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Protecting What Matters Most


The Affordable Care Act - Is It Really Saving You Money?

More than a year has passed since the full rollout of the Affordable Care Act, but myriad questions and concerns about the legislation are still resonating throughout the nation. In fact, analytics show that there are roughly 14,800 monthly Google searches for the query “Affordable Care Act” in the state of Texas alone. One question on the minds of many is, “Is the Affordable Care Act even ‘affordable’ at all?”

7 Major Transformations the Affordable Care Act Made

Texas is one of 26 states that have opted to have the state’s Health Insurance Marketplace operated by the federal government. With the highest percentage of uninsured residents in the country, 25% of Texans were uninsured prior to Open Enrollment this year. This percentage fell to 17% by March 2015.

According to this study conducted by Rice University’s Baker Institute, the decrease in uninsured is almost entirely attributed to a rise in individually purchased health plans. In addition to the 32% decrease in uninsured Texans, here are seven major healthcare transformations that can be attributed to the ACA:

  1. Health insurance rates are now based on age, location and smoking status.

  2. Approval is now guaranteed, but the cost of coverage can be higher as a result. Gone are the days of denial for pre-existing conditions, as well as waiting periods to get approved for coverage.

  3. The ACA created a nationwide Open Enrollment period for new enrollees. From November 15th to February 15th each year, individuals have a chance to enroll in a plan of their choosing, as long as they are not eligible for group insurance benefits.

  4. The date coverage begins is contingent upon the date you apply for coverage. For example, if you apply from November 1st to 15th, your insurance will begin on the first of December, but if you apply between the 15th and 30th of November, your insurance won’t become active until January 1st.

  5. The Affordable Care Act provides a special enrollment period for those that have a qualifying life event such as a new baby, marriage or divorce. Plus, if you lose coverage, you have 60 days from the time your coverage was lost to enroll in a new plan without penalty. This helpful article gives greater detail on qualifying life events, per ACA legislation.

  6. Low and middle-income individuals in Texas are now eligible for government subsidies to their monthly health insurance premiums. Subsidies are available for those who make between 100-400% of the federal poverty level. The specific amount of the subsidy is based on income, age and the cost of insurance in the area. For 2015, the 400% federal poverty level income cap for ACA subsidies is $46,680 for single person, $62,920 for a family of two, and $79,160 for a family of three.

  1. Employers with over 50 employees are now required to offer health insurance and pay 50% of the employees’ insurance premiums.

So, do physicians save money with the ACA?

The answer to that question really depends on the stage of your medical career you are in, as well as on health-related factors.

Medical students and medical residents who have a lower income may benefit from ACA subsidies, making coverage more affordable that it was a few years ago when those subsidies did not exist.

However, for established physicians with incomes well above the subsidy cap, it’s likely that healthcare premium costs will actually be adversely affected by the ACA’s impact on healthcare costs globally.

No exclusions for pre-existing conditions and no coverage waiting periods are a double-edged sword. These ACA provisions can be a literal lifesaver for those who need coverage for serious health issues, and who would have been denied coverage in the past by insurance companies seeking to mitigate risk and keep costs low. But with companies now forced to accept all applicants regardless of health condition, premium costs are on the rise.  

With an end goal of providing affordable, high-quality health coverage for all Americans, the ACA still has a long road ahead to become a success. One thing is for certain when it comes to the Affordable Care Act -- finding the right health coverage in today’s tumultuous insurance marketplace can be a challenging task for busy physicians. Our sole focus at TMA Insurance Trust is serve Texas physicians in order to meet their personal and group insurance needs. Contact us today and let us help you navigate the ACA to ensure you have the very best coverage in place for you, your family and your staff.

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