Simple Explanation of Obamacare

Obamacare sticker shockCan Obamacare be explained simply? Is there a way to take a 2400 page law and offer an easy, simple explanation of  Obamacare, a complex law that affects ALL citizens, not just those who are currently insured? Will health insurance rates rise? Can I lock in today’s low health insurance rates?

  • Who is included in Obama-care?
  • Will I be allowed to keep my current plan?
  • Can I keep my current doctor?
  • How much will health insurance cost under Obamacare?
  • How much will Obamacare cut from Medicare? Will I have to pay more?

All great questions and typical of inquiries I get on a daily basis. Let’s start with a simple explanation of Obamacare, if that is even possible.


Obamacare Explained Simply

In the most basic terms, Obama-care requires everyone to have health insurance. Not only must you have a health insurance plan, but it must meet certain standards of coverage and affordability (as defined by the government). If you are not covered under a government plan such as Medicare or Medicaid, and do not have health insurance provided by your employer, you must purchase health insurance from an insurance company.


Who is Included In Obamacare?

Virtually everyone who is a citizen or is in this country legally must have an approved health insurance policy.


Will I be Allowed to Keep my Current Health Insurance Plan?

Probably not.

A simple explanation of Obamacare rules for plan design and “affordability” means everyone will eventually lose their current health insurance policy and replace it with an Obama-care approved plan.

You can forget “If you like the plan you have you can keep it.”


Can I Keep my Current Doctor?

Maybe, but not likely.

Patients with Medicare and Medicaid currently have difficulty in finding doctors willing to take on new patients. It is not unusual to wait 3 months or longer to get an appointment if you are a new patient. The same is true if you have a health insurance plan and go on Medicare, Medicare or have an “exchange” purchased health insurance plan.

If your health insurance was purchased through the exchange (now called the “marketplace”), good luck finding a doctor. A simple explanation of Obamacare includes a provision that requires doctors to provide health care at no charge if you fail to pay your health insurance premium. How many doctors do you think are willing to provide free health care?


How Much Will Health Insurance Cost Under Obamacare?

A lot.

Expect premiums to double for most. If you are under age 35 your rates may easily triple.

A simple explanation of Obamacare means insurance carriers are now required to issue coverage to anyone regardless of health. That means two people age 35, one is athletic trim while the other is 200 pounds overweight and takes 6 different medications, pay the same premium.

Rates will go up next year. But you can lock in today’s low rates and never have an increase in premiums until 2015. Click now to compare plans and rates for over 100 plans. 


How Much Will Obamacare Cut From Medicare?

A simple explanation of Obamacare is this. President Obama has directed Congress to reduce funding for Medicare by more than $700 billion dollars between now and 2020. If you are on a Medicare Advantage plan your premiums, copay’s, deductibles and out of pocket costs will go up.

If you have original Medicare and a Medicare supplement plan your premiums, deductibles and copay’s will increase. Georgia Medicare Plans offers free, no obligation quotes for over 40 different Medigap plans at this site. We showed one Georgia couple  how to save over $1700 in Medigap premiums by making a simple change in coverage.

How much can you save?

Is there a simple explanation of Obamacare? In a word, no. This far-reaching law affects everyone and very few people will be pleased.



Maternity Insurance Coverage in Georgia

If you are looking for maternity insurance coverage in Georgia you are out of luck. There are NO individual major medical health insurance plans that offer regular maternity benefits.

You can blame that on Obamacare.

maternity insurance coverageThree years ago several health insurance plans including Assurant (Time), Blue Cross (BCBSGA), Golden Rule, Humana and Kaiser Permanente included maternity options. Once Obamacare became law every carrier except Kaiser and Blue Cross stopped offering maternity insurance coverage.

Kaiser dropped maternity options two years ago and Blue Cross ceased to offer maternity insurance coverage in 2012.

PCIP, the government health insurance plan for those with pre-existing health issues was an option for many, but PCIP is bankrupt and not accepting new applications.

If you live in poverty, you may qualify for taxpayer funded Medicaid. Over half the live births in Georgia are paid for by taxpayers through the Medicaid program. Finding a doctor willing to accept Medicaid and a hospital that still has a maternity department is a challenge.

Several hospitals in the Atlanta area have closed their O.B. department and many in rural areas as well. For some, the nearest hospital with a delivery room is 2 hours away.

Approximately 30% of doctors in Georgia accept Medicaid patients and most of them do not offer obstetrical services.

However, all is not lost.

