After much discussion and debate on whether to reform or eliminate the Affordable Care Act (ACA), Congressional leaders chose to leave the measure in place.
However, those who are interested in signing up for the ACA will see changes that have been enacted this year.
One of the primary changes is on the enrollment period, which has gone from 12 weeks to six weeks with an upcoming deadline of Dec. 15.
For many local health insurance brokers, the shorter enrollment period has made things just a little bit hectic.
Ron Nemetz, owner of Nemetz Insurance in Buda, said he’s kept busy with the reduced window, but is still is focused on having quality conversations with clients in order to find them the best plan for their specific needs.
Through the exchange on healthcare.gov, the site will prompt questions about a person’s age, their zip code and whether they smoke or not.
Nemetz said he asks for a bit more information in order to find the best options.
If a person has a set of doctors they prefer to use and types of medications they are taking, those are important to consider when choosing a health insurance coverage.
Nemetz said he is very familiar with the specializations that hospital systems and networks offer, knowledge that he can refer to when finding a right plan for a client.
When working with any broker, he said, it’s important that customers ask for qualifying health insurance plans.
Indemnity insurance, Preferred Provider Organization (PPO) for individuals and short term plans are not considered qualifying health insurance plans, he said.
Included in the unqualifying list are plans that are not underwritten, and do not cover wellness, out-of-pocket-maximums, maternity and do not allow people with pre-existing conditions to join.
PPOs, which allow an individual to go to any doctor, only qualifies for group insurance if companies offer the plan to their employees, Nemetz said.
He said depending on an individual’s circumstance, a PPO, even if it does not qualify, may be the best route. A person may find that even with a tax penalty for not having qualified insurance,, the gains in savings by purchasing a PPO may outweigh the penalty, Nemetz said.
A person may have to pay a tax penalty if they “can afford health insurance but choose not to purchase it,” according to healthcare.gov.
This penalty, part of the individual mandate, that requires all Americans obtain health insurance, is eliminated in the Senate and House tax bill which is in the process of being reconciled to one bill, according to reuters.com.
Nemetz said his concern is if the individual mandate is removed, healthy people would stop buying health insurance, causing premiums to go up. In turn, it could make insurance less affordable for those who need it.
“When you only have sick people in the pool and healthy people stay out, I’m really worried it will cause a death spiral,” Nemetz said.
He’s plugged the numbers and understands there are people who have benefited more than others from the law.
For example, last year he received a call from a woman in her late 50s, making $17,000 a year, who did not qualify for Medicaid, and he signed her up for $28 a month health insurance plan with $250 deductible.
After three months of purchasing health insurance, he said, the woman spent months in the hospital due to a brain tumor. What could have drowned this person in debt due to medical bills years ago, with health insurance she only paid $900 in total on $600,000 in medical bills, he said.
The impact of possibly eliminating the individual mandate in the health insurance system continues to be debated.
But in the meantime, Nemetz has his schedule pretty packed with appointments with people looking for the best healthcare plan available.