If you’re a baby boomer, you may feel you’re at the prime of your life. The kids are out of the house, and you have the freedom to start over if that’s what you choose.
For some that may mean pursuing a long-held dream, like starting a small business, or devoting more time to volunteer activities. But boomers face special challenges as well. Many people get their health insurance from their employer. The reality today, however, is that many people have lost their health insurance after being downsized. Some simply go without coverage – buying a private policy can be pricey. Others have been denied coverage due to an existing condition or a history of health problems. And yet baby boomers, the oldest of which are now in their 60s, need health insurance the most.
Now, with the the Affordable Care Act law, things have changed. Since January 1, 2014, most everyone is required to have health insurance. Those who choose to go without insurance may face a tax penalty that starts at 1% of income (or $95, whichever is greater) for the 2014 tax year, and go up to 2.5% of income (or $695, whichever is greater) by 2016. Many people are, understandably, concerned about the price tag. Fortunately, the law has made provisions to offset the cost for folks who may need help. The law has also added consumer protections. Every plan is required to provide a core package of key benefits, and more of your medical bills are covered – in the end saving you money.
Some important shifts have taken place. Insurers must cover the cost of preventive care at 100% when you use a doctor in your network. This includes annual check-ups and screenings for blood pressure, cholesterol and other potential health problems that can start in middle age. Women can receive physical exams and preventive screenings, such as mammograms and Pap smears, with no co-pay or meeting a deductible.
There’s a slew of other changes that affect your health plan: Insurers can no longer put lifetime limits on the dollar amount of your covered healthcare expenses. Annual limits were phased out as of January 1, 2014. This is especially important to individuals facing medical expenses for the long-term treatment of conditions such as cancer or diabetes.
More big shifts happened in January, 2014. No one who applies for insurance can be turned down because of a pre-existing condition. And your premiums can’t be more than three times the rate of a young person.
Plans must now include a minimum of “essential benefits”, including lab services if your doctor orders blood tests, prescription drugs, and the cost of hospital care. Given such coverage, you don’t need to sweat it financially if you need a monthly supply of medications or even hip replacement surgery. However, the additional benefits mean plans will have somewhat higher premiums.
If you don’t currently have insurance and don’t have access to a group plan through an employer, you need to buy an individual policy or pay a penalty. One way is to use the online Health Insurance Marketplaces. Some states chose to set up their own Marketplace, and others used or partnered with a federally-run Marketplace. Either way, they’re designed to be a one-stop shop for comparing plans and prices from a variety of health insurance companies. Health plans are required to provide a document called a “summary of benefits and coverage.” Similar in concept to Nutrition Fact labels on packaged foods, all plans use the same format to compare plans “apples to apples.” They also include coverage examples for scenarios like breast cancer treatment. If that still seems a bit overwhelming, you can buy directly from insurers like Humana, where you’ll find an even wider array of plans from which to choose, or contact an insurance agent.
Many people have questions about fitting health insurance into their budget. The law includes a few rules to help make the costs of insurance more manageable for individuals and families that meet certain criteria.
On January 1, 2014, government subsidies kicked in. If you buy your insurance using the online Marketplace and meet certain income requirements, you could get help paying your premium with a monthly tax credit and your deductible or co-pays may be lowered. States also have the option to expand Medicaid coverage to more people by loosening income guidelines.
Budgeting for healthcare is just one way to remain financially solvent through your retirement years. You’ll want to familiarize yourself with the rules, so you can make well-educated choices. That way, you can relax and enjoy the prime of your life.
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This information is only a high-level summary of certain provisions of the health care law. This information does NOT attempt to summarize all provisions of the health care reform law. This information is not and should NOT be used as legal or tax advice; it should not be used as a basis for decisions regarding how the health care reform law will affect you and/or your business. Should you have any questions on how the health care reform law (including the high level summary of certain provisions of health care reform) will affect you and/or your business, you should seek professional advice from attorneys or other advisors.
Insured by Humana Insurance Company, Humana Health Plan, Inc., Humana Health Insurance Company of Florida, Inc., or Humana Health Benefit Plan of Louisiana, Inc. or offered by Humana Medical Plan Inc., Humana Employers Health Plan of Georgia, Inc., or Humana Health Plan of Texas, Inc.
For Arizona residents: Insured by Humana Insurance Company. For Texas residents: Insured by Humana Insurance Company or offered by Humana Health Plan of Texas, Inc.
Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, call or write your Humana insurance agent or broker.