Fort Mill Times

Health care reform update: Quiet before the Storm

The initial enrollment for the Affordable Care Act was completed April 15, 2014.

Although individuals who have a qualifying event can still enroll today, everyone else must wait until Nov. 15 for the enrollment period to begin. Currently, this period will last until Feb. 15, and the earliest new plans will go into effect will be Jan. 1.

Participants have experienced many challenges during enrollment and the current benefit period. One of the most difficult has been the confusion about physician networks. I spoke to one of our elected officials, and even he was misinformed regarding the networks.

It is my understanding that the insurance companies are working daily to expand the number of participating physicians and facilities. It is important to check with your insurance company’s most recent network listing to confirm if a physician is in network.

Please note: Just because a doctor’s office says it accepts your plan, you have to pay the out-of-network pricing if they are not in network for your plan. You will pay the full cost for services with no co-insurance, and your costs will most likely not count against your deductible or maximum out of pocket. Stay in your network if at all possible.

If you received a subsidy when you purchased your insurance under the Affordable Care Act, now is a good time to review your current income as it compares to the estimate you provided during the application process. Your benefits and any subsidy were based upon your estimated income for 2014. If your estimated income fell between 100 percent and 400 percent of the federal poverty level, you may have qualified for a federal tax credit.

The IRS is completing form 1095A; with this form, you will compare your income to the credit received. Your tax preparer will then complete form 8962 and submit that with your tax return. If your actual income is greater than the estimate you provided and you received a higher tax credit than you qualified for, you may be required to repay some or all of the excess credit you received.

If you meet with your tax preparer and review your income now, you can (1) update CMS and revise your information and credit amount, or (2) take steps to reduce your taxable income to more closely match your expected income. Now is the time to contact your CPA and discuss this, not in April!

November’s enrollment should include changes to existing plans and new plans to choose from. If you are looking to make a change effective Jan. 1,you will need to enroll in your new plan by Dec. 15. The website is a great source for information and will remain the access point to enroll for those who qualify for plans under the Affordable Care Act.

The new health-care plans remain a point of contention and debate. For those individuals who could not obtain coverage due to health or financial reasons, the new health-care rules have been a blessing. For those individuals who had to change physicians and/or pay higher premiums, the new health-care rules have been more than disrupting and frustrating. Regardless, our current health care system is a reality we all must learn to navigate.