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Do you want to see what Healthcare Reform is going to look like in 2014….. if it passes?

May 08, 2012  |   Posted by :   |   Health Insurance   |   2 Comments»

by Michael G. Grace – President of Orlando Insurance Store

So you think you want healthcare reform to pass? You think it’s a good idea? Maybe you’re not sure….. Well let’s find out, shall we?



As you may already know, the closest coverage that already exists to the new reform bill coverage is in the State of Massachusetts. So, let’s use an analogy. When you want to see how a car engine runs do you open a book and read a description of what it might sound like and how it might work, or would it be better to open the hood of your car and observe the engine while the car is running?

That said, why not go out to the existing Massachusetts state exchange and run a quote for yourself? In doing so, whether you are a resident of MA or not, you will have a good understanding of how “mandated” healthcare is implemented and regulated. You will also get a great impression of what the plan benefits for 2014 might be like. And lastly, you can see what your coverage might cost with healthcare reform style mandates in place. Just follow these simple steps….

1) Go to (The MA State Health Insurance Exchange website)

2) Once on the site, select the first box that says “Individuals & Families”, or if you are a young adult, select he second box that says, “Young Adults”.

3) On the next screen click “Start Now”.

4) Enter your family size by clicking the number on the screen equal to the number of family members that will be on your plan.

5) Answer the question about your household income. (more or less than $33,516) NOTE: This is the income criteria for MA, and the jobs there pay pretty well. If your state’s jobs do not pay as well as MA expect this income disqualification number to be a lower figure, and for your states qualifying subsidy level to be lower.

6) You will now receive this message, “Enrollment is closed. Please come back during the next open enrollment period: July 1, 2012 – August 15, 2012. Yes, you read that correctly. Like Medicare and Group Insurance, in MA they are at the mercy of an “Enrollment Window”, and they have lost the ability to change plans at any time unless there is a ” life qualifying event”. In Massachusetts they have 1 1/2 months to figure out what they want, and apply. If you miss the window you could pay a penalty for not having coverage, or a late enrollment fee.

7) On that same page you will see a line that says “Just Window Shopping?” just below the “Enrollment is closed” information. Below that you will see a line that says, “Browse Now”, click that link.

8) You will be asked to Enter a Zip Code for where you live. Obviously you might not have a MA zip, so enter Boston’s zip for the example, “02112”, or play with other MA zip codes if you like. You will also be asked for Date of Birth for all applicants. Enter them.

9) The system will now gather your Rates….. On the next screen you will see “Bronze”, “Silver”, and “Gold” plans. DO NOT SELECT any of those options. Instead, select the “View All Plans” option at the bottom.

10) You will now get to see all of the plans, gold, silver, and bronze, as well as the rates and basic summaries of the plans. Simply find the coverage that most resembles your plan and you now have and apples to apples comparison to go off of.

My Personal Example –

In my own personal quote, I compared the results of 4 states without reform, to the MA rates for similar coverage. I also included a basic summary of Benefits for the coverages that I compared. (I picked a pretty standard plan in the industry to make the comparison as “Apples to Apples” as possible)

CA= $175 – Plan : Blue Cross of CA -Smart Sense Standard RX – ($2,000 Ded , $5,500 Out of Pocket Max, $30 Copay, $15 Generic RX and Brand Name RX coverage with a Copay, $100 ER Copay)

VA= $124 – Plan: Anthem Blue Cross Blue Shield – Smart Sense with Enhanced Drug – ($750 Ded, $5,000 Out of Pocket Max, $35 Copay, $15 Copay for Generic and Brand name RX, 30% Coinsurance after Deductible at ER)

NC = $204 – Plan: Celtic – Basic PPO 80/20 – ($1,500 Ded, $3,500 Out of Pocket Max, $30 Copay, $15 Generic Rx and Brand coverage after a $1000 deductible, $250 ER Copay)

FL = $171 – Plan: Cigna – Open Access 2000 80% – ($2000 Ded, $5,000 Out of Pocket Max, $25 Copay, $10 Generic and Brand Name coverage with Copays as well, $500 ER Copay)

MA = $291 per month! – Plan: Neighborhood Health Plan – ($2,000 Ded, $5000 Out of Pocket Max, $30 Copay, $10 GENERIC ONLY, $150 ER Copay )

At $291 per month, that is 42% higher than the next closest plan in NC, and that NC plan has MUCH stronger benefits due to the $3,500 out of pocket Maximum on that coverage.

Do you still want Healthcare Reform to pass? Run your quote today and see for yourself.

What we at Orlando Insurance Store already know, based on several other quotes we ran, is that if you are on a Group Insurance plan as a “family” right now, don’t expect to have your rates change much when reform passes. State Exchanges are most similar to Group Insurance plans, and those plans do not have pre-existing conditions limitations. Group rates are based on group plan participants medical conditions already factored into the group insurance plan premiums.

However, if you are a Healthy Individual covering yourself because benefits are not offered at your place of work, or if you are a Healthy Self-Employed Worker, or even if you are a Healthy Family on your own Individual plan, most likely you do not have the pre-existing conditions of everyone else assessed into your rates, and they are cheaper. That said, even though you have taken care of yourself, if you do not qualify for a government subisdy, you can expect a significant rate hike if reform passes and everyone is placed into State Exchange programs. This is due to the fact that every person with a pre-existing condition will now be assessed into your rates, and your new rates will now be based on the overall health of your State Exchange, not your personal health. Right now the government subisdy income disqualification figure is not determined, but experts and carriers are estimating it at about $14,000 – $33,000 depending on the poverty levels in your state. If you make more than that, healthy or not, do not expect ANY assistance from the Federal Government as you will not qualify for the subsidy. If you don’t think you can not afford healthcare right now, based on your budget and income, but you make more than what the government defines as “Poverty Levels”, they are going to fine you for not having a “qualifying healthcare plan”. The description of what a “qualifying healthcare plan” is, is not yet determined…. However, if it’s anything like MA, run the quote engine and see what you will be paying per month to get coverage and avoid the federal fine.

Still think it’s a good idea?