Sarah O’Leary Offers Tips On How To Navigate The Affordable Care Act

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(credit: Adam Gault/Getty Images)

(credit: Adam Gault/Getty Images)

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STUDIO CITY (CBSLA.com) — Need health insurance?

Sarah O’Leary, owner of ExHale Healthcare Advocates, a company that helps Americans navigate through the healthcare system with the help of industry insiders and patient advocates, visited the KCAL9 studios Wednesday.

With less than 100 days before the Affordable Care Act goes into effect in California, Sarah has the tips and insider knowledge on what we need to know, what to look out for and what questions to ask.

There’s No Need to Fear!

• Americans have been told by a host of employers, political groups, media outlets, insurance companies and healthcare providers that the ACA is a dangerous enemy certain to fail catastrophically and take all of us down with it.

• If history is any indication, we can be pretty certain those trying to convince us of impending doom may be doing it for their own benefit, not to protect consumers.

• It is best to consider your unique needs and how the ACA may or may not affect you personally.

• If you look back to the decades leading up to the passage of Medicare, you’ll see many of the same groups are engaged in the fight against this latest healthcare reform.

• Today, people over the age of 64 couldn’t imagine life without Medicare. No system is perfect, but no system at all is dangerous.

• Many facets of the Affordable Care Act have already been enacted, and it’s already helping insure millions who would have gone without insurance otherwise.

• The federal web site, ACA.gov, is a good place to find information about the Affordable Care Act and how it may affect you. Millions of Americans who have insurance through their employer might not even notice a difference.

Open Enrollment for 2104 Begins October 1st

• The term “open enrollment” can be confusing for the average person who hasn’t purchased health insurance before.

• Essentially, it is a time period people can enroll into an insurance program or make changes to an existing insurance policy without risking a delay in their coverage or financial penalties.

• For individuals and small businesses owners who want to get health insurance through the Affordable Care Act, they can begin to enroll on-line through state (and potentially federal) insurance exchanges beginning October 1st. The open enrollment period continues through the first months of 2014. If you enroll by December 2013 (barring any unforeseen processing issues by the insurance company you choose), you will be covered by January 1, 2014. Insurers can no longer refuse care based on their assessments of pre-existing conditions, so the enrollment process should be easier than in the past for individuals.

Millions of Consumers Won’t Be Denied Health Insurance Because of Pre-Existing Medical Conditions

• This is an enormous change for individual/small business policy holders. Most Americans who have coverage through their employers (a group plan that isn’t based on an individual’s medical history) aren’t aware that small business and individuals have been subjected to higher insurance rates and denial and terminal of coverage based on how insurers judged their health.

• Prior to 2014, private insurers were allowed to decide what individuals they would approve or deny for insurance coverage based on pre-existing medical conditions.

• Each insurance company had its own (often somewhat arbitrary) list. A major PPO in Michigan, for example, counted acne and erectile dysfunction as potential reasons to deny an applicant coverage.

• Once you’ve been denied individual coverage, it is almost impossible to get it anywhere else. (Major insurers ask if you have been denied coverage by any other insurer because of a pre-existing condition on the application).

• If you could afford it and it was available, you could end up in your state’s high risk insurance pool, potentially paying hundreds of dollars more a month than your neighbor for the coverage.

• The government is also requiring that insurers include an expanded number of tests, exams, procedures and life events (such as pregnancy) in their policies. Coverage of certain mental wellness services will also be made available to individuals under their insurance plans.

Transparent Pricing and Competition is Good for Consumers

• States such as California made health insurance companies bid on the opportunity to sell individual and small business insurance policies through the ACA state exchange.

• This is a “cards on the table” approach to health insurance that can only help drive prices down for average consumers.

• The 13 insurers who are participating in Covered California, the name for the state’s exchange, will have to reveal their pricing structures policy details up front, allowing consumers to shop around for the best policy.

• This means that the insurance companies will have to work harder to win the individual’s business.

• Many experts predict that the competition and transparency will actually mean that those who have been insured individually in the past might get even better coverage for less than they pay now.

Individuals And Small Business Can Receive Take Credits for Participating

• Those who qualify can receive tax credits designed to offset the price of the insurance.

• If you do not get insurance before the deadline, you may be required to pay a nominal fine when you file your taxes. See IRS.gov for more information.

Understanding Your Insurance And Coverage Can Be Daunting

• No one should navigate through their healthcare alone. Whether you are trying to decide which plan to become a part of or you are experiencing the backlash of a procedure, which is followed by endless bills, an industry insider can really help the process.

• Whether it’s negotiating the cost of a procedure, battling a claim or being denied coverage for a needed treatment, you need someone on your side who will be your advocate.

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