Enrique: self-employed, pays a lot for coverage

Under the Proposed Health Reform Bills:

CHOICES

• Enrique will have a variety of new choices in a new "store" called the health insurance exchange.
• Whichever plan he picks must cover his mental health needs as part of the new minimum benefits package. Insurers could not exclude Enrique for his pre-existing condition or charge higher premiums because of the condition.
• Depending on the proposal, Enrique could also buy coverage outside the exchange.
• Enrique can also keep his current coverage. It is “grandfathered” and doesn’t have to meet the new minimum benefit requirements.

COSTS

• Enrique’s new insurance choices would feature lower deductibles. New rules would limit how much of overall medical expenses the patient is expected to pay.
• Enrique may see his annual premium increases moderate over time as health plans compete for customers. New rules require everyone get coverage and determine how premiums are set. This should even out premium increases, as more people come into the insurance “pool.”
• At his income, Enrique would not qualify for the new premium credits that would help lower-income individuals afford coverage.

DIFFERENCES

House bill (H.R. 3962, passed November 7, 2009):

• Individuals could not buy coverage outside the insurance exchange, except for "grandfathered" coverage that was already in place (like Enrique’s coverage).
• The new national insurance exchange would feature a new public insurance plan option, in addition to private options.

Senate bill (H.R. 3590, passed December 24, 2009):

• Enrique could still buy an individual policy outside the exchange. This coverage would have to follow most of the same “rules” as coverage in the exchange, although insurers would not have to use the same standardized forms to describe their products as used in the exchange.
• The new state-based exchanges would feature new “multi-state” plan options – new, national private insurance plans regulated by a federal agency, at least one of which would be a non-profit plan.

Click here to learn more about new rules