Ups and Downs with my New Affordable Health Care Act Bronze Saver Plan

Good news first, then the bad:

The last time I went to the pharmacy I used my new Prescription insurance, Blue Cross Blue Shield Bronze Plan, and I thought I did something wrong when the clerk told me my prescriptions had no co-pay!  I was very excited about that.  I also got a decent price on my antibiotic.  So that is the plus.

The cons are that I was never notified by my plan Blue Cross that I had to use preferred labs! So now, I just got slapped with a $900 lab bill for a service that should have been covered under the ACA.  The insurance company did not send the book explaining my benefit plan, instead all I got was a card and a bill.  It was on me to investigate my plan and make sure that I was using preferred labs.  I was supposed to log on and check the benefits before I went to my doc.  This info was buried on page 18 of the 52 page document.  Apparently insurance companies can get away with these types of practices, so I am going to appeal the coverage decision (a new guaranteed right under ACA).  Not sure how it will come out, but more likely than not, I will lose..  Just a warning to those of you who may have a Bronze plan.  The Silver and Gold plan do not require you to use preferred labs with Blue Cross.

Recently I gave a talk and overview of the ACA.  Here are some key points to know:

March 31st is the deadline to enroll for 2014 coverage and avoid being taxed!  if you miss it, the tax penalty (Individual Mandate) will be $95 per person or 1% of household income, which ever is higher, and if applicable  $47.50 per child under 18

Some exemptions, that would excuse you from paying if you don’t sign up, include:
foreclosure on your home, being homeless, filing bankruptcy, or if the lowest priced plan would exceed 8% of your annual income
Affordable Care Act Overview: 
  • The ACA bans lifetime limits on coverage for most benefits
  • College age children get coverage on parent’s plan until age 26
  • Women’s preventative care covered–well woman visits (pap smear, pelvic exam)
  • Contraception (religious organizations exempt)
  • Mandates coverage for those with pre-existing health conditions, and children under 19 with pre-existing condition cannot be limited (cancer, long term disease)
>>>Did you know that previously pregnancy, previous Cesarean section, or a history of having survived domestic abuse, were considered pre-existing conditions and could have been used as reason to deny coverage or adjust rates? The ACA stopped this practice.
Grandfathered plans?  Yes you can keep your old plan for now, but this is only a one year grace period.  If your old plan is found to be non compliant with the ACA, for example, if it does not guarantee your right to appeal a coverage decision, after 2015 you will still be subject to the tax (individual mandate).
There are ups and downs here.  Please share your stories here. Sign up at , if you haven’t yet, time is running out;    You may qualify for income subsidies to contribute to the cost of your health care insurance.  
 Disclaimer: This blog is Commentary Only and nothing here is to be interpreted as legal advice, solicitation, or any claim that the quality of legal services offered by The Keli R. Edwards Law Office, LLC is greater than the quality of legal services performed by other lawyers.  I welcome your feedback and comments