Navigating the Affordable Care ActSep 25, 2013
Dr. Tom Miller, chief medical officer at University Hospital, outlines what the Affordable Care Act is and how Utahns can access health insurance exchanges to find the coverage right for their families.
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Interviewer: It seems like we've been hearing about it for a long time, but it's finally here, I guess, The Affordable Care Act, or Obamacare as some people call it. October 1st Utah's insurance exchange for underinsured, or people without insurance, or if I have insurance do I . . . There are a lot of questions.
We're here with Dr. Tom Miller from University of Utah Hospital. Tell us a little bit, first of all, what is this Utah exchange that we're hearing so much about. Break it down for me.
Dr. Tom Miller: It's been a long road to get to this point, as you mentioned, but Obamacare is now ready to roll. On October 1 they're opening the insurance exchanges where those of us who are underinsured, who don't have insurance, or who are paying too much for insurance can go and find a plan that will suit their budget. They may also receive subsidies depending on their income level and the number of folks that they have in their family.
Interviewer: All right. Those subsidies, what do those come in the form of? Is it tax credits?
Dr. Tom Miller: Tax credits. Basically, you'll be able to get a certain amount of money towards your plan depending on your income level. That can be determined by going to the navigators. There are several navigators that people like yourself who may want to ask questions about health insurance can look up, talk to, read about, and then learn what plan is best for you.
Interviewer: These navigators, they're simply people that can help navigate this process that you can call.
Dr. Tom Miller: Right. I think for a lot of people looking at health insurance is a confusing prospect. What you can do is go to healthcare.gov and you can look up what plans are available. You can get into the information about the exchanges. Maybe more importantly, you can find out which navigator you can call and talk to about your particular situation, and what products are available to you, and whether or not you have subsidies that will go towards purchasing health care.
Interviewer: Help is also available through United Way's 211. Just dial 211 on your telephone and you'll get their community help line.
Dr. Tom Miller: Right.
Interviewer: If I don't have insurance currently, by law I'm going to have to have insurance.
Dr. Tom Miller: By 2014 you're going to have to purchase health insurance or you're going to have to pay a penalty. Now is a good time to get signed up. It's also great thing in the long run, because many people who are uninsured now have the option of having affordable insurance.
Interviewer: Okay. If commercially provided insurance isn't affordable, these exchanges are more so for somebody without insurance right now?
Dr. Tom Miller: It's a little more complicated than that. If you have insurance through your employer you don't really qualify to go to the exchange. You can keep your insurance, unless you are paying more than 9.5% of your income. In that case you're able to go to the exchange and purchase a product there.
Interviewer: Okay, so if I have insurance, unless I'm paying crazy amounts . . .
Dr. Tom Miller: You'll stay with your employer. Most people would probably do that anyway.
Interviewer: Yeah. For the average person this really doesn't concern them.
Dr. Tom Miller: Right.
Interviewer: But, somebody without insurance, this would be a cheaper option than commercial plans? Is that the goal? Is that the thought?
Dr. Tom Miller: There are several ideas behind it. Number one, there are no pre-existing conditions, so you're not excluded from plans. In the past if you had a pre-existing condition you would have to pay a premium in order to get insurance, and a lot of times that was prohibitive. Now, you can get on the exchange and get insurance no matter what health problems you may have, and you can get the plans for a reasonable price.
Interviewer: Okay. Now, it's really confusing, so let's go down here. If somebody's covered by Medicare, what do they do?
Dr. Tom Miller: With Medicare you're going to stick with your plan. You're going to stick with Medicare. There's no reason to purchase a plan. Medicare is your basic insurance after the age of 65 or in case you're disabled or meet other requirements.
Interviewer: Same with Medicaid I'd imagine.
Dr. Tom Miller: Medicaid is a little bit different. This state hasn't decided whether they're going to join the Medicaid exchange. That's to be determined later. Our governor has not decided whether we're going to join the national Medicaid exchange.
Interviewer: All right. We've already talked about if you have your own coverage. Likely, this probably isn't something that concerns you. If you're uninsured October 1st is when you can start getting some information.
Dr. Tom Miller: October 1st is the go live date for the exchanges where you can begin to sign up.
Interviewer: All right.
Dr. Tom Miller: I believe it's in January when the insurance products are actually available.
Interviewer: As a physician here at the University of Utah Hospital, is this a good thing?
Dr. Tom Miller: It's a great thing, because there are many people out there now that don't have insurance, and they couldn't afford insurance. They're small business owners and individuals who may have the means to pay a certain amount of money for insurance but currently are not able to get into the health insurance market because the premiums are too high. I think this offers a large segment of the public, I think the numbers are about 360,000 in the state of Utah, an ability to purchase health care.
Go to healthcare.gov. Get the information you need. Work with the navigators to find out what products will work for you and your family. Find out if you have an option for subsidies to help pay for the insurance plan.
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