Obamacare and Pre-Existing Condition Coverage

Starting January 1st of 2014, all qualified health plans must begin to cover pre-existing conditions with no waiting periods for 10 core essential health benefits.  These benefits include hospitalization, ambulatory patient services, emergency services, laboratory services, rehabilitation, mental health services, preventive care and wellness, maternity and newborn care, prescription drugs and ambulatory services such as doctor's office visits.  Each plan will have different coverage levels depending on the benefit structure of a given policy.  For more information on health care reform in North Carolina, visit Obamacare NC.

What Will Happen to Your Current Individual Policy When Obamacare Begins?

If you are one of those who currently have a health insurance policy that has been in force and unchanged since March 23rd of 2010, you have a grandfathered policy and for 2014 your policy will remain largely the same as it is today.  However, if you have a policy effective or that has been changed since March 23rd, 2010, then you have a non-grandfathered policy that must conform to the Affordable Care Act (ACA), more commonly known as Obamacare.  Starting January 1st, 2014 your policy will either automatically become ACA compliant or you will be rolled onto an ACA compliant plan.  During the open enrollment season you will be given the option of changing plans to another carrier, or switching to a higher or lower benefit plan.  During open enrollment you will also be given the option to see if you qualify for a health insurance subsidy through the NC Health Insurance Marketplace.  If you have a plan already, you should contact your agent to help you through this process or if you are applying for a new plan, the agent or carrier of your choice will be able to help you see if you qualify.  If you currently have a plan in force I recommend making these changes prior to December 15th, 2013.  The best time to get these changes made will be late October or early November, because during that period I expect to see a lull in new enrollments and it will be easiest at that point to get in touch with an agent.

Visit our website for more information about open enrollment and Obamacare in NC.

How to Get a Subsidy to Pay for Your Health Insurance Through Obamacare

Qualifying and accepting your health insurance subsidy should be fairly simple provided you meet the income guidelines.  Those between 100% and 400% of the Federal Poverty Level will qualify for a subsidy on a sliding scale.  When open enrollment begins on October 1st, to apply for a subsidy, there is no need to provide documentation as long as your income is within 10% of your 2012 Modified Adjusted Gross Income.  When you contact an agent to get health insurance quotes, you'll tell the agent your estimated income.  Then, when you decide on a plan you'll be linked to the NC Health Insurance Marketplace where your income will be verified with the IRS by your tax ID number.  Once your income is verified you will decide how much of the subsidy to accept.  If you accept to much, then you will owe it back to the government when you file your 2014 taxes.  If you accept to little, then you can accept the balance of your subsidy also when you file taxes.  For this reason it is advised to accurately estimate your current income so that you don't accept to much subsidy.  If your income is less than 90% of your 2012 income and you want to accept your full subsidy, then Equifax will be used to verify your income.  If that is not adequate, then you may have to provide pay stubs or other proof of your current income.

For more information on Obamacare and to receive important updates, visit the following link: Obamacare NC

Maternity with Obamacare

So it looks like the complications involved with individual maternity insurance will get much more simple after January 1st, 2014.  Maternity will now be an automatic benefit for all non-grandfathered or new health insurance policies on the 1st of next year.  That also means that even if you are already pregnant and your delivery occurs on or after the 1st, it will be covered under the provisions of the Affordable Care Act as long as you have an individual non-grandfathered health insurance policy in force.

The downside, if you're one of those who opt not to enroll in coverage during the open enrollment or subsequent annual enrollment periods, is that you won't be able to add coverage at any time.  So, if your plans are to wait and get health insurance after you find out that you're pregnant then you'll be taking a gamble.  Especially with the new subsidies available through Obamacare, not many people really has an excuse to be uninsured anymore.

As things stand now, if you apply for a maternity policy with an effective date in 2013, you may not get much benefit out of it.  You'll pay the hefty maternity rider fee for the remainder of the year, and if you deliver in 2014, the bulk of your cost would have been covered anyways.  The benefit of adding the rider this year is that prenatal care will be covered, but unless you hit your deductible before the end of the year, then the policy really won't pay for anything and then you'll have to meet your deductible in 2014 again when the policy renews.  I don't want to say not to get a maternity rider if you plan on getting pregnant this year, but the costs and benefits should be weighed with an agent first to determine if it's in your best interest.

If you'd like my advice feel free to visit my office or give me a call at: Blue Cross Blue Shield Authorized Agency - Goebelt Health Insurance, 212 S Tryon St, Suite 1605, Charlotte, NC 28281, 704-733-9015. Health Insurance Charlotte NC

If you'd like to stay abreast of future Obamacare updates, visit my website at: Obamacare NC.

Will Obamacare make my health insurance cost more?

Yes for some and no for some.  If you have low income or if you have serious health issues, then Obamacare will make your health insurance cost less.  If you make more than 400% of the federal poverty level or if you are in good health, chances are Obamacare will make your rates go up.  400% of the federal poverty level in 2013 is $45,960 for one person, $62,040 for two people, $78,120 for three people, and $94,200 for four people.  Most people will fall below the 400% FPL threshold to be eligible for a subsidy from the government.  If you are between 100% and 400% FPL, then you will be eligible for a subsidy, which is graduated based on your income.  The net effect of the subsidy will be that someone at 100% of FPL will pay 2% of their annual income for health insurance.  As you make more, you pay a greater percentage until you reach 9.5% of your annual income at 400% FPL.

I real world example of the subsidy in action might be helpful.  If an individual makes 100% FPL or $11,490 per year, then their annual expected health insurance premium would be $229.80 per year or $19.15 per month for the second lowest cost silver plan under Obamacare.  On the flip side, if an individual is making $45,000 per year (just under 400% FPL), then their expected annual health insurance premium would be $4,275 or $356.25 per month under Obamacare for the second lowest cost silver plan.

