Let me begin by defining which individuals the Affordable care Act (ACA) will not affect when it is fully implemented on January 1, 2014:

Anyone now on Medicare (including Pre-Age 65 Early Disability Individuals).
Anyone covered by an employer-sponsored Group Health Insurance Plan. (But you will have to upgrade to an ACA-compliant plan when your employer’s group plan comes up for renewal during 2014.)
Anyone with an individual health insurance policy bought prior to March 23, 2010 (the date that the ACA was signed into law) and which is still in force today, and unchanged from its benefits prior to March 23, 2010. These are called “Grandfathered Health Plans.”

If you are not among the above three groups, then come January 1, 2014, you will have to buy a new individual health insurance policy. By now, you should have received a notice from your current health plan that advises you that your Non-Grandfathered Health Insurance policy will be canceled on December 31, 2013. This notice will also likely advise you of which “most similar” ACA-compliant health insurance your current health insurer recommends as your new health plan to start January 1, 2014.

You also have full freedom to select any other new ACA-compliant health insurance plan for 2014 – either from your current insurer, or any of the other 3 remaining health insurers offering individual health insurance in California in 2014. While this initial ACA Open Enrollment Period for individuals runs until March 31, 2014, if you wait until after December 15, 2013, your new coverage will not begin until February 1, March 1 or April 1, 2014, and that would leave you without any health coverage for one to three months.

Initially, it appears that the rates for these new ACA-compliant plans will range from slightly higher premiums to as much as 40% higher, unless you qualify for a subsidized Covered CA Marketplace plan. It all depends on many varying factors that will affect each person’s premiums for ACA plans.

The issue with which I am most concerned is that all new ACA-compliant health insurance plans sold to individuals in California (inside and outside the Covered CA Marketplace) will have something new and very restrictive: “Narrow Networks” both for PPO and HMO plans. These Narrow Networks will only include between 50% and 70% of the physicians and hospitals that are available in today’s PPO and HMO networks.

The foreseen result is that many individuals who currently have individual health insurance plans (especially PPOs) will face a strong possibility that they must change their doctors or have their new “Narrow Network” PPO pay only about 25% of the medical bills from their soon-to-be Non-PPO Network doctors. Although many doctors are still undecided, ask your doctor which plan they will be joining.

I will continue to keep you posted as new developments occur, and welcome your calls and questions.

Bill Robinson has been a licensed agent for 31 years, and he is owner of Palm Canyon Insurance Agency in Palm Springs.
(760) 416.4225