Navigating the Affordable Care Act — How it affects you and your practice

The health insurance landscape continues to change significantly with each implementation phase of the Affordable Care Act (ACA) and members have started asking us about how it affects them. In response, the WSBA’s Law Office Management Assistance Program is rolling out a new series to better acquaint our solo and small firm practitioners with the changes the ACA brings.

We encourage you to look for our weekly blog post and watch for other updates and information coming soon to the WSBA website.

Washington’s Health Insurance Marketplace is Open

Most folks know by now that they must have health coverage in 2014 or pay a fee pursuant to the ACA. If you do not have health insurance, the penalty for most is the greater of $95 per adult and $47.50 per child, or 1 percent of your income. It is important to note that this fee increases quickly: By 2016 it is 2.5 percent of income or $695 per person.

The Washington Health Insurance Marketplace, Washington state’s Exchange for the ACA, opened its virtual doors on Oct. 1, 2013. If you enroll by Dec. 15, 2013, coverage begins Jan. 1, 2014 (or earlier in certain circumstances). If you enroll after Dec. 15, 2013, coverage should begin the first of the following month. Open enrollment ends March 31, 2014. After that, the penalty will apply.

What the Marketplace Does

By giving minimal information (birthday, zip code and county) you can see the plans available to you, access more information on the carriers and details of the plan, and determine your monthly premium, deductibles, and out-of-pocket costs.

A check for Medicaid or the Children’s Health Insurance Program (CHIP) eligibility is made and, if eligible, the application can be done on the spot. More folks will qualify because Washington’s Medicaid program will expand.

Five Reasons You Should Visit the Marketplace Even If You Have Insurance

• You may find insurance (or better insurance) for you and your family. Savings is income-based, but not only indigent clients benefit (though savings is greater as income decreases). For example, a family of four with combined incomes of $94,200 would likely be eligible for savings.
• There are caps on out-of-pocket expenses for certain income ranges.
• It is a valuable comparison tool with plan benefits and feature options presented in a standardized format. The Marketplace requires all providers explicitly set out benefits, monthly premiums, out-of-pocket costs, and deductibles.
• You are guaranteed to view plans that cover the essential health benefits, pre-existing conditions, and preventative care. In private markets, some plans need not rise to this new standard, but it is required for all of them at the Marketplace.
• You should get used to it, because updating information that affects eligibility (e.g. marriage, divorce, or change in job) can be done here in the future.
• Sometimes you are eligible for insurance through the Marketplace even if you have insurance. If your job-based health plan does not cover the new minimum standards or it costs more than 9.5 percent of your household income, you could make a switch at the Marketplace. (To do so you will need your employer’s plan information.)

We encourage you to check it out. The Marketplace is getting a bad rap in the media right now for being fraught with problems, but it is still the first step in taking charge of your health care decisions and it has a wealth of beneficial information.

Tell us what you most want to know about the ACA today by commenting or emailing us at lomap@wsba.org. We will do our best to incorporate your questions and feedback into this ongoing Navigating the ACA series.