If you are not curently pregnant and are in good health you can still purchase health insurance and I can show you how to find doctors and hospitals willing to discount their services and work out a pre-payment plan. You can also fund your out of pocket costs on a tax deductible basis.

You have questions about maternity insurance coverage, we have answers.


No More Babies

Hospitals in Georgia are closing the maternity dept. and saying “No more babies“. Hospitals lose millions each year on maternity patients and closing the maternity dept. is one way of saving money.

Last year, Burke Medical Center faced some tough math in trying to keep its childbirth services going.

The 40-bed hospital in Waynesboro, in rural east Georgia, was losing more than $1 million per year on its obstetrical services.

Given the high overhead, a hospital must deliver 500 babies or more a year to break even on that service, says Stephen Shepherd, CEO of Burke Medical Center. “In rural areas, getting up to 500 babies is tough.’’

Georgia Health News

Hospitals that say “no more babies” is a growing trend.

Among Georgia’s “critical access” hospitals –- rural facilities with no more than 25 inpatient beds –- 32 of 34 have given up maternity services, according to Jimmy Lewis of HomeTown Health, a rural hospital organization.

About 60 percent of births in Georgia every year are covered by Medicaid, and Georgia physicians and hospitals say the government insurance program generally does not pay them enough to make up for the costs of the care. Georgia OB/GYNs have not had a Medicaid pay increase in more than a decade.

Mothers that rely on the taxpayer to fund the cost of labor and delivery might have to reconsider the consequences of their actions. You can’t expect doctors, hospitals and staff to perform services at a loss if you don’t have the means to pay for your care.

Obstetricians will not be getting an increase from Medicaid due to restrictions in Obamacare. In fact, most will be expected to take a pay cut.


Maternity, Be Careful What You Wish For . . .

Maternity benefits. The folks at Consumer Reports open their mail bag . . .

I'm pregnant. Can my health plan refuse maternity coverage?


Q. I thought I had completed my family, and was confident of never getting pregnant again because I had an IUD. So we bought an individual family plan from Blue Shield of California that excludes pregnancy. But I got pregnant anyway. I asked to be moved to a plan that covers pregnancy, and was denied because of my "pre-existing condition." Is this legit?

A. It sure is. In every health-plan underwriting manual I have ever seen, pregnancy is on the list of conditions that will get you turned down flat for new individual coverage.Moreover, the vast majority of health plans sold to individuals exclude maternity coverage. A recent study of some 3,300 individual policies by the National Women's Law Center, a Washington, D.C. advocacy group, found that only 12 percent included maternity coverage, and half of those were in the handful of states with laws that require it. In a few states, including Colorado, Connecticut, Nevada, and South Carolina, not a single plan available to a 30-year-old woman included maternity coverage.

In other states, you can get limited maternity coverage through an add-on rider that costs extra, but typically must wait a year or more before the benefits kick in, meanwhile paying an additional premium that may cost more than the basic policy itself.

"You can buy coverage in $1,000 or $2,000 increments, but by the time you've waited, you get back $100 or so if it's a normal delivery," says Judy Waxman, the center's vice president for health and reproductive rights. "It's just not worth it."This is one of many ways that individual health insurance is inferior to group coverage, which has included maternity care without exception for years.

But you, dear California resident, are in luck. Last year, California became the ninth state to pass a law requiring all individual health plans to cover maternity care. The new law takes effect July 1, 2012. According to a spokeswoman for Blue Shield of California, as of that date, the new benefit will automatically be added to all the company's individual plans, starting immediately. If your due date is any time after that, your remaining expenses for prenatal care and delivery will be covered.

The Affordable Care Act, aka Obamacare, will fix this problem for good. As of Jan. 1, 2014, all individual health plans sold in the U.S. must include maternity coverage. And you can sign up for a plan even if you're already pregnant, because insurers won't be able to turn you down for any pre-existing condition.

Yes dear readers, Obamacare will "fix" all that. Starting in 2014 all major medical plans will be required to cover maternity. Not only will men have to pay for maternity coverage, but so will pre-menstrual girls, post-menopausal women, sterilized women and those who, for any number of reasons, are unable to get pregnant.
Everyone will see their rates increase. How much? We will get an idea by looking at California.
Expect Dave Fluker to post something on his blog as soon as July rates that include maternity are released, but don't expect it to be pretty.
All this is part of that spreading around the wealth thing.

Maternity Insurance at Costco?

Maternity insurance at Costco? You can buy a 5 pound bag of potato chips, 30 rolls of toilet paper and now in some states you can also buy health insurance. But can you get it with maternity insurance?

