With all of the recent changes in healthcare within the last year, many questions have yet to be answered regarding how the Affordable Care Act (ACA) will affect the everyday American and consequently influence the primary insurance plans which cover collegiate student-athletes. I think all those involved will agree only time will tell. Here is some general information to get us started in understanding the reform.
THE HEALTH CARE PLANS
There are several. The bronze level will be basic, silver midrange, while gold and platinum will be the higher-end plans. There will also be a catastrophic option. Catastrophic insurance covers three doctor visits per year at no cost and preventive care such as screenings and vaccines. This plan will carry a higher deductible. All plans bought through the exchanges must offer the same coverage benefits, offer free preventive care, and cap out-of-pocket expenses to $6,350 and $12,700 per family.
Student Health Insurance Plans (SHIP) will also have to be compliant with the ACA by August of 2014. One important note: These plans typically don’t cover injury from participation in intercollegiate athletics. Check the current plan offered on campus specifically for this exclusion and if they follow the American College Health Association standards.
What varies between the plans is cost. Some will carry higher deductibles. Some ask for higher co-pays. Costs will vary based on where you live. If you want to see what your bill may look like, be sure to check out the premium estimate tool on HHS.gov.
The majority of people uninsured today can find a policy for $100 or less a month, taking into account subsidies and Medicaid eligibility, according to the Obama administration. No matter what the cost, you will pay a monthly premium, and may also have a co-pay or be asked to meet a deductible when you go to the doctor or hospital. The good news is if you go through the exchanges rather than buy directly from an insurance company, you will likely be eligible for tax breaks and subsidies to pay for your insurance. The assistance is available to those with incomes of up to four times the federal poverty level -- this year, that's $45,960 for an individual or $94,200 for a family of four -- and will be calculated on a sliding scale. You can take this subsidy as a tax credit or the government will pay the insurance company directly.
If your SHIP individual premiums have not been increased already, it is most likely because it is not yet ACA compliant. In order to be a qualifying plan it must be compliant for the 2014 school year. Expect this premium to increase according.
WHO IS EXEMPT FROM THE MANDATE?
Some Americans will be exempt from the mandate to have coverage. These are people who can’t afford it: For example, people who make so little that they don’t have to file a tax return are exempt. People who are in this country without authorization are exempted, as are members of a federally recognized American Indian tribe who are eligible for services through an American Indian health care provider and people with certain religious beliefs that conflict with acceptance of the benefits of private or public insurance. People with certain hardships are also exempt; so are people in states that don't expand Medicaid.
Students who buy the Student Health Insurance Plan (SHIP) offered by your institution are most likely exempt from the mandate since most of these plans will be compliant with the ACA by August of 2014.
Theoretically, cause and effect of this law should increase the percentage of your student- athletes who have primary coverage. We all know that this is the biggest factor affecting the medical expense that a university athletic program assumes the responsibility for. Keep in mind that any Medicaid or government program will be excess to your secondary athletic accident plan (both traditional and self-funded plans). The demographics of your population will have a big impact on what type of primary insurance program your student –athletes have or don’t have. 2014 will give us a clearer picture of the ACA and how it affects the insurance exposure in college athletics. Some questions have been answered but there is still a long way to go. It is our hope that this newsletter and the resources noted help us all down that path.
For any questions on the above information, please contact the Borden Perlman Sports Team at firstname.lastname@example.org.