Health Care Reform and Premium Subsidies

Posted on: November 19th, 2012 by SamTabes No Comments

The Actors Fund, a national human services organization that helps those in the performing arts and entertainment through social services, emergency assistance, health care and insurance information, put together a valuable article with some highlights of health care reform which is pertinent to those in this industry.  By 2014, everyone will be required to carry health insurance, aside from a few exceptions, and individuals without employer-sponsored health insurance will need to take the time to shop around.  It’s more important than ever that Americans fully understand their options, and it’s good to know groups such as the Actors Fund are helping to spread accurate information.

People with low to moderate incomes will receive subsidies from the federal government which will help with the cost of premiums and out-of-pocket medical costs.  How much a family will receive will depend on the size of the household and the total household income.  As an example, a person that makes $21,000 a year will have their premium capped at 6.3% of their income and their out-of-pocket costs for the year will be maxed at $1,983.  See the chart below from The Artists Health Insurance Resource Center’s article “Every Artist Insured: Understanding Health Care Reform”:

Individuals who do not obtain health insurance coverage through their employer or federal programs such as Medicaid or Medicare will need to buy their insurance from the health insurance market through a broker, health insurer or an Exchange.  The Exchanges are competitive, private insurance marketplaces which each state should have by 2014.  Only health care plans that meet the affordability requirements will be able to sell through these Exchanges.  They will also administer the subsidies and help people enroll in Medicaid as well as the Children’s Health Insurance Program.

The article also details the future of Medicare under President Obama’s health care reform.  Many Medicare costs will be going down and those with Medicare Advantage Plans will be able to keep their coverage.  The new law does cut some government subsidies of these plans though, so the structure will be changing.  Some insurance companies may choose to drop their Medicare Advantage plans due to the new rules, and this may force eligible members to change insurers or return to traditional Medicare plans.

One of the most talked about changes from health care reform is the availability of free services under Medicare, especially preventative services.  As of January 1, 2011 many services became available to eligible individuals under Medicare free of charge, when previously there was a price tag associated with these costs.  Some of these free services include blood pressure screenings, diabetes screenings, cholesterol tests, breast cancer screenings, vaccines and immunizations.  Even certain counseling services on healthy lifestyles are included under health care reform.  The Actors Fund does a great job of summarizing all of these changes that will ultimately end up affecting almost all of us in a few short years.

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