Simplifying Obamacare | As It Turns Out

Whether we like it or not, Obamacare is happening. So maybe it’s time to settle down to the idea of change (grumble) and figure out what this actually means and where to find details.

Obamacare (aka, Affordable Care Act or ACA) is a federal law requiring states to provide a marketplace where private health insurance is offered.

The health care act mandates that each 2014 health insurance policy made available cover these 10 essential health benefits:

Emergency services.
— Hospitalization.
— Ambulatory patient services.
— Prescription drugs.
— Laboratory services.
— Preventive and wellness services.
— Chronic disease management.
— Mental health, and treatment of substance abuse disorders.
— Rehabilitative and habilitative services and devices.
— Maternity, newborn care; and pediatric services, including oral and vision care.

You may note that this is a heck of a lot more coverage than policies most of us have ever carried.

Simply put, the state’s health insurance marketplace, which was created by the Washington’s Health Benefit Exchange, is called the Washington Healthplanfinder and will be found online in full swing Oct. 1 at www.wahealthplanfinder.org. At that time, enrollment will begin for insurance coverage which starts Jan. 1. The site will explain in detail what’s going on and what is available including rates, benefits and financial aid resources, as well as open enrollment. It’s your option whether you want to use this service or go directly to an insurance provider.

The four insurance companies selected to supply Washington coverage for 2014 are: Bridgespan (owned by Regence Blue Shield); Group Health Cooperative; Lifewise (a Premera subsidiary); and Premera Blue Cross.

There are four options for coverage: the platinum plan covers 90 percent of costs; gold covers 80; silver covers 70; and bronze covers 60 (the least expensive plan). Premium rates are not in yet.

The health care act mandates that most every Washington resident purchase health insurance with these particular 10 benefits by March 31. A penalty will be applied by the IRS on income tax to anyone not exempted.

Exemptions to the mandate are those due to the health care act’s 10 essential health benefit requirements already being met and include Medicare, Medicaid, CHIP, TriCare, veterans’ health program, and grandfathered plans existing before the act was enacted March 20, 2010, with at least the bronze plan benefits. Other exemptions include: members of Native American tribes; religious objections; undocumented immigrants; or incarcerations.

Kitsap Public Health District in Bremerton will make available in-person assistance for residents of the county to enroll into qualified health plans with the best personal fit.

There is help if you can’t afford this coverage. The health care act raised the income limit on eligibility for Medicaid and has simplified how to qualify and apply. (The name Medicaid is being changed to Apple Health.)

Financial help for low-income individuals or families is available through Washington’s Healthplanfinder and includes tax credits or rebates, subsidies, or even free coverage — all depending on income. If you need them, your public library has computers with internet access.

OK, so I do have a gripe … three delays. Delayed until 2015 are: large business employers (more than 50 employees) to offer affordable insurance to their full-time employees; procedures to verify incomes of people claiming eligibility for government subsidies to buy insurance on the exchange; and caps for total out-of-pocket medical costs for group health plans that use multiple service providers (ex. one for major medical and one for prescription).

These delays will force many people to pay a lot more money — especially those who are seriously ill and need protection the most.

Change is coming, whether we’re onboard or not.

Here are some online sites for more details.

— Washington Healthplan finder: www.wahealthplanfinder.org.
— Washington Health Benefit Exchange: www.wahbexchange.org.
— Washington Health Care Authority: www.hca.wa.gov.
— Washington Office of the Insurance Commissioner: www.insurance.wa.gov.
— Federal Health Care Marketplace: www.healthcare.gov.

— Marylin Olds is an opinion columnist. Comments are welcome at marylin.olds@gmail.com.


We encourage an open exchange of ideas on this story's topic, but we ask you to follow our guidelines for respecting community standards. Personal attacks, inappropriate language, and off-topic comments may be removed, and comment privileges revoked, per our Terms of Use. Please see our FAQ if you have questions or concerns about using Facebook to comment.

Read the Oct 28
Green Edition

Browse the print edition page by page, including stories and ads.

Browse the archives.

Friends to Follow

View All Updates