Affordable Care Act - USA


Staff member since Feb, 2009
Senior Administrator
Mar 24, 2008
United States United States
As the USA's Affordable Care Act starts to officially take effect, we thought there should be a place where BoneSmarties could post information related to how the process works for them in obtaining medical coverage. We're looking information or "lessons learned" type posts - not political viewpoints about whether or not the new program is a good one. So please keep your posts in that vein.
Thank you Jamie and Jo for allowing this forum to be here. I think it is important for people to understand what this legislation means for people and how it can help you.

I am happy to answer any questions here so that everyone can learn. If you have something especially private that you do not want to share please PM me.

If you are confused about the ACA.don't beat yourself up. I would say that most of the country is confused.
One of the best things for us Smarties, is that if you are younger than Medicare age, and have had a joint replacement or have any disease that is considered pre-existing, it was nearly impossible to get health insurance or pay enormous additional costs. Even an ingrown toenail..ooops..pre-existing..Now, with the ACA we can all get the insurance coverage that we need.

Obviously this is for those of us in the US.
Let's keep politics out of it and just deal with the facts. Hopefully we can share information and get you to the right resources. I do not pretend to know it all..Oh, it is complex but if I cannot give you an answer that I am certain of, I will do the research and get back to you.

And remember, you have til Dec 15, 2013 for coverage to start Jan 1, 2014. There will be no coverage under this new plan until Jan 1, 2014 for anyone.
For those BoneSmarties who might not be aware, Knitter4444 is our resident expert in these programs. If she doesn't know the answer, it is likely that she knows how to find out the information you may need.

Thanks, Knitter4444, for volunteering to help with this thread! Your input is importat. Plus, we are also looking for folks to pass on their experiences and tips for working with our new health program.
I have a question regarding this program as it relates to knee replacement. I will be replacing one knee under a different insurance soon, and I need my second one done "on my own" without health insurance yet. In looking at the dizzying array of plans, I wonder if it doesn't make sense to select a high monthly cost plan with a low deductible/out of pocket, get my knee replaced asap after the plan is in effect, then after surgery and recovery downgrade my plan to high deductible/high out of pocket to reduce my monthly cost. As it looks now, I can get a plan for about 600-700/mo with low deductible...and at the other end of the spectrum a plan for about 120/mo. for catastrophic-type coverage only.

Does this make any sense or am I completely missing the boat here? Is this even an option?

Also, I can't seem to get an answer from anyone on workmans compensation payments (non-taxable percentage of my former salary) considered income for the purpose of the cost of these plans?

Any help would be appreciated!
I can't answer the Workers' Comp question. That's an accounting/tax question.
Yes, you can get a low deduct plan Jan but you need to keep that plantil the next open enrollment period. Some states are listing medical providers for each plan. I am in CA and we expect to see the list next week. So if you have an OS that you like be sure that he or she will be on the plan that you choose.
And if you ask the office today they probably don't know or may not give you accurate info because of the confusion. Certainly do your research but I wouldn't sign up today. Hope this helps.

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One thing I have learned is if you already have insurance, then it is up to your company to decide how they will handle the insurance matters. My husband and I will not be affected in 2014, but in 2015, could be absorbing a 6% tax that the company is paying this year.
Some of this is state specific. Most people looking at the marketplace are those without insurance or for those who are paying incredibly high premiums because of medical issues. Usually group health insurance will give you better benefits for less money. We'll just have to see what happens.
For folks on COBRA this should be great.

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I have a couple of questions which hopefully make sense. 1. Should everyone even if you are currently covered by an employer group health plan enroll in the marketplace? And (2) if a person currently employed and covered loses his job in march 2014 (just for example) could they at that time enroll and get coverage thru the marketplace? Thanks!

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If you are in a group health plan you will usually have better benefits and hopefully your employer pays part of it.
Yes, if you are without insurance at some point there should be a special enrollment plan as you are required to have health insurance.

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Thank you! It sounds like a great plan to me but a little confusing right now!

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Wow. This is a great tool and very easy to use! Many thanks!

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USA Only.
If you have Medicare or are a part of a group health plan through your employer then you won't find lower rates with the same benefits. And these plans are for primary insurance, not supplemental.

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If you work for a small company (in my case it is around 30), so I don't know how much higher that number could go, it is anticipated by my boss that our insurance costs will increase 10-20% a year and the plan benefits will have to decrease in order to afford the insurance. Small companies will get hit very hard by the Affordable Care Act, making it much less affordable for those who in this type of company!
My husband is with a large company, and they are absorbing the costs instead of passing it onto us. Like I said in 2015 though, we might have to pay a 6% tax!
The issue is same benefits. Depending on the state some employers are being told to renew earlier to save money. These are generally what are considered small employer groups.

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Ok, so my BIL works for a small company, less than 15 so should he be concerned? His employer goes for the cheapest insurance he can find, and Ronnie has had a quadruple bypass, needs neck surgery, knee replacements and cpap supplies. Should he look for an additional policy on the side?
I also work for a small company - 30 employees. We requested a renewal similar to our policy we have which is no deductible and a copayment of $35 per visit instead of the "metal" level policy. Our insurance company was shocked as the policy is about the same in cost and the copayment went down to $30. We have been hearing at work how bad our medical was going to be with the Affordable Care Act and how our company could not afford the changes. After getting our policy costs, it appears this program is to help small businesses and the uninsured get coverage. Also to protect people with pre-existing conditions. i did find out that all children will have dental coverage until age 18 - it is part of the law and there was an additional cost to companies for each child. it may hurt larger companies but these companies can still offer the same healthcare or send employees to the marketplace. Where I work our lower income employees will also benefit by going to the marketplace to get financial assistance for health care costs and the website knitter provided is very helpful for income limits and information. I am comforted in the fact that I could lose my job and still have healthcare I can afford even with tkr and other health issues - not the high cobra rate!

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