the tax credits and subsidies and your insurance company is giving you an option to keep your old plan for one more year, you should most definitely consider keeping it as the rates are probably significantly lower unless you are looking for additional benefits that your current plan does not provide.

  9. You Should Compare Health Plans:  In 2015, we will have at least 9 major health insurance companies offering plans on the exchange including Blue Cross Blue Shield of Georgia, Coventry, Cigna, Aetna, Kaiser Permanente, United Healthcare of GA, Assurant, Alliant, Peachstate and Ambetter.  It just makes sense to compare rates and benefits and choose wisely!

  10. Your Health Insurance DO NOT Change if you use a Broker:   Health insurance industry is not like the travel industry where you can sometimes find lower rates by going directly to the company.  Your health insurance broker can help you choose a plan that is better suited for you and may also provide additional service in addition to what the insurance company provides.  Look for someone with experience in the industry as it is a specialized market.

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