For more information on health insurance changes in 2014 or to apply for Obamacare through Blue Cross Blue Shield please visit the following link: Obamacare NC or Health Insurance Charlotte NC or visit us at:  Blue Cross Blue Shield Authorized Agency - Goebelt Health Insurance, 212 S Tryon St, Suite 1605, Charlotte, NC 28281, 704-733-9015.

When Can I Get Obamacare?

Obamacare health insurance through Blue Cross Blue Shield NC will become available for enrollment on October 1st, 2013 for January 1st, 2014 effective dates.  Open enrollment will last for six months, from October 1st, 2013 to March 31st, 2014.  After the initial open enrollment period, there will be an annual open enrollment which will last from October 15th to December 7th each year.  Changes made during the annual open enrollment will take effect on January 1st of the following year.  The purpose of the annual enrollment period is to allow you to make policy changes or to change health insurance companies.

For more information on Obamacare in North Carolina or to get quotes or apply, visit the following link:  Obamacare NC

Maternity / Pregnancy Insurance Options in North Carolina

There's not much information available online regarding strategies for planning to pay for maternity, including delivery and prenatal care in North Carolina, so I've decided to write this article to provide a little insight on the issue.

If you are currently pregnant, your options, in order of desirability, are Medicaid, group insurance, and prepayment plans. After you are pregnant, it is not possible to issue an individual policy. Application will automatically be declined. If you are in the process of planning your pregnancy, the best options for minimizing your maternity costs are Medicaid, group insurance, individual insurance with Blue Cross Blue Shield, prepayment plans, in order of descending desirability.

The average total maternity charges submitted to Blue Cross Blue Shield of North Carolina in 2007 was $20,015 per pregnancy 1. A patient may be required to pay this full amount, however many families negotiate with hospitals and providers to pay a discounted rate when the only option is to pay out of pocket.

When planning to cover the costs of maternity the four primary options in North Carolina are as follows:

1. Group maternity insurance coverage. This is often the most advantageous way to pay for maternity costs because many group policies cover maternity for all females on the policy without an additional rider. Also, if you are already pregnant, and don't meet the income requirements for Medicaid, this is your best shot at getting your pregnancy covered by an insurance company. Additionally, some group policies do
not consider pregnancy a preexisting condition, so this is a good option to consider if you are already pregnant.

After the charges have been submitted to the insurance company, it is worthwhile to ask the hospital if you can get a discount by paying the deductible in full as opposed to making payments over time. I am aware of instances where the deductible has been discounted for a prompt payment in full.

2. Individual maternity insurance coverage with Blue Cross Blue Shield. At the date of this writing, I am only aware of one individual health insurance company in North Carolina that offers coverage for maternity. The company is Blue Cross Blue Shield and the policies are Blue Advantage® and Blue Options HSA sm. I am not aware of any individual health insurance policy that will cover you after you are already pregnant. HumanaOne previously offered an individual maternity policy, but has since discontinued it. I am generally skeptical of small health insurance companies, if you are even able to find one that offers maternity, because they are often on tight budgets and as a result their policies often contain ungainly loopholes.

The Blue Cross Blue Shield individual policy is somewhat similar to a prepayment plan through a hospital, as the premiums for adding the maternity rider are fairly substantial. However, the benefit of the policy is that, in the event of a pregnancy that involves complications, your costs are much more predictable. Pregnancies with complications are often significantly more expensive than a normal delivery, so this option is more desirable than a straight prepayment plan.

Blue Cross Blue Shield's maternity plan uses the deductible and coinsurance of the plan it is attached to, so it is important to evaluate the varying cost of maternity riders within the context of the deductible and coinsurance of each plan. For example, suppose the maternity rider for a plan was $350 per month. Suppose this plan has a $2,500 deductible with 100% coinsurance. Now the total cost for the pregnancy over the course of a year is $350 times 12 months = $4,200 + the $2,500 deductible = $6,700 for the pregnancy. Now, suppose a second plan had a maternity rider for $450 per month. Suppose this plan has a $1,500 deductible with 100% coinsurance. Now the pregnancy would cost $450 times 12 months = $5,400 + the $1,500 deductible = $6,900. With this hypothetical scenario, the first option is better even though the deductible is higher. The purpose of this example is the illustrate the importance of paying attention to how much it costs to lower your deductible.

With Blue Cross Blue Shield's maternity plan, it is also important to plan the timing of the pregnancy. The individual deductible reset every January 1st, so it is best to start a maternity policy at the beginning of the year and start trying to get pregnant at that point. Otherwise, the pregnancy will overlap calender years and you may have to meet your deductible more than once.

To learn more about the Blue Cross Blue Shield NC individual maternity policy follow this link.

3. Medicaid maternity coverage. Follow this link for income eligibility requirements and instructions for application of coverage.

4. Prepayment plans. I you are already pregnant, a prepayment plan is a last resort. In this case, you should contact the prenatal and delivery caregivers to negotiate a prepay rate. Many hospitals offer discounts for paying out of pocket in advance. When conducting prepayment negotiations it is important to be very specific about what is covered by the arrangement and if the price includes complications of pregnancy, or only normal delivery.

Summary
Overall, from a financial perspective, Medicaid is typically the least expensive option, followed by group insurance. Individual maternity with Blue Cross Blue Shield is the third most desirable as a measure to minimize the cost of unexpected complications of pregnancy. The fourth option is the prepayment plan negotiated directly with the provider.

Blue Cross Blue Cross Blue Shield

NC Maternity Pregnancy Insurance Coverage

1. Average charges submitted to BCBSNC for maternity services, professional and hospital etc. in 2007. Your charges
may vary.