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Affordable Care Act - How You Can Benefit

How a Colleague Saved $6000.

We have a colleague who was paying about $1200 per month for insurance, with a $5000 deductible.  And more shocking, it only covered 50% of her medical costs.  The plan covered chiropractic but had no dental, no naturopathic, no mental health and no preventative coverage.  She couldn't shop for a cheaper plan because she had a pre-existing condition.


Through the Affordable Care Act, our colleague will be paying around $530 per month, with a $750 deductible, and a $15 copay.  Her new plan covers chiropracticdental, naturopathic, mental health and preventative treatment such as mammograms.  Now she can not be turned away for having a pre-existing condition. 


She doesn't qualify for government tax credit because she made slightly more than the $46,000 a year, but just gave herself a $6000 raise. She will be saving about $650 per month!!  And have better coverage as well 


Why Use an Insurance Broker?  Her insurance broker, Randy Coryell, was very helpful in deciding which plan was best for her.  And it cost her nothing.  The insurance company pays his fee.  It doesn't increase her rates.  Randy also shared some other tips:

  • You can use the website to look at plans, but only those who qualify for a government subsidy can sign up on the website.  Please see the chart below for whether you qualify for a subsidy.
  • The deadline for signing up to be covered in January 2014 is December 4, 2013.  If you sign up after that, you won't be covered until the following month.
  • Because of the roll out problems, fines for not signing up have been postponed to March 2014.
  • The website application can be time consuming.  So working with a broker can save you valuable time and help explain ALL the options.  There are no fees or charges because the insurance plan pays a small fee to the broker.

Randy suggests that you use an insurance broker to sign up for insurance, regardless of whether you qualify for a subsidy.  They have trained extensively and know all the details to find the best plan for you. 


How much will the government pay?  Randy says:  " If you are a single person and make under $15,856, you will  qualify for Medicaid.  If you earn $15,856 to $45,960, you will qualify for tax credits which would basically bring their premiums down.  Over $45,960, you get the benefit of Affordable insurance coverage. 

Household Size    Medicaid Eligibility   Premium Tax Credits

      1                       $15,856                    $45,960

      2                       $21,404                    $62,040

      3                       $26,951                    $78,120

      4                       $32,499                    $94,200

      5                       $38,047                   $110,280

      6                       $43,594                   $126,360


We have talked with Randy, the insurance broker, and he welcomes your inquiries, whether you sign up through him or not. You can reach him at:  RC Insurance LLC, Randy Coryell, 520 SE 15th St, Gresham OR 97080, 503-666-8912 


We hope this helps you or a loved one take advantage of the incredible benefits waiting for you.  It may save you money and give you better coverage as it did our colleague. 


The Facts about the Affordable Care Act


The ACA provides insurance for individuals who are uninsured, have been denied coverage in the past, or who  want new health options.   You can sign up between October 2013 to March 31, 2014.


How can I choose the best plan for me and my family?  You can compare apples to apples programs and select the one that best fits your needs. You can find out more at the easy-to-use website  


Good News For Mental Health Care!  The new law requires that mental health services be covered the same as medical care.  Under the new law, insurance plans can no longer deny  because of:

  • Prior mental health challenges.
  • Pre-existing conditions.
  • Annual visit limits. Imposing annual visit limits on mental health services unless the health plan was purchased prior to March 2010 and was renewed without change. However, this does not mean that you will have unlimited visits. Your provider may be required to provide information to your insurance company to justify continued visits.

Things to be aware of when you select your coverage:


1.     Not all plans cover all conditions or treatments and you must choose accordingly.


2.     When deciding on a health plan, look for mental health services in the "Essential Health Benefits" category you'll find at the Health Insurance Marketplace website.


Essential Health Benefits Required on All Policies.  All plans sold through the Health Insurance Marketplace are required to offer ten basic kinds of healthcare called "Essential Health Benefits" including:


Wellness & disease management, Prescription drugs, Hospitalization, Laboratory Services, Emergency Services, Maternity & newborn care, Children's care, dental & vision, Rehabilitation & habilitation, Mental, behavioral health & substance abuse care, Outpatient clinic Services


Not all policies are equal when it comes to mental health services. Each plan may offer different types of coverage.  Ask about:

  • Types of therapy covered, e.g. EMDR, Play Therapy, Hypnosis, Art Therapy
  • Pre-approval requirements
  • Out of Network Providers are covered by the plan. Your current therapist may not be covered or on the panel, as insurance companies call it.


Need Financial Help?  If you have limited income, you will get discounts on your insurance premiums. For:

  • Single people if you earn $45,960 or less
  • Couples earning $62.040 or less
  • Family of three, earning $78,120 or less
  • Family of four, earning $94,200 or less

If you earn less than $15,282 you will be automatically enrolled in Medicaid and get free coverage. What you own will have no impact on your coverage, simply your income.


What If I Already Have Insurance?  You will be able to keep your current insurance. However, parts of the ACA may improve your current plan:

  • Children can no longer be denied benefits
  • Children up to age 26 remain on parents' plan
  • Annual coverage limits may be eliminated

Compare plans to find one that fits your needs at: .


Your employer will be giving you a form that will indicate whether or not your insurance meets the minimum standard of the ACA. If it does not, you are free to drop that coverage and use


If your policy costs you more than 9.5% of your annual income, it is considered unaffordable and you'll be eligible for assistance in the ACA system.


Is My Counselor Covered?  If you sign up with Affordable Care Act check to make sure that your therapist is listed in-network with the insurance you are thinking about choosing.   If not on the panel make sure your plan offers out-of-network coverage. Expect to pay 50% payment for out of network providers.


What if I don't buy insurance this year?  You will pay a fine. The first year you'll pay $95 as a single person, or $285 for a family. When you file your taxes, you will need to show proof of insurance.


What if I wait until I get sick or have an accident to sign up?  Playing the odds seems like it might be a good idea to save money. But the ACA coverage is not retroactive, and it takes a couple of weeks for the plan to take effect. But more importantly enrollment opens at the first of every year.


In 2014, you can enroll from October 2013 to March 2014. In 2015 enrollment will open on October 15 and close on December 7, 2015 without exceptions.  


The average 3-day stay at a hospital costs $30,000. A cancer treatment can cost as much as $100,000.


How To Apply   By phone: 1-800-318-2596   Online:


You may also choose to buy directly from a health insurance carrier or through your employer



Jonelle Richards LCSW  and Suzie Wolfer LCSW

Co-Directors of Counseling Services of Portland