ObamaCare!
Yes, here we go again. Here we go again, because even if those of us who boast “Elder status” are already enmeshed in Medicare (or whatever) and don’t have to deal with this, we have kids and grandkids and nephews and nieces and friends who do (or should), and it’s still our job to show them the way, so quit yawning and sighing and PAY ATTENTION!
This is about people who don’t have health insurance getting health insurance. Health insurance pays (to one degree or another) for healthcare, so let’s talk about what healthcare this health insurance is going to cover.
Some of us have heard about “bronze plans” or “gold plans” or whatever – What’s that about? Well, these are just “levels” of insurance, measured by the dollar-amount of coverage that a plan will pay, so bronze = 60%, silver = 70%, gold = 80% and platinum = 90%; thus, if you go to a doctor for a covered service, a “silver plan” will pay (more or less) 70% of that bill, get it?
There will not be any platinum plans in Washington in 2014 – I don’t know why.
Let’s backup and begin to put this together. Last week I went on about levels of “help” that will be available to purchase this health insurance. The first level of “help” was (Is!) Medicaid. Medicaid is Medicaid is Medicaid; in other words, Medicaid covers what it covers (and doesn’t cover what it doesn’t cover), and that’s that for that – You don’t need to decide anything.
The next level(s) of “help” is through tax subsidies – Coming back to you? OK, so what these tax subsidies subsidize (or don’t subsidize, if your income is above the levels I assaulted us all with last week) are the purchase of “qualified health plans,” which means health insurance plans that have been reviewed up one side and down the other by the Washington Health Benefits Exchange, holding hands with the Washington Office of the Insurance Commissioner.
Said plans had to meet all kinds of conditions and eliminate the dreaded “fine print” and what-not. They also have to provide (at a minimum – by law) “10 Essential Benefits,” so this where we STOP thinking about money and mandates and penalties and politics and START thinking about what helps people we love. These 10 benefits are:
1. Ambulatory patient services – Going to the doctor or clinic or whatever – NOT in the hospital!
2. Emergency care
3. Hospitalization
4. Maternity and “newborn” care – Think about that, Mr.
5. Mental health and substance about services – Think about that.
6. Prescription drugs
7. Rehabilitative and habilitative services and devices – Something very bad happened, so now you have to relearn how to do things (e.g. walking, etc). “Habilitative” means services that help you to keep the skills/abilities you’ve got or actually increase them.
8. Lab services – Tests, etc.
9. Preventive and “wellness” services – Including regular physicals, immunizations, managing “chronic conditions,” etc
10. Pediatric services for kids under 19 – There will be add-ons for dental and vision, too.
OK? So, the “bronzes” and the “silvers” and the “golds” ALL have to offer at least these benefits, and will generally pay 60%/70%/80% of their costs – Coming together?
For those of you who are new to the netherworld of health insurance, almost NO health insurance pays 100% of almost anything – No health insurance pays 0% of everything.
This is still a few weeks away (October 1st is “go live”), so we’ll talk more about the “how” and “who can help,” so just try to let this all sink-in; for now, consider this: Most of us have car insurance, hoping that we’ll never need to use it; personally, I’d rather have it and not need it than need it and not have it.
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