After Randi Redmond Oster”™s son suffered from complications following a surgery, she began to take note of the health care industry”™s dysfunctions.
A former executive at General Electric, Oster says the list of inefficiencies throughout the health care industry is endless. But now that her son”™s illness is in remission, Oster is on a mission to help others navigate the health care “minefield,” using her business and leadership skills.
She”™s held three dozen talks to more than 1,000 Fairfield County residents and in January, her book, “Questioning Protocol: An Empowering Toolkit and Personal Memoir,” will be published. With the Affordable Care Act slowly taking hold, Oster has shared with the Business Journal the top five questions she most often hears. Her responses are as follows:
1. How do I know if my plan will be canceled?
Your insurance company is required to send you a notice within 90 days of cancellation plus:
Ӣ Offer you the chance to buy any of the companyӪs plans available to you in 2014.
Ӣ Tell you about your option of using the state marketplace to shop for coverage.
You can also shop for plans outside the state marketplace and get private insurance directly or with an insurance agent.
2. Do I qualify for subsidies?
Individuals who earn up to $45,960 a year may qualify for tax credits to help cover their monthly health insurance premiums. Families may also be eligible, depending on income and size. For example, a family of four earning up to $94,200 a year might qualify. Some individuals may also qualify for cost-sharing reductions that lower the amount they pay out of pocket for essential health benefits. To see if you qualify in Connecticut, visit Assess Health CT”™s website.
3. What are the benefits of the insurance products on the exchange?
Starting Jan. 1, the following “essential benefits” must be included under all insurance plans with no lifetime or annual dollar limits:
Ӣ Emergency services
Ӣ Hospitalizations
Ӣ Laboratory services
Ӣ Maternity care
Ӣ Mental health and substance abuse treatment
Ӣ Outpatient or ambulatory care
Ӣ Pediatric care
Ӣ Prescription drugs
Ӣ Preventive care
Ӣ Rehabilitative and rehabilitative services
Ӣ Vision and dental care for
children
4. What is my penalty if I don”™t get coverage?
As of Jan. 1, most U.S. residents will be required to have health care coverage. The federal government has set the following tax penalties for individuals who do not have coverage:
For 2014, $95 or 1 percent of your gross household income over the federal income tax filing threshold ”” whichever is greater.
By 2016, the penalty increases to $695 or 2.5 percent of your gross household income over the federal income tax filing threshold ”” whichever is greater.
5. How do I protect myself?
Learn. Find out about the new offerings and compare to your current plan. Go to www.accesshealthct.com and find out if you are eligible for subsidiaries. Also, when you choose a plan, verify that the plan covers your doctors, specialists and any drugs you may be taking. Also, find out if your preferred local hospital is considered in-network with your plan.
Good article Jennifer, however it should be noted that the answer to Question #3 above is misleading. As of January 1, 2014, all individual and small group medical plans must include the essential health benefits. This applies to all plans purchased on or off the exchanges. Therefore to imply that this is a benefit to purchasing plans on the exchange is misleading.
However, a benefit to enrolling on the exchange is the ability to apply for subsidies to assist in the payment of medical premiums for those whose incomes fall below certain income levels as discussed in Question #2.