Q's on BC in a Obamacare world

[janine]

I'm not the biggest supporter of Obamacare but there are pieces I can appreciate. Especially if it lowers my costs at all. The only piece where this seems to be the case is for BC which from what I read is now free.

Except looking at newly released plans for my firm, they are still charging 20%after deductible, which might as well mean 100%.

I called and they said there is no change and the law is not effective yet. Huh?
Or does this mean 100% of 0 is zero.

Anyone run into this? I'm asking because I'm considering opting for the lowest cost plan to cut some costs and I'm relatively healthy. My kids are on DH's plan which is far more generous. My only expense would be BC all else being ok. If I could just figure what that is!

[AngB]

I am just guessing it may be like the coverage for breastpumps (which they are required to cover, 100%, no copay or deductible) . The breastpump coverage went into effect in either Aug./Sept. but only for new plans, or as existing plans renew. DS2 was born Oct.26th, our plan renewed Nov.1, so they wouldn't cover the breastpump the first few days he was here but covered it starting in November. (Which is dumb.) I know a lot of people have policies that renew in Jan and that's when the coverage should go into effect for most people. I can't say for sure that birth control coverage is working the same way, but that would be my guess.

ETA: Found a few links that confirms it is when the plan renews, or a new plan is started, on or after Aug.1 2012. http://www.everydayhealth.com/womens-health/0629/what-the-affordable-care-act-means-for-women.aspx


Effective Aug. 1, copays for well-women visits, screenings for gestational diabetes, domestic violence screenings, breastfeeding supplies, and contraceptive services will be waived. Mammograms, cervical cancer screenings, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits are already available with no cost-sharing under Affordable Care Act.

If you already have insurance and make copayments for birth control, your new contraception coverage will kick in at the beginning of your new plan year (most likely Jan. 1), Pearson says. "I have to say that as a consumer advocate, I do not dream that every brand of contraception will be covered, but every type of contraception will be covered under the law," she explains.

[ett]

It's currently open enrollment for us and HR said the free BC was a new change for next year. (our insurance is by calendar year.)

[niccig]

I checked - ours doesn't start until plan is renewed and that's January for us. And you have to check with your insurance company on what TYPE of BC they consider to be free. It won't be all types of BC or even all types of BC Pills. And each plan with have different ones covered.

[Melbel]

Well I guess we are plain screwed when it comes to Obamacare. Our health care plan costs are doubling this year (through DH's employer) and much of our costs for Lyme treatment out of state are not covered by insurance. DH has already had the big V, so no BCP benefit for us either. Sorry for the somewhat off topic rant.

[MSWR0319]

Effective Aug. 1, copays for well-women visits, screenings for gestational diabetes, domestic violence screenings, breastfeeding supplies, and contraceptive services will be waived. Mammograms, cervical cancer screenings, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits are already available with no cost-sharing under Affordable Care Act.

So is this saying all prenatal care should be no cost? Our well baby and yearly checkups are covered 100% but my prenatal care wasn't. We paid up to our deductible and then 80/20.

[rin]

Yeah, I don't get to benefit from Obamacare either because I have my insurance through a Catholic institution, so no birth control coverage for me. Particularly annoying since we just paid for an IUD OOP and I'm already strongly considering having it taken out since it's just not working out for us . . .

[AngB]

Effective Aug. 1, copays for well-women visits, screenings for gestational diabetes, domestic violence screenings, breastfeeding supplies, and contraceptive services will be waived. Mammograms, cervical cancer screenings, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits are already available with no cost-sharing under Affordable Care Act.

So is this saying all prenatal care should be no cost? Our well baby and yearly checkups are covered 100% but my prenatal care wasn't. We paid up to our deductible and then 80/20.

If your plan wasn't new or renewed from Aug.1 till now, this wouldn't have gone into effect for you yet. And I'm not sure how it would work for "prenatal care" being covered since many/most OB's charge one global fee for delivery and all visits.

