Consumers should get informed about ACA
Micah Trautman
MOSES LAKE - Consumers should ask questions - a lot of questions - with the implementation of the Affordable Care Act, and that could save them some unpleasant surprises when it comes time to pay the bill, according to local insurance agents.
"You need to understand and participate in the process to keep your costs down," said Micah Trautman, an agent with Basin Insurance Associates in Moses Lake. He cited the options available to Grant County residents as an example.
The law requires Americans to purchase health insurance, and people who don't sign up are assessed a penalty, subject to some exemptions. Undocumented aliens, jail inmates, self-insured people or businesses, and people whose income is below the threshold for income tax won't be assessed a penalty, Trautman said. There's also a penalty exemption for people with religious objections, but the rules on what constitutes a religious exemption aren't clear, he said.
The law sets up a state-operated insurance marketplace, called an exchange. In Grant County, people looking for insurance as individuals or families have access to three plans offered by two different insurance providers, Trautman said.
Each includes health care providers within its plan, called a network. That's not new to the insurance market, Trautman said, but what is new is that some companies - including the ones that provide health insurance in Grant County - are reducing their networks to save money.
In Spokane, most health insurance companies had networks that extended to a number of different hospitals. Now the companies that offer plans in Grant County have a contract with Deaconess Medical Center, and that's it, Trautman said. A patient who goes to another hospital may end up paying out of pocket for some or all expenses incurred there, he said.
The same principle applies to the whole health care process - everybody who would get payment in the case of a patient who needed a knee replacement would have to be in the insurance network, Trautman said. That's the primary care provider, orthopedic physician, even the doctor who administers anesthesia, he said. It could be up to the patient to pay for any services from health care providers not in the network.
"You need to know what that provider network is," he said.
Patients also should ask about procedures, and how procedures are listed for billing purposes. A procedure that could quality for insurance payment if it's listed as preventative care might not be paid for if it's called something else, Trautman said. In that case the patient might be responsible for the bill, he said.
Under the law, patients have access to up to four levels of insurance plans, depending on where they live and their income. People who have incomes up to 400 percent of the poverty level are eligible for what Trautman called "point of sale discounts" and tax credits under certain circumstances.
Trautman said the discounts are based on the customer's income, and on the mid-price plan, called the silver plan. The discounts don't necessarily change if a consumer buys a higher cost (gold) or lower cost (bronze) plan. "It (the discount) goes further with the bronze plan and it does with the silver" or the gold plan, Trautman said.
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