Dear Insurance Adviser,
My husband has health insurance with only emergency coverage for our two daughters, who are 7 years old and 6 months old. For doctor’s office visits for the baby, including vaccines and wellness checks, we have to pay approximately $1,500 a year. For my older daughter, we have to pay approximately $350. We didn’t realize the insurance wouldn’t pay for those visits, so now we want to know what we can do about those bills. I haven’t worked since my pregnancy, so the cost is too much for us. Will Obamacare help us?
Obamacare, aka the Affordable Care Act, passed Congress and was signed into law back in 2010. Under the law, all new health insurance plans as well as existing plans that make changes in coverage must cover vaccines and other preventive care of all kinds for adults and children, with no deductibles or copayments.
Those existing plans already in force when the law passed and that have made no changes in the interim are “grandfathered,” which means they are exempt from the preventive care requirement. The fact that your husband’s plan is not paying $1,850 in preventive care costs means his plan is probably one of those that are grandfathered.
Starting Jan. 1, 2014, the meat and potatoes of Obamacare kicks in, and virtually all Americans will be required to have health insurance or face penalties. There is an initial open enrollment period from Oct. 1 of this year and March 31, 2014. Open enrollment means you can’t be turned down for insurance if you have pre-existing health problems, nor can you be charged an extra premium. All plans must cover preventive care, maternity, mental health care and more.
Also starting Jan. 1 is a health insurance subsidy program for those with incomes up to 400 percent of the federal poverty level. Only your income will be considered. So if, for example, you own a home with some equity or have a retirement nest egg, you still will qualify for a subsidy if your income is low.
If you do qualify, you must buy the insurance coverage through one of the new health insurance exchanges being set up in every state. Someone such as your husband, who is covered by a group health insurance plan, would likely not be eligible for a subsidized plan through the Obamacare exchanges. However, there would be no barrier for you and the children.
If there was ever a time when you needed a professional health insurance agent to help you sort through all the options, this would be it.
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