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How the Affordable Care Act Affects Retirees

How the Affordable Care Act Affects Retirees

Six points to review with your clients

The long anticipated roll out of the Affordable Care Act has come and is in full swing now.  Aside from some technical glitches during the first month, the health insurance exchanges are operational and open for enrollment.  However, many of your clients may still have lingering questions, especially those clients in the baby boomer generation.  Here are some things to keep in mind as you contemplate how the new Affordable Care Act will affect your clients.


Qualification Guidelines

If your client currently receives health care coverage through his employer, he won’t be eligible to choose a health insurance option on the health exchanges. These marketplaces are for those purchasing non-group insurance for themselves or their families. However, companies that have less than 50 employees will be able to apply through the health exchange. Those age 65 or older who are on Medicare won’t have to do anything to continue receiving their government benefits.  Medicare fulfills their insurance requirement.

If your client doesn’t have coverage through his employer, Medicare, Medicaid or some military or veteran’s plans, he will need to purchase health care or pay a penalty come April during tax time.


No More Denials

In the past, many baby boomers were worried about being denied access to health insurance benefits because of their health. This is now a thing of the past.  Beginning in January 2014, insurance companies can no longer deny insurance because of pre-existing conditions; those with pre-existing conditions such as high blood pressure or diabetes can’t be charged more because of their health status or be issued a policy that excludes coverage for specific conditions.


Deadlines to Remember

Coverage on marketplace health plans will begin on Jan. 1, 2014.  Open enrollment runs until March 31, 2014. If your client enroll between the 1st and the 15th of the month and pays his premium, his coverage will begin the on the first day of the following month.  Therefore, if your client wants health insurance to begin on Jan. 1, he must be enrolled by Dec. 15 and pay his first month’s premium.

If your client enrolls for insurance between the 16th and the end of a month, his coverage will be effective on the first day of the month after that.  For example, if your clients enroll on March 31, the last day to enroll and pay the premium, his insurance will begin on May 1.


Enroll in the Proper State

If your client is fortunate enough to spend part of his year in another state, he must pay attention to which state he signs up in. Each state has its own health insurance marketplace, and your client must sign up for your insurance in the state of his primary residence. If your client is a snowbird who splits his time between states, he’ll have a choice of multistate plans available to him on the marketplace.

If your client moves his primary residence out of the state he signed up in, he’ll need to re-enroll for insurance coverage in his new state.  Such a move will allow him to sign up for insurance outside of the open enrollment period.


Forget about Job Lock

Some may feel they are locked into their current insurance policy at their present job until they become eligible for Medicare at age 65.  This is likely because they developed a medical condition while under their current policy that will preclude them from qualifying for a new health insurance policy elsewhere.  Now that insurance companies can’t turn individuals down or charge them more for pre-existing conditions, it will stimulate job mobility among the baby boomers.  It’s expected that this change will encourage many to start their own businesses or even consider early retirement.


Rates Can Still Increase

With the new law, insurance companies can no longer increase your client’s premium at a renewal time after your client has been diagnosed with a disease such as cancer.  Rates can increase, however, across the board for everyone who brought the same plan from the same insurer.  Premiums will stay the same throughout the calendar year, but can be increased from year to year.

This initial coverage period runs from Jan. 1 through Dec. 31, 2014.  If insurers find that they’re paying out more than they planned for on policies offered on the marketplace, they will likely increase premiums the following year. This will be stated during the open enrollment period for the following year, and consumers will have the option of choosing another plan.



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