More Questions About the Affordable Care Act

Before I get into the questions, I want to invite you to visit the Health Care Reform page for Prevention magazine. I’m now the editor-at-large for healthcare reform for Prevention, and have a story on the ACA in the October and November issues.

You can also participate in a Twitter chat with me on Monday, September 30, from 1-2 p.m. eastern. Join in using hastag #PVNHealth. My handle is @debragordon2012.

Plus, I have a couple of questions of my own:


— When people say that Americans “hate” the ACA and that the ACA is “destroying” the country, what do they mean, exactly? I think most Americans don’t understand the Act. . . how can you hate something you don’t understand? And I really want to know how it is destroying the country. Really.

— Why are people so opposed to providing a way for people who can’t get or can’t afford health insurance to get health insurance? No one 65 and older seems to be complaining about the Medicare program they participate in.

I also recommend this article in today’s Washington Post, where you can read about real people and the ACA.


Now, onto the questions (and please send more!)

Question: I currently have a day job through which I get healthcare coverage for myself only. I need to obtain coverage for my three sons (ages 20 to 24). However, I’m hoping to leave the day job sometime within the next year – and also would probably prefer not to have coverage that is dependent on an employer. Can/should I try to get family coverage through the exchanges that will be available as part of the Act?

Answer: Yes, you should obtain insurance on the exchanges. Your sons can sign up now, even while you have insurance. And they should—they are exactly the demographic that experts say need to join the exchanges since, by and large, they are healthy. You can either keep your insurance through your employer now, or drop it and get insurance on the exchange. If you keep it and quit your job and need insurance, you will be allowed to enroll in the exchanges even if it is not open enrollment time.

Question: For my sons, are there any pros/cons of obtaining coverage as part of a family group, as opposed to each of them getting it individually?

Answer: Subsidies are based on household income, so if they are still part of the household (ie, you take a deduction on your taxes, they live at home) then a family plan might be the way to go. The nice thing is that you can try it both ways and see what your premiums will be.

One other thing: Pennsylvania expanded its Medicaid plan and will begin covering childless adults up to 133 percent (really 138 percent) of the federal poverty level. Your sons might qualify for Medicaid.


Question: Not sure if details about the particular plans have been released yet, but in general what sort of terms (mainly as far as deductibles) will they offer?

Answer: They must provide a set of essential benefits and limit out-of-pocket costs. There are four levels of plans, with the highest (platinum) covering 90 percent of medical costs and the lowest (bronze) covering 60 percent. Trust me, you will find a major difference between getting insurance on the exchanges and today’s options. The main reason is that plans cannot rate you based on preexisting conditions.

Preliminary reports suggest that while premiums will vary from state to state, they are coming in lower than expected. In Pennsylvania, a family of 4 with a household income of more than $94,200 a year would pay $675 for a “silver” plan (which covers 70 percent of medical costs), while that same family making $50,000 a year would get subsidies to bring their premium down to $282. A 27-year-old person making more than $45,960 a year would pay $187 a month; if they make $25,000, subsidies bring that down to $145.

Here is a state-by-state listing of premiums.



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