Understanding the Affordable Care Act (ACA)

The Affordable Care Act (ACA) is here to stay. The ACA (formally named Obama Care), which was signed into law back in 2010, has finally taken shape and all employers will comply in 2016. The law requires that each individual within a household be required to do one of the following: have minimum essential coverage, have an exemption from the individual mandate, or be prepared to pay the penalty for not complying with the individual mandate upon filing a federal income tax return.

One of the big misconceptions of the ACA is that healthcare will be free or low in cost. While free isn’t the plan’s intended purpose, there have been some changes that do help individuals financially. One of the main components of the ACA Plan is that preventive services are at no cost (100% covered), with no deductible if you use an in-network doctor. Services such as routine physicals, certain screenings, child well-visits, women’s health and plan-approved contraceptives are now covered at 100%. Make sure when calling to set up your well-visit, you identify it as a preventive well-visit, so that your visit is billed appropriately.

If your condition isn’t life threatening be a smart shopper. Always ask if there is a generic alternative for what your doctor is prescribing. Utilize your health provider’s on-line tools to help search your area for best costs. This could help create additional savings, especially if you have chosen a high-deductible plan. I was recently told a story from someone who needed an MRI. He looked at his health-care provider’s on-line tool to see area costs. The nearby hospital costs would have been $3000 and the free-standing clinic a few more miles down the road (which he went to) charged him $400. The difference in payments can be that significant.

As the ACA and health programs continue to evolve, here are a few tips to help you become a smarter health-insurance consumer:

  • Always use an in-network provider – this can help reduce your health care spending.
  • Utilize the Wellness Benefits – as the saying goes “an ounce of prevention is worth a pound of cure.”
  • Try calling your doctor to “pre-qualify” your symptoms, an over-the-counter drug could be available for your condition.
  • Review Explanation of Benefits and bills sent by your providers. Make sure that you and the plan are being charged only for services that you received.

If you are eligible for healthcare through smartdept. inc. and have any questions about your coverage, contact me, Angi Budnick, HR Generalist here at the smartdept. inc. 872.222.5605 or by email: angi@thesmartdept.com.

Have a Happy & Healthy 2016!

From the desk of smartdept. inc. HR Generalist: Angi Budnick