Business Insider offers this information about their health insurance, including maternity insurance.maternity insurance

In partnership with Aetna, Costco will dole out the Costco Personal Health plan in several states, according to a company press release – Arizona, Connecticut, Georgia, Illinois, Michigan, Nevada, Pennsylvania, Texas, and Virginia, with more to be added later in the year.

Costco is following the path of Wal-Mart by offering health insurance to their members but do you really get a good deal?

The short answer is, no.

A quick check on Georgia health insurance from Costco including maternity insurance resulted in this finding.

They only offer health insurance through Aetna.

Aetna does not offer maternity insurance coverage. In fact, they never have included maternity insurance as an option.

They only offer 5 plans in Georgia. If you really wanted health insurance from Aetna you can buy it through Georgia Insurance Shop and have access to 10 different plans.

The rates for the Costco health insurance plan are slightly less but the coverage has been stripped. In other words, you get less coverage for a lower premium.

Well duh!

The less expensive plans (read higher deductible) do not cover ANY brand name drugs. One plan covers brand Rx only after a $4,000 deductible.

There is NO maternity care, unless you incur "pregnancy complications." This could be a major deterrent for many consumers, especially considering how important families must be to business.

Deductibles are sky-high, which is unfortunately a growing trend for private health care plans. For individuals, they range from $3,000 to $7,500 for in-network care and $6,000 to $10,000 for out-of-network care. For families, deductibles start from $6,000 to $15,000 for in-network and $12,000 to $20,000 for out-of-network care. 

Here's a clue to the folks at Business Insider. After Obamacare was signed all Georgia carriers stopped offering maternity insurance except one (BCBSGA). And don't forget that Aetna NEVER offered maternity insurance as an option.

Costco consumers who apply for insurance with Aetna will have to go through medical underwriting which means your premium can increase or you can be turned down.

Costco is a great place to shop for toilet paper but you can do much better on health insurance and we can show you maternity insurance options as well.

Preggers, No Insurance

What if you are pregnant and do not have health insurance? The responsible adult action is to "man up" and pay the bills. But why do that when you can get someone else to pay?

A man called looking for health insurance in Georgia. Wife is pregnant. They have not had insurance in "at least 3 years, maybe longer".

Rejected by several companies. Someone suggested he look at Georgia health insurance for the self employed.

That's how he found me. I help GA business owners find the right plan for themselves and their family. If they have 2 or more employees we look at options for group health insurance including the HSA (health savings account) or HRA (health reimbursement arrangement).

Yes, he owns a business with 5 employees.

Yes, we can set up a group insurance plan that will cover his wife's pregnancy.

The catch?

He has to cover his employees AND pay at least 50% of the premium. I estimated a minimum of $4,000 per month but probably more.

He balked at that and asked about something else that was suggested. Medicaid.

Yes, you may qualify for that but there are income requirements.

"I probably make too much money to qualify".

Well then, you can pay out of pocket. Negotiate up front with the doc and hospital. You should be able to get in the $6,000 – $7,000 range for a normal delivery.

"Any other options?"

Well, there is PCIP.

"How much?"

$220/month and no waiting period on maternity.


For the rest of us who plan ahead, there is an affordable Georgia health insurance plan.

Obstetricians Get the Bronx Cheer

According to the WSJ online, obstetricians in New York will not be able to renew medical malpractice policies issued by Medical Liability Mutual Insurance Company.

The hospital delivers about 2,700 babies a year. Many of the patients are teenagers or have diabetes, high blood pressure or other medical problems.

The letter cited a "method of practice" among the doctors that made them "an unreasonable burden" to other policyholders.

Wonder how many of their patients are on Medicaid?

Maternity Coverage in Georgia

Looking to buy maternity coverage in Georgia? Your options are limited if you want someone else to pay for your care. Blue Cross of Georgia is the only health insurance company offering maternity “insurance” at this time. Obamacare wiped out all the other options.

UPDATE: Click for current maternity options in Georgia.

If you want Blue Cross to assist in paying for the cost of your pregnancy you must buy the most expensive plan they offer then pay an extra $200 or so each month for maternity coverage.

If you want to use the maternity benefits you must wait 12 months before maternity benefits are payable. Your pre-natal care will be covered as any illness subject to copay’s and the major medical deductible.

When time comes to deliver you owe the hospital $3,000, Blue Cross pays the rest.

Not much of a benefit.

