Options For New Health Care Law

Health insurance broker breaks down Affordable Care Act choices for Gila County residents


by Tom Russell, Special to the Roundup


Tom Russell

Though off to a rocky start, the Affordable Care Act’s healthcare.gov Web site will likely be operational within the next few weeks.

The latest available information reports the site will be operational by Nov. 30.

Waiting for the bugs to be ironed out is probably wise, since you have until Dec. 14 to enroll for insurance coverage with an effective date of Jan. 1, 2014. Enrollments will be allowed through March 31, and with the recent Web site glitches, that may be extended.

At this time, Medicare beneficiaries are not impacted by the Affordable Care Act. They do not have to visit any online exchanges to enroll for 2014. If you are on Medicare, you can safely ignore the details in this article, and ignore anyone who calls you or stops by your home to “enroll you in Obamacare.”


Five companies offer health plan choices on the federal healthcare.gov exchange, that are accessible to Gila County residents. As you shop, keep these seven key points in mind: 

1. Provider Networks

Some of the plan choices available to Gila County residents have provider networks limited to Maricopa County. Carefully consider the provider network attached to the plan(s) you’re considering. Don’t look at price alone. A plan with a slightly higher premium, with a strong Gila County network, could result in a lower overall cost when time and travel cost is taken into consideration.

2. On & Off Exchanges

Not everyone will need to purchase a health plan through the federal healthcare.gov Web site. Other choices exist “OFF EXCHANGE.” Only applicants who qualify for a federal subsidy based on their income, must use the healthcare.gov “ON EXCHANGE” Web site.

Whether you purchase coverage ON or OFF Exchange, you cannot be denied for pre-existing conditions, and you will be asked no health questions.

3. Subsidies

Subsidies exist for individuals earning less than approximately $46,000 a year, couples earning less than $62,000 per year, and a family of four earning less than $94,000. Google “Kaiser Subsidy Calculator” for estimates.

Qualification is based on your projected Modified Adjusted Gross Income for 2014. Consult your tax professional.

4. Grandfathered Plans

Some people have a Grandfathered Plan. These policies have an effective date prior to March 23, 2010. If you have one, you can keep it. However, what is the premium on your Grandfathered Plan? Are there (specific to you) health condition exclusions in your Grandfathered Plan? It could be wise to explore your options.

5. Plan Choices

Whether you buy ON or OFF Exchange, you’ll have choices between Bronze, Silver, Gold and Platinum plans. You’ll also see a plan option called “Catastrophic.” This option is for people under 30, or for those who can prove a financial hardship. If you qualify for a subsidy, it is based on the cost of the Silver level plans. Once you obtain your subsidy amount, you can stay with a Silver plan, or you can buy up or down.

For example, if you apply your Silver level based subsidy to a Bronze plan, it will be less insurance, but probably less cost to you. Those who make less than 250 percent of the Federal Poverty Level will also have additional cost-sharing assistance, with lower co-pays and deductibles. Individuals or families who earn less than 133 percent of the Federal Poverty Level will qualify for Medicaid.

6. Health Saving Account

Health Saving Account (HSA) plans are alive and well with the Affordable Care Act. These plans allow you to choose a higher deductible policy with a lower cost, and add a tax-deductible savings account for your medical and dental expenses.

7. Enrollment

You can work your way through the plan choices and enrollment process on your own, or you can elect to have a licensed insurance agent assist you. If the agent has done additional training and certification, they can help you explore your options and enroll ON EXCHANGE, as well as OFF EXCHANGE. You pay no additional premium if you choose to have the assistance of an agent.

Yes, there are many options with the Affordable Care Act, with the possibility of many more people obtaining insurance, or perhaps improving the insurance they have. This is something no one can afford to ignore. Know where you stand.

Tom Russell is an independent health insurance broker, serving the Rim Country for 20 years. He specializes in Medicare plans, and under 65 medical plans. He is licensed both ON and OFF the Exchange for the Affordable Care Act health plans. He can be reached at 474-1233 or www.TomRUSSELLinsurance.com.


don evans 3 years, 2 months ago

Barry care. Can't you just feel that chill running up and down your leg? Could this be the beginning of the second coming?


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