Since the Affordable Care Act was signed 3 years ago, more than 370 innovative medical practices called “accountable care organizations” have sprung up all over the USA , with over 150 more planned.

Several of these organizations are located in Los Angeles and surrounding areas and they are doing something very unique in the health industry.  At these centers, Medicare or private insurers reward doctors financially when their patients stay healthy.  The doctors actually make money when their patients require fewer hospital stays, emergency room visits and surgeries.  This is the opposite of what doctors have traditionally been paid to do.  The more money the organization saves, the more money its participating providers share.

Just how exactly are they doing this?  These organizations are using information technology to monitor the patients most at risk.  Using patient records, they are looking for patients who are overdue for checkups and finding out which patients have not been filling their prescriptions.  Then, using teams of doctors, health coaches, care coordinators and nurse practitioners, they work with the patients and encourage them to live healthier lives.

At one center in North Carolina, patients with a history of congestive heart failure get a daily phone call from a nurse asking them to step on a scale and report their weight (a good, early indicator of an impending emergency).  Another provider in California offers Medicare patients free dance lessons, healthy cooking classes and other fun activities.  A Buffalo clinic is building a gym and a teaching kitchen for its patients.

These organizations are setting the trend for the future – preventative health care.   Now, having health insurance coverage isn’t just about help for medical emergencies anymore.

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In Los Angeles, as well as the rest of California, “counselors” are now being prepared to help the flood of applicants who will be signing up for health care coverage.  Many of these “counselors” will have no health insurance background.  How much sense does it make to have an inexperienced person advise you on what type of insurance is best for you and your family?

Individuals have until December 15^th, 2013, to be signed up for coverage, starting January 1.   They will not the only ones to be fined for not having insurance.  Many companies will also have to make health care available to all full-time employees.  Businesses will have until 2015 to comply or face fines.

Now is the time to speak to a qualified insurance agent and get all the facts.  Don’t wait until last minute when the insurance industry is flooded with applicants.

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• No more denial of insurance because of pre-existing conditions.  This does not go into effect until 2014, but anyone who would like coverage now, can apply to the state to get temporary health insurance coverage.
• Insurance companies must get “OK” from the state government before raising premiums.
• Obama Care says that insurance companies must spend at least 80% of premiums on providing actual medical services.  If they spent it elsewhere (i.e. salaries or marketing), they have to pay it back to the policy holder.
• Most families will no longer have to make co-payments on wellness or pregnancy exams.
• If an insured member gets sick, they cannot be dropped from their plan.
• Parents can add their adult children, up to age 26, to their plans.
• If a child is chronically ill, a new insurance company cannot deny coverage for the child.
• Obama Care requires that 50 procedures recommended by the” U.S Preventative Services Task Force”, be covered as preventative services.    These include well-women visits, domestic violence screening, and support for breastfeeding equipment and contraception.
• Maternity and Newborn Care is categorized as preventative care, and must be provided at no cost.
• Though most plans currently provide services and devices to help with injuries, disabilities or chronic conditions, Obama Care will also cover goods and services  to help  maintain a standard of living if a person contracts a chronic disease.
• Obama Care plans cover 100% of preventative lab tests.  This does not include tests that have been ordered if a person has already been diagnosed with a disease.

A new era for health insurance is about to begin.  Talk to one of our insurance expert about your options

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Take Los Angeles as an example.  It is estimated that at least 20 percent of the population is living below the poverty level.    In a city of several million people, that is a considerable number of people who will not be able to afford health care for themselves, or their family.

What are lower income people going to do?

There is good news.  People with low to medium incomes may qualify for federal subsidies to help offset monthly premiums and deductibles.  Anyone earning 400% of the poverty line will be eligible for a subsidy which is up to $45,960 for an individual and $94,200 for a family of four.

The Kaiser Family Foundation estimates that 48% of Americans who buy individual insurance today would be eligible for subsidies.  They would receive an average of $5,540, which would cover 66% of the price.

Though premiums will vary significantly across the country, right now it is estimated that a 25 year old making 25k a year, will pay about $62 a month for health insurance.

Of course, the lower the income, the larger the subsidy for Obama Care.  For instance, let’s take someone who makes about $17,235 a year.  That individual will pay about 4% of their income, or $57a month.  A person who makes between $34,470 and $45,960 will pay a maximum of 9.5% of their income, or $364 a month.  The balance is covered by the federal government.  Anyone who earns above $45,960 a month will pay the full premium.

There are various subsidies available at various income levels.  When a person applies for Obama Care they can apply for an advance subsidy by estimating their income.

Call us and find out what subsidies you might be eligible for.

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This is a huge change in the insurance industry, and insurance companies have complied, reworking policies to expand benefits and decrease premiums.  Through Obama Care, new policies will be made available during a brief “open enrollment” period in on-line health insurance marketplaces.  In California, the site is Covered California where individuals and businesses can sign up for coverage between October 1, 2013 and March 31, 2014.

