Health Insurance

Five More Fallacies of ObamaCare

Wanda No Comments

As I pointed out in my ObamaCare video, we are constantly bombarded with misinformation about the Affordable Care Act(ACA) or ObamaCare. Here are five more examples of these fallacies:

fallacy #1:All health insurance must be purchased from the Marketplace.”

It is true that you must go through the Marketplace if you want help from Uncle Sam paying for it. However, if you don’t qualify for a subsidy it’s probably a waste of your time. If you live in the Research Triangle Park Area and qualify for a subsidy you must choose a plan from the companies that are participating in the Marketplace. These companies are BlueCross BlueShield of NC, Coventry(a.k.a. Aetna) and United Healthcare.

Applicants who don’t qualify for a subsidy can purchase from these three companies as well as Assurant, Cigna, Humana or any company which is approved to sell health insurance in North Carolina. A health insurance broker (an agent who represents multiple companies) can help you determine if you qualify for a subsidy and sort through your choices.

fallacy #2: “You will never qualify for a government subsidy if you have access to a group health insurance plan.”

Good news for people who work for companies with lousy health insurance. This is not always true. If based on your household income and size your plan at work is considered unaffordable by the Feds you may still qualify for help from Uncle Sam. Also, you might qualify if the plan you receive at work is not at the coverage level of the “Bronze” plan sold on the Marketplace.

fallacy #3: “Anyone who does not qualify for a large government subsidy is paying a lot more for health insurance because of the Affordable Care Act.”

It is true that some folks who don’t have pre-existing, are not taking any medications and do not need or want maternity coverage are paying more. However, according to a June, 2013 CBS report about 70% of Americans take prescription drugs and about 20% take 5 or more. Before the ACA even people taking common drugs to control high blood pressure or mild depression paid more for health insurance they purchased themselves. Those who were bi-polar or had sleep apnea, diabetes, seizure disorders, cardiac problems or were cancer survivors had limited choices for health insurance and paid huge premiums. Even healthy women paid an enormous amount for maternity coverage. As a result, ObamaCare has lowered the cost of health insurance for many people even when their income is too high to qualify for a subsidy.

fallacy #4: “You can purchase health insurance anytime during the year if you are not applying for a subsidy.”
Even if your income is too high to qualify for a subsidy you must purchase your health insurance during the open enrollment or when you have a Qualifying Life Event, which gives you a 60 day Special Election Period to purchase a policy. Examples of a Qualifying Life Event are moving to a new state, losing coverage due to a job loss, getting married and the birth or adoption of a child.
Uninsured individuals can purchased Short Term Medical plans outside of Open Enrollment, but these plans do not cover pre-existing conditions and are not Affordable Care Act compliant. As a result they will not prevent one from paying a penalty for being without health insurance.

fallacy #5: “An uninsured woman can purchased health insurance outside of Open Enrollment if she discovers she’s pregnant.”
Some women with unintended pregnancies have been surprised to learn this is incorrect. If the pregnant woman is unmarried she can get married and her marriage will be a Qualifying Life Event which would provide a 60 day window for her to buy a policy. Otherwise she will have to wait until Open Enrollment.



6 Tips for Choosing the Best Dental Plan

Wanda 2 comments
Dental Insurance in Raleigh, NC

Unlike most people I enjoy going to the dentist. As a child I had a dentist who knew how to entertain his patients while performing dental procedures that were usually painless.  When my dentist retired his son took over the practice and continued the family tradition of making the patients feel at ease.  It’s good that I have always had access to exceptional dental care since I was not blessed with good teeth. My numerous childhood fillings resulted in a lot of crowns and root canals as an adult.

Fortunately my personal experience has helped me understand the important features of good dental plan and how to assist my clients in evaluating these plans. Here is my advice for buying dental insurance:

  1. If you are leaving your current employer and have a dental plan that fits your needs, your best option might be to take the dental part of COBRA.  Even if you do not take the medical part of COBRA, you normally can accept the dental and stay on it for 18months.  The monthly premiums might be lower than your other options.  If you have a child who needs braces and your current plan offers Orthodontia, you should stay on this plan. Dental plans that individuals purchase do not include Orthodontia.
  2. Although most dental plans cover 100% of two cleanings (preventative) per year, some will only cover one or require you to pay a co-pay or percentage. Make sure you understand what you will be required to pay for preventative.
  3. Dental plans usually have  a 6 month waiting period before they cover basic services such as fillings, extractions, oral surgery and root canals. For major services such as crowns and bridges there is often a 12 month waiting period. When you leave a dental plan they provide a Certificate of Coverage showing the start and end dates of your dental coverage. Some dental plans will waive these waiting periods if you can provide a Certificate of Coverage showing that you have not had a break in dental coverage of more than 63 days during the past 18 months.
  4. Check to see if your dentist is in the plan’s network and ask questions about how the plan will pay if you go outside of this network.  Since your dentist will probably not be able to perform all procedures such as root canals and oral surgeries, it is also important to know if specialists such as oral surgeons and endodontists are in the network in your area.
  5. Understand the cancellation policies and initial enrollment fees of all the plans you consider.  Initial enrollment fees and a 12 month requirement to remain on the plan are not a problem if you are a retiree or self employed individual who expects to be on the dental plan for a long period.  However, if you are currently unemployed, but expect to be employed within a few months in a job that provides dental benefits this could be a problem.
  6. When you do your cost comparison don’t just consider the monthly premiums. Also compare deductibles, yearly maximums and percentages that each plan pays for various procedures. Some plans will increase your yearly maximum if you remain on the policy a specific number of years.