•     The law will require that all “qualified” health plans offered in the individual and group markets must provide a comprehensive package of items and services known as Essential Health Benefits.  Essential Health Benefits must include items and services within at least the following 10 categories: Ambulatory Patient Services, Emergency Services, Hospitalization, Maternity and Newborn Care, Mental Health and Substance Abuse Disorder Services, including Behavioral Health Treatment, Prescription Drugs, Rehabilitative Services, Laboratory Services, Preventative and Wellness Services and Chronic Disease Management, and Pediatric Services, including Oral and Vision care.
•     All health insurance plans will become Guarantee Issue.  People with pre-existing health conditions can no longer be denied coverage.
•     Preventative wellness exams and procedures will no longer be subject to the health insurance plan deductible, co-pay or co-insurance requirements when performed by an in-network provider.
•     Males and females of the same age and geographical area will have the same premium.  The only exception to this will be for tobacco users where the premium can increase up to an additional 50%.
•     Lifetime maximum care limits will be eliminated.
•     Medicaid programs will expand.
•     Federal tax credits will become available for consumers whose income falls within 100% to 400% of the Federal Poverty Level.  This benefit will help many lower and moderate income families afford private health insurance coverage, perhaps for the very first time.  Subsidies will only be available for plans purchased from a public government exchange.
•     To determine if you may be eligible for premium tax credits and cost-sharing subsidies, please refer to the Healthcare Reform Premium Subsidy Calculator.

A Few Disadvantages Associated with Healthcare Reform:

•     Mandatory enhanced benefits and the elimination of medical underwriting will result in Imminent Premium Shock!  For those of us who do not qualify for any government subsidies, our health insurance premiums are likely to increase dramatically.  Even with government subsidies, many consumers will not be able to afford the annual deductibles and co-insurance costs that are associated with the healthcare reform health insurance plans.
•     Many small businesses, especially those with less than 50 full-time employees, may make the choice to terminate their group health insurance plans due to the excessive costs involved.  Your patients may soon find themselves without health insurance or dental insurance coverage for the very first time in their lives.
•     Health insurance plan options will become significantly limited. There will only be four plan levels to choose from and they will be referred to as “metallic” plans.  The Bronze Plan will provide 60% coverage, the Silver Plan will provide 70% coverage, the Gold Plan will provide 80% coverage and the Platinum Plan will provide 90% coverage.
•     Additional taxes (penalties) will be imposed for not purchasing a “qualified” government approved health insurance plan.  There are some exceptions to this rule.  Please refer to The Requirement to Buy Coverage under the Affordable Care Act for more information.
•     Businesses with more than 50 full-time employees will be required to offer health insurance that is “affordable” and that provides “minimum essential coverage” to their employees.  If they choose not to do so, they will also be subject to tax penalties.

Enrollment Periods:

Annual enrollment periods are designed to ensure that individuals and families don’t wait until they get sick to enroll in a health insurance plan, or switch to more comprehensive coverage when they are in need of an expensive medical procedure.

•     Initial Enrollment Period:  Begins October 1, 2013 and extends through March 31, 2014.
•     Annual Enrollment Period:  For plan years beginning on or after January 1, 2015, the annual enrollment period begins on October 15th and extends through December 7th of the preceding year.

In summary, the financial consequences of Healthcare Reform could result in decreased revenue and increased overhead expenses for your dental practice.  What can you do now to prepare for the challenges that lie ahead? 

Next week I will present some strategies to help you maintain your active patient count through these changes.

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