“Do I need to be on an Obamacare plan (Affordable Care Act),” this is a comment I hear about 50% all the time when I first speak to a new client. The fact is if you have NO major pre-existing conditions, you do not have to be on an Obamacare plan. Also, the good news is that the IRS Individual Mandate is now history.
The IRS announced early Tuesday, February 14, 2017 that it will no longer require tax filers to indicate whether they had health insurance during the previous year.
So which plan is right for you? Obamacare or Non-Obamacare?
Non-Obamacare Plans were created for people who have no major pre-existing conditions. Major pre-existing conditions are heart disease/stroke, cancer, chronic obstructive pulmonary disease (COPD), diabetes, human immunodeficiency virus (HIV), and substance abuse. What are the benefits of these plans?
- Nationwide PPO (excellent coverage for doctors, office visits, hospital stays, surgeries, and prescription drugs)
- Lower deductible and out of pocket costs
- Fully customizable (you choose how much you want to pay for your monthly premium, deductible, etc.)
- ½ the cost of an Obamacare plan
- Sign up anytime and cancel anytime during the year
- Multiple carriers who offer Non-Obamacare
Obamacare Plans were created for people with major pre-existing conditions (heart disease/stroke, cancer, chronic obstructive pulmonary disease (COPD), diabetes, human immunodeficiency virus (HIV), substance abuse or for people who need maternity care or invitro fertilization. What are the advantages of Obamacare plans?
- Every legal US resident is eligible for an Obamacare plan
- There are no medical questions in order to qualify
- Depending on how a family income compares to the Federal Poverty level, family size, and how much healthcare insurance costs where you live, individuals and families can qualify for a subsidy
The disadvantages of Non-Obamacare Plans are:
- Doesn’t cover major pre-existing conditions; however, if you do get sick while on Non-Obamcare, you can switch to an Obamacare Plan during open enrollment
- There are a few medical questions that a new client needs to answer
- The plan is only available to healthy individuals who have no major pre-existing conditions
There ARE a few disadvantages of having an Obamacare plan as well.
There is only one carrier that offers an Obamacare (which does increase your premium somewhat due to no carrier competition)
- The networks are limited to only counties and cities
- If you get sick or hurt out of state, your plan will not cover 100% of your bills
- These plans are mostly HMOs which means these plans are not portable
- Because everyone qualifies for an Obamacare plan, the premiums are very costly due to the many sick individuals on these plans. There is a shared cost to help people with surgeries, medications, and more
- You do not get to customize your plan meaning you do not get to choose your monthly premium, deductible, etc.
- Open enrollment is only once a year between November through December
After comparing the Non-Obamacare plan to an Obamacare plan, you can see that individuals with MAJOR pre-existing conditions only have ONE choice and that’s to get Obamacare. Healthy individuals with NO major pre-existing conditions have a choice between an Obamacare plan and a Non-Obamacare plans. This is not a knock against Obamacare plans, but they are very expensive, very limited networks, one provider in most states, and high out of pockets. In addition, without what is called a qualifying life event, you cannot get an Obamacare plan until Nov. 1st 2017. Which plan works best for you?