Tonawanda News

Local News

November 13, 2013

Forum Tuesday provided 'Obamacare' details

(Continued)

Tonawanda News — —Some people’s insurances were cancelled because they didn’t provide the “10 essential benefits” such as hospitalization, pharmacy coverage and ambulatory service, as required by the federal law, but New York state has been requiring most of those benefits for years. In this state, many providers who cancelled policies steered their clients directly to new policies with all 10 benefits.

— The Affordable Care Act may cut individual insurance costs by more than half, she said.   

—In January, the act mandates dental insurance for all children under age 19. 

Through the course of the question and answer session, Marchese explained that those who think insurance companies are pocketing huge profits should know that every health insurer must pay out 80 percent of all money collected to claimants. If the amount paid out to claimants is less than 80 percent, the difference has to be paid back to policy holders, she said.

While she stressed that not much changes for small business owners, companies that employ more than 50 employees will face some changes in 2015, such as being fined for every employee who doesn’t have health care. The same is true of individuals, who will also be fined up to $695 in the third year of the law if they don’t have health care. A few larger employers are saying publicly they’ll opt to pay the fine rather than provide insurance, she noted, of about $3,000 per employee.

To those big companies, she advised: “Do the math. You’re giving the government potentially half a million dollars for nothing.”

To residents and business owners, she advised three things: Do your homework. Pay attention to your health care costs. Shop around.

One resident in attendance, Diane Tattersoll, a retiree from Niagara Falls, said she believed the Affordable Care Act would increase competition among health care providers. She also noticed that since “Obamacare” has come into the national conversation over the last couple of years, her rising insurance bills have “calmed down.”

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