But you get access to Blue Cross discounts which reduce the total bill for pre-natal and delivery to about $6000 for a normal delivery. Add about $2,000 to that for a scheduled c-section.

If you are going to be required to fund the bulk of the cost of maternity any way a better choice would be to buy an HSA qualified high deductible plan and take advantage of discounts through Careington.

By pairing the two you save at least $150 per month in premiums (and usually much more than that) and get tax deductions as well.

Another advantage to using a discount plan such as Careington is there are no waiting period for benefits to begin. Unlike health insurance that will not issue coverage if you are already pregnant, Careington can be purchased any time, even if you are already pregnant.

Careington can also be used to generate discounts on pre-existing medical conditions not covered by your health insurance policy.

Affordable Health Insurance in Georgia

Georgia Insurance Shop has solutions for all of your health care needs, including maternity coverage.

Obamacare and Single Payer

For some reason, many think they want a single payer health care system. What they don't know is, Obamacare has already created that in some situations.

I had a call today from a lady looking for health insurance with maternity coverage. I told her how her options were limited to one carrier. When she asked why, I said this was due to Obamacare.

She became annoyed and said this is why we need single payer so the carriers won't hold us hostage.

At this point I had no desire to give singing lessons, so I thanked her for calling and went back to the business at hand. But that got me thinking.

If you consider states like Maine that have intense regulation and mandates with regard to health insurance then it doesn't take long to figure out the only choice other than a government plan is Blue Cross.

If you don't like or don't qualify for the taxpayer funded plan you buy from Blue Cross . . . and you pay some of the highest health insurance premiums in the country.

Obamacrap has come to Georgia already in a sense. Last spring if you wanted maternity benefits you could pick from about a half dozen health insurance companies and different kinds of maternity benefits.

Thanks to Obamacrap, now you have one choice.

Blue Cross.

If you want maternity coverage in Georgia you buy from Blue Cross. The additional premium (in addition to the regular premium on this "Cadillac" plan) is about $200 per month. You must pay that premium for 12 months before you conceive and then you can start to access the benefits.

Over a two year period (your one year waiting period plus another 9+ months waiting on the baby) you will pay in over $2,000 in additional premiums. Once the baby arrives and the bill is totaled, your share of a normal delivery will be about $5,000 and Blue Cross will pay less than $1,000.

Once Obamacrap became law every carrier but Blue Cross pulled out of the maternity market making them, in effect, a single payer.

Many will remember the days of Ma Bell when you got your service from AT&T (or one of their subsidiaries) or you didn't have phone service. Your phone came in a basic black (although they later added different colors for the Princess line), but your choices were limited.

And everyone complained . . .

Now we have phone service in all sizes and packages, and people still complain, but at least you have a choice. If you don't like your current phone company you can go somewhere else.

But in Georgia, if you want maternity coverage you pick Blue Cross. If you don't like what they have to offer you do without because Obamacrap has made them a single payer when it comes to maternity coverage.

So for those who think they want single payer, how is this working for you?

Affordable Health Insurance in Atlanta, Georgia

If you want health insurance and especially if you don't want a maternity benefit, Georgia Insurance Shop has health insurance plans to fit almost every need and budget. We have rates from all the top health insurance companies, including Blue Cross, but also Humana, Cigna and others.


Obamacare – The Impact on Georgia

How has Obamacare impacted the citizens of Georgia? How many HEALTHY children can no longer obtain health insurance on their own? How many women cannot purchase maternity coverage? How have rates and choices been impacted already by the implementation of Obamacrap?

As a result of Obamacrap, no child left behind has become all children left behind when it comes to health insurance.

Women of child bearing age who want to purchase health insurance to cover the cost of maternity have only one choice.

Prior to Obamacrap about a half dozen health insurance companies offered maternity benefits, now there is one. If you want maternity coverage you have to buy the plan a year before conception and pay an additional premium (roughly $200 per month on top of your regular health insurance premium). Once you become eligible for maternity benefits you will have to satisfy your major medical deductible (typically $2500) before anything other than office visits are covered.

That means most pre-natal testing is paid for by the mother, not the insurance company, until she reaches her deductible. A woman who conceives in the summer will have to satisfy two deductibles. One for the current year then a new one the following year.

In addition to the outpatient pre-natal care the mother is required to pay the first $3,000 of the hospital bill.

All thanks to Obamacrap.

On Tuesday, December 7, 2010 (Pearl Harbor Day) Rob Johnson of WGST AM640 in Atlanta will interview me live on the air at 7:50AM. You can listen on the radio or by clicking the link.

Wish me luck!