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Touching on new rules for healthcare
by Tim Delaney
Feb 03, 2014 | 17 views | 0 0 comments | 22 22 recommendations | email to a friend | print
Velma Gonzales photo
Isaac Mireles, left, explains the Affordable Care Act’s rules for insurance companies during a “Lunch and Learn” noon session put on by the Refugio County Community Development Foundation and the Refugio County Chamber of Commerce on Thursday, Jan. 23.
Velma Gonzales photo Isaac Mireles, left, explains the Affordable Care Act’s rules for insurance companies during a “Lunch and Learn” noon session put on by the Refugio County Community Development Foundation and the Refugio County Chamber of Commerce on Thursday, Jan. 23.
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REFUGIO – The key to understanding the Affordable Care Act is realizing the act is not a plan. It is a new set of rules for health insurance.

That was the gist of a Refugio County Community Development Foundation and Refugio County Chamber of Commerce Lunch and Learn Series, “Health Care Reform: Are You Ready,” on Thursday, Jan. 23.

Isaac Mireles, a benefits consultant with Heavin & Associates Insurance Agency Inc., of Corpus Christi, said only 46 percent of businesses are offering healthcare coverage in Corpus Christi.

He said the example is typical and that the larger half of business does not provide healthcare coverage.

But now people must have healthcare, and open enrollment is in progress until March 31.

“After that, you cannot buy health insurance unless you have a qualifying event,” Mireles said.

A qualifying event would be a newborn or a divorce.

And if you miss the deadline, you have to wait until the next open enrollment period.

A penalty for missing the deadline amounts to $95 per adult or one percent of the family income. Mireles said the penalty increases in 2015 to $325 per adult or two percent of family income. In 2016, the penalty increases to $695 or 2.5 percent of the family income.

Mireles said the goal is to get as many people covered as possible, to help those who are sick.

Mireles said the enrollment website was not working properly a few months ago.

“Things are beginning to look better,” he said. “The Affordable Care Act is a set of rules other insurance companies have to follow.”

He said the ACA has made changes, some for the better.

“In the past, you were hit hard if you had medical difficulties. As of Jan. 1, insurance companies cannot discriminate based on medical conditions,” he said.

Now, four levels of coverage are available: Bronze with the lowest premium, paying 60 percent of coverage; Silver paying 70 percent; Gold paying 80 percent; and Platinum paying 90 percent.

The deductible in each level ranges from $5,600 with the Bronze coverage to a zero deductible with Platinum coverage.

The maximum out-of-pocket allowed per individual is $6,350 a year. After that, the insurance pays 100 percent, including co-pays.

All plans must include essential health benefits such as annual checkups, maternity and newborn care and pediatric services.

A premium tax credit is also available for those who don’t have access to a group health plan.

To get the tax credit, a qualifying household income of 400 percent or less of the federal poverty level is required (annual income is less than four times the federal poverty level).

Mireles said people should consult with their insurance agent to enroll if they haven’t done so.

He said some people have lost coverage because their healthcare plan did not meet the standards or new rules.

When replacing plans, he said sometimes the new one is not as good. Some people experience rate increases and some experience rate decreases.

All of it depends on family size, age and whether or not one smokes cigarettes.

“One of the biggest things about healthcare reform is they have not educated people about it,” Mireles said.
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