November 14, 2017 Meeting 


Affordable Care Act


Terry Linton 

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Linton and Associates LLC




Terry started out by explaining how everyone needs to have health insurance or you get fined two and a half percent of your adjusting gross income or $695, whichever is greater. The fine started in 2015 and in 2018 that will be the same penalty. Children are 340$ which is less expensive but can add up if you have more children. You cannot be declined for medical conditions and that has been a huge this for the ACA and ensuring New Mexicans. Can be rated based on age, location, and smoking status. But a 22-year-old is cheaper than a 45-year-old, and less expensive than a 60-year-old.


Obama wanted to have 100% coverage for prevented care. He felt that we can tackle things early it won't cost us as much if we find something later on. Preventive care is completely free, such as a physical. Terry said, “But if say, ‘my shoulder has been hurting’, it automatically turns into a diagnostic and that's where copays come in”. His best advice was to not say a word when  having your physical.


In order to get the Affordable Care Act you have a certain time to enroll. Trump is trying to get rid of the ACA, so he's decreased the open enrollment time. It uses to be Nov 1st through Jan 31, but now it's Nov 1st through Dec. 15. If you are an individual you needing to enroll soon or else you might get penalties in the future. If your income is under a certain level then you are able to get help.



For individuals, you can buy insurance off the exchange or on the exchange. There are cons and pros to both.

Off the exchange is recommended for people who make a reasonable income. You got directly to an insurance carrier, no tax credit or subsidies. There are three carriers here, Blue Cross, Presbyterian and New Mexico Health Connections.  On the exchange is where you can get a subsidy. You can also shop for medical and dental. The two carriers are Molina and Blue Cross. Presbyterian doesn't want to be on the exchange. It's about a 45-minute process to get on the exchange. You need to register on, enter personal information and then you need to show what your income is to see if you qualify for a tax credit. If you're not applying for a subsidy or a tax credit you would be better off to apply for the off the exchange because it's a less hassle.


In ACA there are four different levels and they're both for individual and group. They're properly called metallic level, and are the platinum, gold, silver, and bronze. Platinum is the most expensive and more robust, and bronze is the least expensive and less coverage. Very few people choose the platinum plan, and most of the people chose the gold and silver.  When making these type of decisions people to check benefits and prices. Terry stressed on making sure not to ask if the physicians "take" Presbyterian. They will always say "of course we take it", you need to ask "are you contracted", it's essential.







Now today the rates have changed and will increase by next year. Now, 1-16 is one, 17 is a rate, 18 is a rate, 19 is a rate and 20 is a rate. An example can be a 60-year-old individual in Silver went from $548 to $825, which is a 60% increase. The carriers had to file the rates in June since they didn't know what was going to have with the ACA and what President Trump was going to do with it. Therefore they aired on the side of being conservative. They priced all of their products with no CSR and no cautionary reduction reimbursement by the federal government, thus given the high rates. Trump is using this as one of his ways to torpedo the ACA.


President Trump signed an executive order to  the Health and Human services labor and Treasury to take actions that will allow small business to participate in association health plans, expand the availability of short-term, and allow more employees to reimburse employees for the cost of the individual.


Association Health plans: buying insurance across state lines. Trump and his advisors think this is a really big deal. It's not a big issue for New Mexicans since we are cheaper than Arizona, Colorado, and Texas.


Short term help plans: Obama said to have a short-term help plan it can only be three months. Trump extended it for twelve months and it could help some people that are temporarily between jobs.


Health Reimbursement Accounts: Employers can reimburse individuals for individual premiums.


Overall this has been an updated on the Affordable Care Act as of date. Every week there are new changes and bills being passed by President Trump. As of now it’s highly recommendable to get insured for the next year in order not be fined.