[janine]

This is our renewal period so this would commence in Jan 2013 which is why I was confused by it saying it was far from free (in the pamphlet). So I called and then they give some odd response that it's not in effect but when I google (and also confirmed by some ladies here) it was as of August. It was the actual insurance company I called. Our benefits dept was outsourced to India, and well I really do not enjoy discussing birth control with them as they try to look it up in their manual. Sigh....guess I'll have to figure another way..I wonder if pharmacists know or the prescription drug carrier.

[niccig]

This is our renewal period so this would commence in Jan 2013 which is why I was confused by it saying it was far from free (in the pamphlet). So I called and then they give some odd response that it's not in effect but when I google (and also confirmed by some ladies here) it was as of August. It was the actual insurance company I called. Our benefits dept was outsourced to India, and well I really do not enjoy discussing birth control with them as they try to look it up in their manual. Sigh....guess I'll have to figure another way..I wonder if pharmacists know or the prescription drug carrier.

I'm also wondering if it's the type of BC. I know not all brands of the pill will be covered. I too have to call and check with insurance co - not looking forward to that phone call - I hate call and waiting and then you get a different answer every time.

[ahisma]

Well I guess we are plain screwed when it comes to Obamacare. Our health care plan costs are doubling this year (through DH's employer) and much of our costs for Lyme treatment out of state are not covered by insurance. DH has already had the big V, so no BCP benefit for us either. Sorry for the somewhat off topic rant.

I'm not sure about a short term solution, but long term the exchanges should provide some relief for you. I don't know your finances, but it sounds like you would be eligible to shop the exchange and purchase a plan there, which would very likely be less expensive and offer better coverage than what you have now.

(((hugs))). Health care expense are hard.

[niccig]

This is our renewal period so this would commence in Jan 2013 which is why I was confused by it saying it was far from free (in the pamphlet). So I called and then they give some odd response that it's not in effect but when I google (and also confirmed by some ladies here) it was as of August. It was the actual insurance company I called. Our benefits dept was outsourced to India, and well I really do not enjoy discussing birth control with them as they try to look it up in their manual. Sigh....guess I'll have to figure another way..I wonder if pharmacists know or the prescription drug carrier.

You may also have to push and tell them you know is has to be covered starting August for new plans and when a plan renews.

Friends were told their DS was ineligible for private health insurance because of pre-existing conditions MONTHS after pre-existing conditions for kids was no longer allowed. She told them it was illegal to reject based on pre-existing conditions and would make complaint to state insurance board and surprise, they back tracked and gave coverage.

It wouldn't surprise me if they keep charging people or saying not covered long after it is. Oops, sorry we made a mistake...I'm very cynical re. health insurance companies.

[tribe pride]

I'm not sure about a short term solution, but long term the exchanges should provide some relief for you. I don't know your finances, but it sounds like you would be eligible to shop the exchange and purchase a plan there, which would very likely be less expensive and offer better coverage than what you have now.

(((hugs))). Health care expense are hard.

Not to hijack the thread, but I have a question about this. Are you saying that, if you're unhappy with the quality and/or cost of your employer-provided health insurance, Obamacare will allow you to purchase insurance elsewhere? I mean, I suppose you can always purchase health insurance through an independent company. But we have not done that because they will not cover pregnancy for several years after beginning coverage, and that's a risk DH and I are not willing to take. Anyone know if Obamacare will require insurance companies to cover pregnancy (like a pre-existing condition)?

The insurance through DH's employer is great for him- all employees are covered 100% with no $ taken out of paycheck. But dependents are not covered at all, so we have to pay the full amount in order to cover the kids and myself. Plus an enormous deductible an $25 copays. The quality of care is excellent, but at this point our health insurance costs us more than 20% of DH's pre-tax income (and his income is not high), and is by far our biggest expense. We'd love a more affordable option.

[ahisma]

Not to hijack the thread, but I have a question about this. Are you saying that, if you're unhappy with the quality and/or cost of your employer-provided health insurance, Obamacare will allow you to purchase insurance elsewhere? I mean, I suppose you can always purchase health insurance through an independent company. But we have not done that because they will not cover pregnancy for several years after beginning coverage, and that's a risk DH and I are not willing to take. Anyone know if Obamacare will require insurance companies to cover pregnancy (like a pre-existing condition)?

