With changes looming for healthcare in the United States, many individuals and employers are on edge and uncertain of what may come down the legislative pipeline. In my community small business association, in Corktown Detroit, a few questions were asked about the Affordable Care Act and the mandates set forth therein.
Question #1: at what size does your business need to offer health insurance for your employees?
For now, if you have 50 or more full-time equivalent employees, you must provide health insurance coverage, or you have to pay a fine. This is known as the "employer mandate" in the Affordable Care Act, aka ObamaCare. This coverage must apply to at least 95% of your full-time employees and their dependents up to age 26. Spouses are not included in this mandate. More information on this topic can be found here.
Question #2: What if one of your employees already has their own health insurance coverage?
Employees with their own insurance plan can keep their current insurance plan. They can also cancel their plan and sign up with their employer's coverage plan. As long as you the employer offer coverage, you won't be fined. But, the employee can't get a marketplace subsidy if the employer's coverage meets affordability and minimum value guidelines.
Question #3: If your employee switches coverage, can they still see their own doctor?
On choosing to keep your own doctor, you can still go to your doctor, but you may have to pay an out of pocket fee. For example, if you have NGS (or Oakwood Hospital Insurance), you are typically pushed to Oakwood doctors. If you decide to see a doctor at Henry Ford, you will not be forbidden from seeing them, you just will have to pay more out-of-pocket because they are not an "in-network" doctor. HAP is the insurance typically coupled with Henry Ford. Blue Cross Blue Shield allows for greater flexibility in terms of choosing doctors as it is accepted by most physicians.
Question #4: How do you find services, doctors, and specialists covered by your insurance?
For finding doctors that accept your insurance, the easiest way is to look up the doctor online and see if they accept your insurance. Alternatively, you can call their office and ask, "do you accept HAP/NGS/Cigna/BCBS?" Finally, you can call the number on the back of your card and ask for your choices for primary care doctors or specialists that are covered by your plan in your neighborhood/area.
Question #5: Our company has less than 50 full-time employees, We aren't making enough money to cover our employees with health insurance, but we would like to provide some sort of health care. What options do we have?
This is the ideal situation for Direct Primary Care practices like Plum Health DPC and many small businesses find themselves in this situation Because we offer an affordable, accessible health care service at a known cost, you as the employer know exactly what you're getting and the price you will pay. For $49/month for adults under 40 and for $69/month for adults over 40, you have access to our doctor and our primary care services when you need it.
Question #6: So, under your plan at Plum Health DPC, what is covered and what isn't covered?
We can take care of 80 - 90% of your health care needs, including coughs, colds, cuts that need stitches, preventive care, and disease management for conditions like high blood pressure, diabetes, asthma, eczema, etc... We also offer wholesale medications, at-cost labs, and at-cost imaging services.
What we can't cover are things like heart attacks, strokes, and auto accidents that are severe. For these issues, you need to go to the hospital or the emergency department for immediate care. This is why we recommend that all of our customers have some sort of catastrophic coverage plan that covers emergency and hospital care.
If you have any further questions about what we do, don't hesitate to reach out!
- Paul Thomas, MD