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.