the Coverage Corner

Young men who aren’t insured through their employers may end up bearing the brunt of new costs under the Affordable Care Act (ACA) due to policy changes.

Here are four provisions of the ACA that may be responsible for premium increases for young men:

Age Limits for Health Costs Will be Removed

Currently, older Americans who are more likely to suffer health issues are charged up to five times more than young adults. The ACA will limit the amount insurers can charge older enrollees up to three times the amount being charged to younger enrollees. This change will result for higher premiums for some young adults and lower premiums for some older adults.

Insurers Cannot Charge More for Pre-Existing Conditions

Individuals with pre-existing conditions can no longer be excluded or charged higher rates for insurance coverage. While those who have been sick now have access to more affordable plans, the overall cost of coverage could become more expensive for healthy people.

Gender Price Differences Will be Erased

Previously, insurers could charge individuals based on their gender. Since women tend to visit the doctor more frequently than men, men typically enjoyed lower premiums than women. But, with the ACA comes a change that requires health insurers to charge men and women the same amount.

Additional Benefits for Women in Health Plans

The ACA also requires the additional of new essential benefits and maternity benefits in all health plans. For example, all health plans will now require maternity benefits even though men will not utilize those benefits, they will be paying for those benefits.

The exact change in health plans costs for young males will not be known until the summer or during open enrollment in the fall.

President Obama recently spoke in San Jose, California to highlight the positive effects of health care reform so far – and also to recruit a specific demographic to sign up for coverage. With major provisions of the 2010 health care law approaching, Obama used his trip to encourage young people and Latinos in particular, to sign up for insurance coverage through the online exchanges.

California has been one of the quickest states to develop its own health insurance exchange. Using the Golden State as an example, Obama highlighted how the state is implementing the Affordable Care Act to the benefit of six million uninsured Californians who will “Soon be able to buy quality, affordable care just like everybody else.”

As the nation’s most populous state, the performance of the health law in California is crucial to the success of the signature Affordable Care Act when millions of uninsured Americans begin shopping for health plans on October 1st. According to White House officials, the Obama Administration is looking for 7 million people to enroll through the exchanges, and 2.6 million need to be younger in order to keep costs low for all enrollees. Nearly one-third of the younger population lives in California, Texas or Florida.

Also helping to promote enrollment among Latinos and young people are Spanish-language TV networks Telemundo and Univision. Health care reform will potentially provide affordable health insurance coverage to over 10 million uninsured Latinos across the country.

As full implementation of the Affordable Care Act draws near, many uninsured Americans — deemed “unbankable” may struggle with what form of payment they can use to purchase their insurance coverage. By definition, unbankables do not have a traditional checking or savings account, making it difficult to pay their bills.

According to the Federal Deposit Insurance Corporation 2012 survey, one in twelve households in the United States, or approximately 17 million adults, are not bankable. Furthermore, 51 million American adults have a tenuous banking relationship, which forces them to rely on check-cashing stores and money lenders as opposed to credit cards or checking and savings accounts.

The new health care law requires most Americans to carry health insurance as of January 1, 2014, but it doesn’t require health insurers to accept all forms of payment. For instance, most health plans currently accept a credit card for the first month’s premium payment and then allow customers to pay monthly with a check or an electronic funds transfer from a checking account.

Medical Loss Ratios (MLR) set under the Affordable Care Act require that health insurers spend a certain percentage of premium dollars on medical claims and care improvement versus administrative costs and overhead expenses. Because of this, certain providers may no longer accept credit or debit card payments. Instead, they’ll ask for consumers to send monthly checks, which would not be a viable option for many Americans.

Concerned experts believe that some consumers may opt out of insurance coverage to avoid returned check fees and overdraft charges that can result from the usage of a checking account.

The year 2014 is the start of some exciting changes. People who purchase health insurance through an exchange can qualify for financial help if their income is no more than 400 percent of the federal poverty line. How do you know if you’re eligible for premium tax credits? It’s not difficult to find out. Just calculate your household Modified Adjusted Gross Income (MAGI) to find out how much you’ve really earned. Here’s how:

Step 1: Calculate Gross Income (GI)

Gross income is every penny, dime and dollar earned in a certain year. So add up everything. Take into account salary, interests, income from investments, dividends, rental and royalty incomes, capital gains, unemployment and alimony.

Step 2: Calculate Adjusted Gross Income (AGI)

Adjusted Gross Income is household income before the application of itemized or standard deductions, exemptions and credits. So take the GI (found in step 1) and subtract all qualified deductions. Contributions to IRAs, moving expenses, alimony paid, self-employment taxes and student loan interest are all qualified deductions.

Step 3: Calculate Modified Adjusted Gross Income (MAGI)

Modified Adjusted Gross Income is a household’s AGI and all tax-exempt interest income. Don’t be alarmed if your AGI matches your MAGI. That’s common. Take the AGI (found in step 2) and add all tax-exempt interest income. Tax-exempt interest income includes deductions for IRA contributions, deductions for student loan interest and tuition, certain foreign income, interest from employee savings bonds used to pay higher education expenses and employer-paid adoption expenses are all tax-exempt interest income.

These steps help determine subsidy eligibility and what you could be getting back in 2014. Check out GoHealth’s easy-to-use health insurance subsidy calculator tool to determine what subsidy you qualify for and what you can expect to pay in premiums.

Research has found that having too many health plans to choose from can quickly become confusing for consumers. That is why starting in 2014, provisions of the Affordable Care Act require health insurers to meet new requirements for standardized health insurance plans. The purpose for standardization of plan benefits and cost-sharing is to make it easier for people to compare several different health plans.

Introducing the Metallic Plans

The standardization of health plans into four tiers will help individuals and businesses make clear comparisons between multiple insurance options. The four levels of coverage, in order as specified by the ACA are: bronze, silver, gold and platinum. Insurers are not required to offer plans in all four levels, but they must offer at least one silver and one gold.

Each metal level plan must cover minimum essential health benefits; and while the scope of benefits is the same among plans, the value of benefits vary. Cost-sharing of deductibles, co-insurance and copayments required by the individual also differs between tiers. Generally, the higher the tier of health plan, the larger share of costs that are covered by insurers. For example, a bronze plan entails that insurance covers 60 percent of health care costs, leaving the enrollee responsible for paying 40 percent of costs. On the other end of the spectrum, the insurer covers 90 percent of health costs in a platinum level plan, while the enrollee pays only 10 percent.

How to Get One

All metallic plans will be available for purchase through the statewide online health insurance exchanges which open on October 1, 2013, but keep in mind that any insurance bought on the exchange won’t begin until January 1, 2014.

Check out our infographic to see exactly how each level of health plan breaks down by costs.