KDA Today

KDA Today

For Immediate Release

Date: Aug 12th, 2013
Contact: Dr. Ted Logan, Jr.
Phone: 800-292-1855
Email: info@kyda.org

The Affordable Care Act: What does it mean for Our Members?

What is the impact of the Affordable Health Care Act? I don't know. In fact, I don't know anyone who knows. There are entire books written and published on "Obama Care." Elected officials spar continuously over the merits and demerits of the Act. Many elected officials voted this Act into law without ever reading the bill. They "passed the bill in order to see what was in it." Is it any wonder why it is so confusing to business and common citizens? One fact I know. The law goes into effect in 2014.

Another fact: Insurance carriers are gearing up now for the 2014 start-up. As renewals occur, policies are being revised and rates are being revised. Carriers, agents, businesses, and yes, associations are being pressed to develop and negotiate suitable plans. The following is an effort to share with members of the Kentucky Dental Association what I think the bill means to us.

Bona-fide Association

An association must be declared "bona-fide" in order for its members to be grouped and avoid having to purchase insurance through an exchange. This declaration must be acceptable to the insurance carrier's legal department who are ultimately responsible to the federal government. Therein lies the first hurdle. KDAIS (Kentucky Dental Insurance Services) anticipates $15,000 to $20,000 in legal fees to prove that we are a bona-fide association. Why is this important? The exchange premium rates are expected to be considerably greater than association rates. KDAIS is working diligently to assure that the KDA is, in fact, a bona-fide association.

Community Rating

The Affordable Care Act is based on community rating. This essentially means that sick and well policy holders are all grouped together. Therefore, those who are not sick and tend not to use their health insurance must pay for those who do use their insurance to the limits. Associations are not community rated. It follows that exchange premiums will be higher than association premiums.

Seniors

Insurance carriers understand community rating. To protect themselves, several changes will occur.

In the KDA plan, Medicare is mandatory at age 65.

Medicare is secondary insurance.

The Anthem association policy becomes primary. Therefore, premiums will skyrocket.

It follows that the KDA association plan is no longer feasible for seniors. The solution is to move out of the KDA plan and into a private Medicare supplement plan. KDAIS can accomplish this for you. If you were previously in the KDA plan, you will not incur a penalty for Medicare Part D (prescription drugs).

One Person Groups

KDAIS has already been notified that one person groups will no longer qualify for participation in the association group plan. As of July 1, 2013, two persons (two contracts) are required for an acceptable group. The short notice was a real problem for our members. KDAIS was able to negotiate with Anthem to allow one more year to come into compliance. That means one person groups may continue until July 1, 2014. It also means, that, if you are in this situation, you should be planning for this change, now.

Additional Changes

Every participant in the KDA association plan must renew on July 1 of every year.

Every dental office must have a 60 day waiting period for new hires. This means that a new dentist can participate immediately upon subscription to the plan. However, all others must wait until the first day of the month after a sixty day period to participate.

COBRA laws apply to every dental office.

Subscriber Benefit Comparisons must be distributed to each participant. These comparisons are derived by the Federal Government. The documents must be retrieved from the Anthem website. Instructions have-been e-mailed by KDAIS.

COBRA

The Kentucky Dental Association will be considered a large group by the Affordable Care Act.  This results in yet another assignment for dental offices.  Dentist employers must abide by COBRA laws.  Compliance will probably require a third party specialist to maintain appropriate records.  Your KDAIS has negotiated a contract with a specialist company, Benefits Management Services.  The KDA will assume the master plan.  This means that there will be no start up fees for the dentist.  Start up fees and administration fees will be absorbed by the KDA.  The dentist will be responsible for monthly fees on a per participant basis.  These negotiated fees are only available to dentists participating in the association plan through KDAIS.

Participants in the association plan will be receiving lots of important information from ABS in the near future.  It is imperative that you read the information and return requested information.  Non-compliance with COBRA is subject to heavy fines.

Personal Observation

Is there anything good about the Affordable Care Act?  I have a difficult time finding much.

  1. Dependants can remain on their family’s plan until age 26.
  2. Mental health parody.
  3. Preventive coverage.      

However, there are some good things about being a member of the KDA and participating in its insurance programs.

  1. It is anticipated that participation in the association plan will be markedly less than participation in the exchange.
  2. KDAIS has assumed the formidable task of wading through the Affordable Care Act as it pertains to KDA members.
  3. The COBRA quagmire has been resolved by KDAIS.
  4. Members who, currently, do not participate in KDAIS programs, now have every reason to do so.  This will favorably impact our non-dues revenues.  It follows that KDA dues will be favorably impacted.

KDA membership and recruitment efforts should be enhanced.

Understand that your premiums for health insurance are going to rise because of the Affordable Care Act.  It is a matter of how you negotiate the troubled waters.  The association plan appears to be your best path with the least amount of pain.  You are ultimately responsible for your own destiny.

Some members will find themselves out of the association plan altogether.  This may result from personal choice or from disqualification.  Know that KDA and its insurance arm, KDAIS, are not the culprits here.  The federal government and its Affordable Care Act are solely responsible.  The solution to disqualification is to contact Kim Logan at KDAIS and get assistance in finding the best individual plan for you.

Personal Experience

I am 68 years old.  I am retired.  I had Medicare and the KDA association plan until July 1, 2013. Medicare became secondary.  This caused my total health care premiums to rise more than 100 per cent.  My exchange premiums were expected to be even higher.  I may also lose all coverage for my expensive drug.  My drug support card does not work with Medicare.  What is an old man to do?

I called Kim at KDAIS and worked out a plan that includes Medicare, Anthem and Humana and saved more than $2,000 from my 100 per cent increase.  Still a lot more than what I paid last year, but a marked improvement over what it could have been.  The point here is to make the best out of a bad thing.  KDAIS can help you do that.

If you would like to read the law for yourself, go to HHS.gov/HealthCare at http://www.hhs.gov/healthcare/rights/index.html

 

 

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