Hi, everyone. Thanks so much for joining us for today���s chat. I’m Kim Richardson, a member of WebMD’s Affordable Care Act team. We’ll get started in just a few minutes, but you can go ahead and submit your questions now by clicking the “comment” link.
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I think we’re about ready to get started. Today we’ll be talking specifically about how Obamacare will impact people with health conditions. You’ve probably heard that you can’t be denied coverage if you have a pre-existing condition under the new law. But what about the details – like, what’s considered a pre-existing condition, exactly? How much will coverage cost?
Helping me surface some of these questions today is Myrl Weinberg, CEO of the National Health Council. The council’s members include many of the nation’s leading patient advocacy organizations, and it provides a united voice for people living with chronic diseases and disabilities. Myrl, it’s great to have you with us.
Thank you, Kim. The National Health Council appreciates this opportunity to participate in today’s WebMD Live Chat. We also appreciate having the opportunity over the past several years to work with WebMD to strengthen the patient voice.
And, to provide answers to questions from Myrl and our audience, we’re joined by WebMD health care reform expert, Lisa Zamosky. Lisa is a health care journalist and writes the Health Reform 101 blog here on WebMD. Also joining us today is WebMD Chief Medical Editor, Dr. Michael Smith.
Lisa and Michael, welcome to the chat!
Hi everyone. Looking forward to a great conversation.
Hi everyone. Great to be here. Looking forward to all the great questions!
One question we’re hearing is, “Is it really true that coverage can’t be denied for pre-existing conditions?” I think many people aren’t aware that this provision made it into the law.
Yes, I hear that a lot as well. I agree that many people are not aware that the law now prevents insurers from denying anyone coverage, regardless of the condition of their health, which it does. Even among people who do know about this provision, many have a hard time believing it’s true. I’ve talked to people with cancer, for example, who simply don’t believe they will be guaranteed coverage if they don’t get insurance through their job.
Yes, obesity is considered a pre-existing condition.
Can you talk a little more about what is considered to be a “pre-existing
condition.” For instance, one of our readers asked if alcoholism is a pre-existing condition. Can you flesh all of this out a little bit –what conditions fall under that umbrella term?
Illnesses, such as cancer, heart disease, diabetes, rheumatoid arthritis and drug and alcohol dependency are all considered to pre-existing medical conditions and in today’s insurance market would certainly lead to a person being automatically rejected by insurers. Even people who have minor conditions may find the search for an insurance plan tricky. Under the ACA, that goes away.
If possible that someone now buying insurance coverage on their own will find the new health plans being sold on the marketplaces, in some cases, will have richer benefits. But another huge potential benefit could be lower costs. Many people with pre-existing conditions who buy their own insurance are being charged more because of their health. That’s another practice insurers will be prohibited from starting January 1, 2014. You’ll be guaranteed a health plan and you can’t be charged more for coverage. Also, there are tax credits available to people making up to about $46,000 per year. So that will lower costs for many people as well.
What factors do people need to consider when they start comparing insurance plans?
This is a really important question when it comes to finding the right insurance for you and your family. It’s a big decision. First and foremost, check to see if treatment and medication you need are included in the plan. Second, if it is important for you to keep your doctor and other providers, make sure they participate in any plan you choose. Third, check to see how much the plan will cost you, including the annual cost (premium) and any additional out of pocket costs, such as deductibles and co-payments.
Yes, Matt, you're absolutely correct. It's hard for many people to believe because it's been the practice of insurance companies for so long, however, if you have a pre-existing condition, starting January 1, 2014 you are guaranteed an insurance plan. And it will not cost you anymore than the same plan would for a person with no health issues.
People over 65 and the disabled already receive federal assistance for their health care through Medicare. Would you please explain how the Affordable Care will impact the services they receive?
Troy, if you currently receive health insurance at work you likely don't need to do anything. The marketplaces are for people who either buy insurance on their own or have none now. In fact, if your company offers you affordable health insurance (defined as no more than 9.5% of your annual income and covering on average 60% of your medical costs) you won't want to switch plans. I just wrote about this issue on the Health Reform 101 blog in greater detail. That will help to better explain why sticking with employer-based health insurance is for most people the right way to go.
Lorena, that's a great question, and one many people are concerned with. First, there are a few reasons why insurers can still charge higher rates. They can charge an older person up to 3X that of a younger person, they can charge up to 50% more if you smoke and they can take into account where you live because medical care costs vary across the country. However, the condition of your health cannot influence your costs. The main concern now is whether enough young, healthy people will sign up for health insurance through the marketplaces. If they do, the expectation is that the market will even out and prices won't spike. If, however, only older sicker people sign up, costs could rise. We won't know for a while how it all turns out.
Many people with chronic conditions rely on expensive medications to life longer and better lives.Is there anything in the law that will help patients better afford their medications?
We received a couple related questions on this topic from our audience – one from a reader with RA and another from a reader whose daughter has a chronic immune disorder. It’s definitely a “where the rubber meets the road” issue for many people.
Katherine, for your daughter and others in her situation, the law means she is guaranteed health insurance. In fact, kids under the age of 19 have had that guarantee for a few years now because of the ACA. As she moves into adulthood, she will not have to be concerned about whether she can get coverage if she happens to work for a company that doesn't offer health insurance.
As of now, I'm not aware of anything that would do away with the COBRA system, though in time that may change.
Speaking of COBRA, one of our readers, Laura Briskman-Ferguson emailed in a question: "What is the best method of obtaining health insurance when you are currently between jobs and not working? COBRA is extremely expensive. Is there another plan that is more affordable?"
This is a tough situation. COBRA is very expensive, but is often the only guarantee of health insurance coverage outside of work until the ACA is fully implemented January 1, 2014. Until then, you may not have great options from which to choose. Still you might try looking for temporary insurance between now and the end of the year. I recommend you do a quick search on Healthcare.gov to see what plans are available to you. Otherwise, your best bet is to log onto your state’s health insurance exchange this fall (they open October 1) and select a health plan. You’ll have a range of new options, be assured of coverage, and depending on your income you may qualify for financial assistance from the government to lower your insurance costs. Just keep in mind coverage won’t take effect until January 1, 2014.
There may short-term insurance options available between now and the first of 2014. Some conditions are considered "gray area conditions". If your friend has one working with a licensed agent who understands the plan in his area might be able to help him find short-term coverage. I recommend you contact eHealthinsurance.com to see what's available. You can also call the 800 number for eHealth to get personalized help (free of charge) from a licensed broker.
We also are hearing a lot of concern about how much coverage will actually cost – as we all know, sometimes even if you can get insurance, it’s not affordable, and people are wondering what to expect from the Affordable Care Act.
Under the new law there will federal subsidies available to help lower the cost of insurance for anyone making less than about $46,000 per year. It works on a sliding scale so those with lower incomes will get a bigger break on a health plan’s cost. Many people eligible to buy insurance through the new state marketplaces are expected to qualify for tax credits. To learn if you qualify and how much your health plan is likely to cost, check out the WebMD Health Insurance Calculator.
One of our readers, Tim Kosse, had a great question about subsidies: "If someone has a mid-year job loss or substantial income loss, can the amount of the subsidy change or does it have to wait till the next calendar year?"
That's a very important point, Tim. If your income changes during the year, you should report that immediately to your state's marketplace. Changes to the subsidy can be adjusted mid-year, and you'll want to report income changes right away to avoid getting a big tax bill.