New Developments with Health Insurance…by Laura Sedlacek

Special to the Caldwell Journal (By Laura Sedlacek – 03/06/2017)…Everyone’s heard of “Obamacare,” right? The correct name is actually the Patient Protection and Affordable Care Act most often abbreviated as ACA. “Obamacare” is just a nickname! However, Obamacare and the ACA are the same thing!

The ACA is made up of the Affordable Health Care for America Act, the Patient Protection Act and the health care related sections of the Health Care and Education Reconciliation Act and the Student Aid and Fiscal Responsibility Act. It includes other amendments as well.

The ACA is a long complicated piece of legislation that attempts to reform healthcare. Reforms include new benefits, protections, rights, rules for insurance companies, tax breaks, taxes, spending, funding, etc. The reform of healthcare doesn’t start and end with the ACA itself.

With the recent Presidential election, you can expect more changes with the ACA and of course it’s possible partial or full repeal. So far an agreement on exactly how to repeal it and/or replace it hasn’t been fully determined.

Suggestions include: refundable tax credits for all based on age instead of advanced tax credits based on household income, expansion of Health Savings Accounts (HSA’s) which are paired with HSA eligible High Deductible health plans, repeal of the mandates for not having health insurance coverage, removal of the minimum essential benefits instead letting each State decide what constitutes those benefits, taxing employer sponsored coverage above the 90th percentile of current premiums similar to the “Cadillac” plan tax already in Obamacare and removal of Medicaid expansion which did not happen in North Carolina in the first place.

One of the newest happenings are “silent tax returns” meaning you can choose not to answer on your taxes the question of whether or not you have health insurance coverage. Another recent change is for Short-term Health plans. Short-term Health is interim health coverage to fill in gaps between jobs, after graduation or for someone waiting until Annual Enrollment comes around again to enroll in an Individual Health plan. As of April 1, 2017, though, the longest term you’ll be able to get on those will now be up to 90 days at one time. You can renew a Short-term Health policy, but you must qualify medically to do so. It’s important to note that these policies do not cover pre-existing conditions, do not meet the ACA’s requirements for having coverage, and require medical underwriting. They are exactly what they say they are: a short-term solution for coverage.

Despite all the rumblings in Washington of spikes in premiums, rising deductibles, and less carrier choices, more than 12 million people signed up for coverage for 2017. This shows there’s still a demand for coverage.

Predictions for 2018 indicate coverage choices will remain about the same as in 2017. The Annual Enrollment time period will have a shortened window to enroll as well.

Another prediction from the repeal of the ACA or from what Congress plans to do to it, is the removal of mandates to have insurance. Until the law is completely repealed and a new plan is in place, those of us buying or working in the health insurance market are faced with possibly many unanswered questions about the future of individual health insurance.

This much is certain for 2017, you can currently enroll on an Individual Health plan on or off the Marketplace if you have a Special Enrollment circumstance, if you have a business you can purchase a Group Health insurance policy for you and your employees, you can be exempt from the mandate (individually) if you have a Hardship Exemption, if you have no insurance you can purchase a Short-term Health insurance plan if you qualify medically, and you can keep your Grandfathered or Transitional health plan (group or individual). You can also purchase additional gap coverages such as Hospital Indemnity, Accident, Cancer, Disability, Critical Illness, Vision, or Dental plans. You can also use discount drug cards at your pharmacy.

Many questions surround healthcare and health insurance, but there are plenty of resources you can use to navigate the complexities:, reference materials at your local library or online, or your local insurance Agent. Take a little time, consider your options, and make your healthcare decision wisely. It goes without saying it’s never too early to start thinking about what you want to do for your healthcare coverage next year now.

Laura Sedlacek is an insurance agent at Bush and Associates in Lenoir. Find out more: Email Phone 828-754-2601 Facebook: bushassociates. Web:

Laura Sedlacek is a Caldwell Journal Contributor.

Copyright 2017 Caldwell Journal on behalf of Laura Sedlacek. All rights reserved.