Last year we took the kids to one of those bounce houses with the huge inflated slides, ball pits and giant air-filled obstacle courses. The afternoon was full of delighted squeals and happy sweaty kids until… I heard a shriek behind me. I turned around to see my tiny six year old holding her arm with huge tears rolling down her face. I tried to hold off the panic as best I could as we quickly piled the kids in the car and made a beeline to the emergency room.
That was one of the worst experiences I have had as a mother. Not knowing if it was a break, sprain or something else completely. All I knew was that my tough, brave little daughter was now bawling to the point that she was finding it hard to breath. I couldn’t imagine being in a situation like this and not having insurance.
Did you know that 15.4 percent of Americans were without health insurance in 2012? They don’t have protection in case of injuries or illnesses which could cause a crippling financial burden for individuals or families. Just our emergency room visit, the x-rays and the follow up appointment with my daughter’s pediatrician came in at 3K! That was just her arm that ended up just being badly sprained. Our bill was not even that much when you consider that a 3 day hospital stay can be up to $30,000!
Health insurance will soon be changing with the Affordable Care Act (ACA). Many new options will be available and enrollment starts on October 1, 2013, so we better start learning about all of the changes to make sure we make the right choices for our families.
There will now be four options:
1. Continue purchasing health insurance through an employer
2. Buy health insurance through exchanges, direct for insurance companies or through traditional brokers
3. Enroll in government programs like Medicaid or Medicare if eligible
4. Go without insurance and pay the tax penalty
A health insurance exchange is a marketplace and functions similar to Amazon.com or Expedia.com. It allows you to compare health insurance options. Coverage will begin January 4, 2014. Under the ACA, you can receive preventative health care at no cost and you can’t be denied for pre-existing conditions. Financial help will be offered to families of four with an income below $92,000/year (and $45,000/year for individuals).
Anthem will make decisions easier by offering online tools that you can use to help you choose the right coverage for your family and a subsidy estimator for qualified individuals and tax credits for small employers.
All plans will offer:
- Emergency services
- Maternity & newborn care
- Mental health & substance use disorder services
- Preventative and wellness services
- Chronic disease management
- Pediatric services including oral and vision care
- Preventative care for women (mammograms, well woman visits, contraceptives, etc.) and women won’t be charged more, or be denied for pre-existing conditions and primary care, OB-GYN and pediatricians can be chosen w/o referrals
Plans will come in levels:
Anthem is negotiating best rates for covered products and services making the plans less costly for members. The levels are based on the percentage each plan pays of the average overall cost of health benefits. Each level will have a few plans to choose from. Platinum plans will have the highest monthly premium but will cover 90% of the expected costs while the Bronze plans will be the least costly for the monthly premiums but will only cover 60% of expected costs.
I hate spending time in the waiting room and then waiting for the doctor in the exam room only to have him/her practically run through the room and out again to the next patient. Anthem wants to bring members a better experience by the doctors spending more time with patients and coordinating all aspects of medical care. They offer primary care physicians incentives to spend more time with patients and focus on preventative care. How wonderful will that be?
There are a few things that I want to talk through with my husband before making a decision for our family. Especially with kids, we will need access to health professionals 24 hours a day, five days a week. Health and wellness initiatives are definitely important for how we want to live our lives to help prevent health issues. Tools to help us compare doctors and procedures would make the decision easier. And I really like having an insurance company who has friendly and yet speedy reps to help if I have questions or concerns. We have to make sure that the products and prices meet our needs as a family.
If you would like more info visit:
- Healthcarereformforyou.com to find out what reform laws mean to you and for timelines and enrollment.
- Anthem.com for more information about the ACA and also for tools to help deciding on a plan easier.
- Kff.org for info from the Kaiser Family Foundation
Disclosure: This is a sponsored post from Anthem Blue Cross and Blue Shield and The Motherhood.