The insurance through DH's employer is great for him- all employees are covered 100% with no $ taken out of paycheck. But dependents are not covered at all, so we have to pay the full amount in order to cover the kids and myself. Plus an enormous deductible an $25 copays. The quality of care is excellent, but at this point our health insurance costs us more than 20% of DH's pre-tax income (and his income is not high), and is by far our biggest expense. We'd love a more affordable option.

This is not really the area of the ACA that I work in, so I don't have all of the specifics nailed down. In short, if your employer-offered coverage doesn't meet the govt's requirements for (1) coverage (meeting the minimum essential health benefits) and (2) affordability then you are eligible to shop on the exchange.

If you have coverage through your employer, but YOUR costs exceeds more than 9.5% of your household income, you are eligible to receive subsidies and shop the exchange. If your income is between 100% and 400% of the Federal Poverty Level then you qualify for subsidies- I think the average was around $5K/year.

I have a chart that we compiled on minimum health benefits, but there are some factors in play that aren't resolved yet. I'll poke around, there must be something online that gives an overview.

[ahisma]

I can't find a really accessible explanation of minimum value. Basically, the deal is that they are still sorting out how to calculate whether a specific plan meets the minimum value benchmarks.

In general, a to meet minimum value a plan must (at the least) cover 60% of the costs in four identified core areas:

physician and mid-level practitioner care
hospital and emergency room services
pharmacy benefits
laboratory and imaging services

[tribe pride]

This is not really the area of the ACA that I work in, so I don't have all of the specifics nailed down. In short, if your employer-offered coverage doesn't meet the govt's requirements for (1) coverage (meeting the minimum essential health benefits) and (2) affordability then you are eligible to shop on the exchange.

If you have coverage through your employer, but YOUR costs exceeds more than 9.5% of your household income, you are eligible to receive subsidies and shop the exchange. If your income is between 100% and 400% of the Federal Poverty Level then you qualify for subsidies- I think the average was around $5K/year.

I have a chart that we compiled on minimum health benefits, but there are some factors in play that aren't resolved yet. I'll poke around, there must be something online that gives an overview.

Thanks for this, it's very helpful! Looks like we might qualify for subsidies, we are definitely under 400% of the federal poverty level. Will have to keep looking into this...

[ang79]

Not to hijack the thread, but I have a question about this. Are you saying that, if you're unhappy with the quality and/or cost of your employer-provided health insurance, Obamacare will allow you to purchase insurance elsewhere? I mean, I suppose you can always purchase health insurance through an independent company. But we have not done that because they will not cover pregnancy for several years after beginning coverage, and that's a risk DH and I are not willing to take. Anyone know if Obamacare will require insurance companies to cover pregnancy (like a pre-existing condition)?

The insurance through DH's employer is great for him- all employees are covered 100% with no $ taken out of paycheck. But dependents are not covered at all, so we have to pay the full amount in order to cover the kids and myself. Plus an enormous deductible an $25 copays. The quality of care is excellent, but at this point our health insurance costs us more than 20% of DH's pre-tax income (and his income is not high), and is by far our biggest expense. We'd love a more affordable option.

DH and I have private insurance, even though there are several plans offered through his company. The really good plan costs a fortune, and the other plan is not very good coverage and still pretty pricey (especially to add me, since women costs insurance companies more due to pregnancy, etc.). They pay an opt-out amount if you don't purchase one of their plans, which we put towards our private insurance rate. We shopped around and ended up with a plan from Aetna. To fit into our budget, its a high deductible plan, so more of a security net if something tragic happens and one of us is stuck in the hospital awhile, etc. It used to not cover any contraceptives (I had the Mirena put in before we left the plan under DH's company), or prenatal care, unless it was deemed an emergency situation. We just got a letter stating that with the changes through Obamacare, they are now covering all forms of birth control (though it didn't say which brands) and prenatal care, starting Jan. 1, 2013. So I'm assuming that is the case w/ most insurances. Starting in Jan. I'd say it would be worth shopping around. You can check out rates and plans at http://www.ehealthinsurance.com