I've been writing about healthcare reform -- and trying to put it in the simplest layman's terms for our readers -- since the Affordable Care Act (ACA), better known as Obamacare, took effect in
"Insurers must cover A- and B-level preventive services, such as screenings and immunizations recommended by the
In other words, flu shots, annual physicals and annual screenings, including physicals with your family doctors, mammograms, PAP smears and colonoscopies, are supposed to be "free" with no co-pays, etc., for people with ACA-compliant insurance plans. And by now, pretty much all of us who are insured have compliant policies, whether through employer group plans or individual polices bought off or on healthcare.gov.
Just this past week, I was ranting about the soaring costs of health insurance premiums and deductibles with a sorority sister who noted her company's group plan, once grandfathered in under pre-ACA laws, now must meet the new government standards that have resulted in higher monthly premiums.
"Grandfather died," she said. Funny.
What's not funny is the onus is on us consumers/patients to make sure we get the benefits promised in today's regulatory environment.
Case in point is what turned into a quest for the my flu shot and that of my 15-year-old daughter, Jess.
Though our shared internist practices only two miles down the road, I didn't schedule the vaccinations through his clinic, thinking I'd avoid the hassle (ha!) and possibly being charged for doctors' office visits, when we simply needed to swing by somewhere and get our, um, quickie flu shots.
So, after picking up Jess after school on Wednesday, I drove directly to
The next morning, I called
So, Thursday night, I whisk Jess to CVS, where we stand -- and sit -- for more than 45 minutes. The staff inputted our information and got our injections ready. We signed the waivers and we were all set, until I noticed a
After another call to LDI late Friday, we returned to CVS on Saturday to get our flu shots. A glitch in the system initially blocked the zero copay for a quadrivalent flu shot with added protection, a customer service rep explained on a message on my voicemail.
Back in the car on Thursday night, Jess made fun of how many times I mentioned "Obamacare." I told her that I hoped I'd modeled good consumerism for her; that she should never pay
My parental lesson coincided with Jess wanting to cash in coins from my piggy banks for a trip to the mall on Friday. The kiosk at
We settled instead for a no-fee gift certificate to Chili's, where we directly drove for dinner. Jess had macaroni and cheese and a pink lemonade, and I had fajitas and a well-deserved margarita.
Obamacare at a glance
Oklahomans can find assistance at: Localhelp.healthcare.gov or at (800) 318-2596.
Consumers whose annual household incomes are between 100 and 400 percent of federal poverty (roughly
The rates for the various ACA-compliant plans are the same whether they're bought through the exchange or directly from an insurance company. The only thing the exchange provides is access to potential premium subsidies.
Employers of 50 or more full-time equivalent must offer affordable, quality health insurance to workers who average 30 or more hours a week, or face annual penalties of
Insurers can't deny coverage based on pre-existing conditions, and may not impose lifetime coverage limits.
Insurers must cover A- and B-level preventive services, such as screenings and immunizations recommended by the
Children who don't receive health care coverage from employers can stay on their parents' plans to age 26, regardless of marital or student status.
An 80/20 loss-ratio rule requires health insurers to spend no more than 20 percent of customer premiums on administration, or issue rebates to consumers.
Most residents must have health insurance or pay the greater of
Mind Your Own Business @ home and @ work.
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