Some Nevada County folks will get big benefits from “Obamacare” (officially, the Patient Protection and Affordable Care Act of 2010). Most people over 65 will feel no effect.
Folks under 65 can get health care coverage starting Jan. 1, and some will find the terms and the net cost very attractive. For Nevada County, two private insurance companies offer plans for all adults, and they will no longer examine your health history, which is great news for many people.
The state’s program for implementing PPACA is called Covered California. People will be able to sign up online or through insurance agents who have gotten special training or eventually through other helpers or “navigators,” working out of local agencies and nonprofits. It’s still too early to sign up, or even to get exact prices and benefits, but we have estimates and previews. There are five levels of coverage, and the most popular plan will be the “Silver” level. Some low-and middle-income people on this plan will have a maximum yearly out-of-pocket share of costs of just $2,250 if their income is $22,980 a year ($1,915 a month) or less. Folks making more could face a share of $5,200 to $6,350 in a big illness. These figures are an improvement over most insurance plans available recently.
Your monthly cost for coverage will vary depending on income, too. Estimated cost for a 60-year-old earning $3,000 a month (adjusted gross income for a single from a tax filing of $36,000 a year) is $285 a month for the Silver plan, after a subsidy. Somebody with an AGI of $24,000 would pay only $132 for the same coverage.
Remember, these are estimated costs. Younger people will pay less.
The coverage compares well with the leading insurance plans in recent years. A primary doctor office visit will cost from $3 to $45, depending on your income. A yearly checkup is free. X-rays and lab tests have reasonable co-pay costs. For surgery or major care, there’s usually a $2,000 deductible before the insurance starts helping.
The bottom line for people who are under 65 without health coverage, or who don’t like their plan, or whose plan ends: look up your adjusted gross income from your 2012 taxes and keep that tax form handy; between October and February, find a local agent or someone working with Covered California or find a good Internet connection to shop for yourself. Watch the fine print and the choice of doctors and hospitals because your choice will be more restricted in this new batch of plans.
The new law makes no major changes for people over 65 and on Medicare. The Medicare system and the supplements and drug plans and Medicare Advantage plans all continue. As fall approaches, it’s a good time to review your coverage so you understand its co-pays and shares of costs.
Free public information sessions to explain Medicare and the insurance options continue Sept. 9, Oct. 7 and Oct. 21 (all Mondays) at both 2 p.m and 7 p.m. at Perko’s in Glenbrook Basin. Reserving a seat is helpful but not mandatory (call 530-272-4650).
David Unterman, of Best Policy Insurance, has specialized in health insurance in Nevada County since the late 1980s. He’s licensed and trained in insurance programs for all age groups. He likes to answer questions about Medicare, Covered California and health insurance. Reach him at 530-272-4650 or by email David@bestpolicyhealth.com