This is part two in a two-part series concerning the Patient Protection and Affordable Care Act. See the October 11 edition of the Boca Beacon for part one.
BY JACK SHORT - According to Carolyn Pope, owner of Pope Insurance, businesses have never been required to provide insurance for employees, and those with fewer than 50 are still not. But larger businesses that do not offer an affordable plan may, though that mandate will not go into effect until 2015.
Individuals who are not exempt will have to purchase a Qualified Health Plan by 2014, Pope said. They come in four levels of coverage, designated by bronze, silver, gold and platinum, and range in coverage from 60 percent of medical costs to 90 percent with varying deductibles.
Since Florida refused to operate its own exchange, Floridians must use the federal marketplace exchange, which went live at 8 a.m. on Tuesday.
Those who aren’t as computer savvy can still enroll via telephone or a paper application, and people can still purchase insurance through providers, Pope said.
Though plans will vary by area, the Department of Health and Human Services released some data on premiums.
The weighted average premiums for the lowest and second lowest cost silver plans, and the lowest cost bronze plan will be $304, $328 and $257, respectively.
Those who already have plans will see premiums change in part, Pope said, because the insured will be divided not into seven groups according to age as they have been, but three.
The former 7:1 age band required that an older individual would pay at most seven times what a younger individual paid, but now that ratio has become 3:1.
“This will bring the 64-year-old’s premiums down, we’re hoping,” she said, “and it brings the young people’s up. They need to bring those young people into the pool. They need their premiums.”
This highlights a concern that some have regarding the PPACA – that if the multitude of young, uninsured do not enroll, the act will not be sustainable since young people’s premiums are needed to balance the cost of additional insured entering the system.
To address this they’ve added a fifth, “catastrophic” plan with very high deductibles, by which they hope to enroll more young people. As an example, a 27-year-old would pay $132 monthly in premiums, according to data released by the HHS.
In response to an audience question, Pope said that over the next two or three years, many would be forced into the plan by penalties.
That is not the only restriction on rating, or methods insurance companies use to assess premiums on individuals and groups. According to a fact sheet from the Center on Health Insurance Reforms, Georgetown University Health Policy Institute, insurers will only be allowed to rate according to four factors: individual vs. family enrollment, geographic area, age and tobacco use.
For many states, Medicaid will expand to include individuals and families who earn up to 138 percent of the poverty level, but Florida elected not to expand its Medicaid coverage. The federal poverty level is $11,490 for individuals, and $23,550 for a family of four as of January.
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