Local Providers Explain Affordable Care Act - WBOY.com: Clarksburg, Morgantown: News, Sports, Weather

Local Providers Explain Affordable Care Act

Posted: Updated:

The Affordable Care Act, commonly called Obamacare, is one of the most controversial reforms in American Government in recent years.

"I keep referring back to Medicare, how people objected to that in the beginning. And now, you can't take their Medicare card away. It's turned out to be something good. The Center for Medicare and Medicaid Services is the one doing all of the education and the center for all of this, this program right now," said Linda Shriver, CEO of the Preston/Taylor Community Health Centers.

While President Barack Obama signed the Act into law nearly four years ago, a large portion of it is just about to affect consumers.

On Oct. 1, 2013, the Marketplace will open, allowing nearly 48 million uninsured Americans to sign up for more affordable care.  This will allow Americans to compare and purchase insurance plans at one, convenient location.  Click here for more information on how to sign up, compare, or find a location near you.

Linda Shriver, CEO of the Preston/Taylor Community Health Centers explained that Americans covered by workplace benefits will most likely not be affected by the changes.  Workers may choose to go with a Marketplace plan, but will be able to keep their existing health-benefits if they desire. 

"There would be no difference in that. It really is primarily for people who have no insurance," Shriver said. Employees who like the coverage they have today can keep it.

Uninsured Americans without access to affordable employer-based insurance may qualify for Medicaid coverage. Medicaid is expanding in West Virginia for individuals and families with incomes up to 138 percent of the federal poverty level, or $15,856 for an individual and $32,499 for a family of four and more people are expected to qualify, Shriver said.

Higher-income Americans without access to employer based insurance, or those with employer plans requiring a premium contribution of more than 9.5 percent of their income for individual coverage, can shop for subsidized coverage in the Marketplace. As Shriver notes, it's unclear what will be considered affordable for employer-based family coverage.

Income-based subsidies will be available to offset the cost of premiums and cost-sharing for Marketplace purchased plans. The subsidies will be available on a sliding-scale for low to middle income families (from $23,550 to 94,200 for a family of four).  Check to see if you qualify here.

Coverage offered through the Marketplace is designed to be comprehensive, with different plan options presented in an easy-to-understand format. "There is a list of essential health benefits that would be available. There will be four tiers of insurance coverage available," Shriver said.

Shriver said premium prices are expected to drop under the act, partly because insurance companies now must spend at least 80 percent of premium costs on actual medical care. It's called the 80-20 Rule and its aim is to eliminate high premiums and high-profit-based pricing.

"There's a lot of skepticism as to how much money when you pay these higher premiums, how much are you really getting out of it? We are trying to make sure patients are receiving services and companies aren't just making profit off of the individual," Shriver said.

The days of additional costs or denial of coverage for those with pre-existing conditions are over too.

"They have to treat you the same. They can not discriminate against you on your sex, [in the past] maybe a female's benefits would cost more than a male," Shriver said.

The act also aims to help out young adults by allowing parents to keep their children on their plan up to the age of 26.

Perhaps one of the most talked about issues regarding the Act is the penalty for not signing up for insurance.

Those who choose to go uninsured in 2014 will be required to pay a fee of one percent of their income or $95 per person, whichever is higher. Uninsured children will also come with a fee of $47.50 per child. The most an uninsured family will pay in 2014 is $285. Those fees will increase significantly over time, jumping up to 2.5 percent of a person's income by 2016.

Shriver said there are still plenty of questions to be answered regarding the act, and providers don't know all of those answers just yet either.

"I think we are still trying to find answers as well, our application counselors had to take a training course to be certified. We're still getting answers now," Shriver said.

Shriver highly encourages checking out the Affordable Care Act website, and said it is also convenient place to find counselors and navigators for the act.