Obamacare Update: Fall 2015

Obamacare, Affordable Care Act, ACA, Dallas dentist, Venincasa DentalWe have tried within our website to give you the most up-to-date and accurate information concerning Obamacare. With all the lawsuits, changes, waivers, deferments, and news concerning Obamacare, it is difficult to keep up. However, we offer you what we understand to be current at this time.

The next and third enrollment period for health plans under the Affordable Care Act (ACA), or Obamacare, begins November 1, 2015. That is right around the corner. These plans would then have the effective date of January 1, 2016. Obamacare is still the current law and will not possibly change until 2017. Obamacare still has certain requirements. These include that all plans are guaranteed issue, there are no exclusions for pre-existing conditions, and the plans must provide a certain mandated coverage.

With the way Obamacare has gone, many health insurance companies are reporting huge losses on their 2014 individual health care insurance business. For instance, Blue Cross Blue Shield of Texas is reporting a $400 million dollar loss. As a result, unless there are fewer claims and if there are no legislative changes, the 2017 rates will increase significantly. So far for the 2016 premiums, all Texas companies selling policies report approximate rate increases from 10-99%. With all rates being subject to your actual age, premiums can be higher even if there was no appreciable rate increase.

Along with higher premiums within Obamacare, the health insurance market of national companies within Obamacare has shrunk. Within the state of Texas, the market may include only three national companies with a small number of hospital-system based plans.

So, what advice do we have to assist you with these fewer national insurance companies and rising costs?

  • Consider a lower deductible, lower office co-payments, and lower-cost prescription copay plan if you and your family see your physicians more than three times a year, if you have a child or a spouse who is accident prone, or if you need high-cost medications monthly.
  • If you do not fit the above parameters, you should consider a higher deductible plan or a health savings account (HSA) to lower your premiums. HSA’s offer the lowest premium and offer tax deductibility of the contributions, which you keep and earn interest from.
  • If you have family members who use health care considerably more than you, you might consider a hybrid approach. You might obtain a higher deductible medical plan for you and a lower deductible plan for your family.
  • Make sure you look into what your total out-of-pocket maximum is, both in network and out of network. This total out-of-pocket expense includes your deductible, coinsurance, and co-payments per calendar year, after which the insurance pays 100% of the costs.
  • When comparing networks, compare PPO to PPO, and understand what out-of-network coverage is and how it works.

For more of our posts on Obamacare, we invite you to follow this link.

If you appreciate our value-added service to you, you will appreciate my dental practice as well. We invite you to experience my unique dental practice by giving us a call at (972) 250-2580.

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