Despite confusing media stories about attempts in the US Congress to change or do away with the law, Dabboussi Insurance Services stresses that the new insurance is available, and people who have not been able to get health insurance before, can now.

Unfortunately, doubts sown in news and social media about Obama Care have distracted many from the fact that for their health benefit payments to start January 1, 2014 on insurance bought through the marketplace, they must make the purchase between October 1, 2013 and December 15, 2013.

This means that there is a 76-day window from the beginning of October to the middle of December to take advantage of open enrollment in a new, high-quality health insurance plan.

Covered California will feature a range of policies, ranked platinum, gold, silver or bronze, according to amount and type of coverage, and the cost of premiums and co-payments.

Employers who don’t already provide health care insurance for their employees will be required to make it available beginning in 2015.  Some companies that already offer insurance to their workers will be allowed to continue to offer older policies that can contain caps on yearly and lifetime benefits.

Uninsured and under-insured Americans, for example those who are ensured through work but have limited benefits, may take advantage of the open enrollment.

Beginning in 2014, Americans that do not have health insurance as of March 15 will be paying in to the system anyway, through tax penalties amounting to 1% of their annual income, or $95, whichever is larger.

However, many individuals and small businesses will be eligible for federal tax credits which can offset the cost of premiums and co-payments.  Some lower and middle income Americans will even qualify for direct subsidies, making insurance even more affordable.

The Supreme Court has affirmed this as a legal tax, and the law is rolling forward.

Though some members of Congress are pushing for complete or partial repeal of Obama Care, the law stands.  People who could not get health insurance before, now can.

Dabboussi Insurance Services recommends that anyone who wants to make sense of the law and take advantage of the insurance and tax benefits should consult an independent insurance broker .  As someone who is familiar with but free to shop around within the entire health insurance trade, an independent broker is especially suited to help clients wade through the market place options.

Dabboussi Insurance Services, owned by Mr. Saffouh Dabboussi, has been licensed in the state of California to transact medical insurance since 1996.  Their client base stretches across Los Angeles, San Bernardino, Orange and San Diego counties.

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The Nightmare

Imagine a family emergency.  You need to fly back to your hometown, somewhere in America.  You hurry to the airport and ask a major airline to sell you a ticket.  The ticket agent looks over the airline’s rules, and says, “I’m sorry.  Our records show you’ve used the airline too many times.  You aren’t eligible for any more flights.  We can’t sell you a ticket.”

You rush over to the window of another airline, and beg them to sell you a ticket.  The airline agent looks over their rules and says, “We will sell you a ticket, but because you have used discounts so many times, you can’t have your choice of flights, and we are going to charge you thousands of dollars to get a seat like the ones we charge other customers a few hundred dollars for — if you promise you won’t ever ask for a ticket again.  Asking for a return flight will cancel this offer.”

By now, you are getting frantic.  You rush to another window, and ask if there is any way you can get a ticket at a normal cost.  You are told, “If you are too poor to buy a plane ticket, we can get you a bus ride.  You’ll arrive four days later than an airplane, but it might get you to your hometown in time to see your father before he dies.”

This would be a good time to wake up and find out it was all a bad dream.

The Good News

Well, our country has woken up to the fact that Americans with pre-existing health care have previously been denied health insurance coverage, or even dropped from existing policies, had their benefits capped and even been forced into bankruptcy to pay for catastrophic illness.

The Patient Protection and Affordable Health Care Acts of 2010 have ended the nightmare of finding the health insurance you need at a price you can afford.

Now, back to our imaginary scene.  Let’s picture some good news.

You need a flight home, and you need it now.  You know you could log on to the Internet and find a site that would help you compare flights from different airlines, at different times, at different prices.

But you know the smartest thing to do would be to contact your travel agent.  Her familiarity with all the different factors guarantees she will find you the best flight, at the best price.  She uses her connections, her years of experience and you have tickets on the flight you need, waiting for you within minutes at your terminal.

Obama Care and Your Insurance Broker

It really is that simple with the new Obama Care provisions.  Insurance companies must sell you a policy that covers essential health care and preventive services, even if you have a pre-existing condition.  Even if you have been denied coverage before.  It is your right, and it is the law.

Your independent insurance broker is the person who can help you find the right insurance for you, at the right price.  As an independent agent, he is able to shop around and find which company is offering what you need, at the price you decide you should pay for premiums and deductibles or co-payments.  You want someone who not only knows the insurance business, but understands how the new laws work in your favor.  You may be eligible for tax credits or even up-front help to offset the cost of your premiums or deductibles.

So if you thought you couldn’t get help, think again.  The laws –and your insurance broker– are on your side.

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