2026 ACA Subsidies: What’s Happening With Advance Premium Tax Credits?

Posted on December 8, 2025 by thehealthinsuranceanswerman

(What Consumers Need to Know for the 2026 Marketplace)

D. Kenton Henry – editor, agent, broker

As we approach the 2026 plan year, one of the biggest questions in individual and family health insurance is what will happen to Advance Premium Tax Credits (APTCs)—the subsidies that lower monthly premiums for millions of Marketplace enrollees.

Why This Is Happening

During the COVID era, Congress passed temporary legislation — most recently extended under the Inflation Reduction Act (IRA) — which made Marketplace subsidies more generous and available to more households. These enhanced subsidies are scheduled to expire at the end of 2025, unless Congress acts to extend them.

If they expire, the Marketplace will revert to pre-COVID subsidy rules, which means:

1. Lower income thresholds for subsidy eligibility

Some households who qualified for subsidies under the temporary rules will no longer qualify at all.

2. Smaller subsidies for many who remain eligible

People who received very large subsidies during 2021–2025 would see higher net premiums for 2026, even if their income has not changed.

3. The return of the “subsidy cliff”

Under pre-COVID rules, households with income even slightly above 400% of the Federal Poverty Level received no subsidy. The COVID-era rules removed that cliff. If not renewed, the cliff returns.

This is why some people are seeing early projections showing their 2026 premiums rising sharply.

Where Things Stand in Congress

Both parties publicly acknowledge that the expiration would lead to large premium increases for many families. As of today:

There is broad interest in finding a solution, but
No final legislation has been passed,
No guarantee exists that the enhanced subsidies will continue, and
Any resolution will likely be tied to larger budget negotiations.

In short: Congress is still debating it, and the outcome directly affects what consumers will pay for Marketplace coverage in 2026.

What Consumers Should Expect

Until Congress acts, the Marketplace must begin preparing 2026 rates under the assumption that the enhanced subsidies expire. This means:

Preliminary quotes may show dramatically higher net premiums
Some currently subsidized families may temporarily appear ineligible for assistance
Final 2026 subsidy amounts cannot be known until legislation is passed — if it is passed

It is important to remember that this may change, depending on Congressional action in the coming months.

Practical Guidance for Individuals and Families

Don’t panic if early projections show large increases.
Stay informed — subsidy rules may be extended or modified.
Review your 2026 options with a licensed, experienced broker who can calculate subsidies under both scenarios.
Update income estimates accurately during Open Enrollment; small changes can affect substantial tax credit differences.

Bottom Line

The enhanced ACA subsidies that helped make Marketplace coverage more affordable since 2021 are set to expire after 2025, and Congress has not yet determined whether they will be renewed. Until a resolution is reached, 2026 Marketplace premiums may appear significantly higher for many Americans.

I will continue to monitor developments closely and provide updates as soon as new information becomes available.

Additionally—

It has come to my attention that my clients have been told the First Health PPO network plan is being mistakenly interpreted by them as being an Affordable Care Act (ACA) compliant PPO network. As such, they incorrectly believe any and all of their pre-existing health conditions will be covered and that all preventive exams and medicine will be covered at no out-of-pocket cost to them. This is wrong and here is the truth, as confirmed by me and ChatGPT:

✅ 1. There are no ACA-compliant PPO plans available in Texas individual/family (On- or Off-Exchange)

Texas has not had a true ACA-compliant individual market PPO option for several years.
All carriers (BCBSTX, Ambetter, United/Optum, Aetna CVS, Oscar, Cigna, Moda, etc.) offer only:

EPOs
HMOs

These networks limit out-of-network benefits and require referrals or tighter network management.

A PPO requires:

National or multi-state contracted provider access
True out-of-network benefits
No referral requirement

No carrier has offered this in the ACA individual Texas market since around 2017–2018.

✅ 2. Aetna is not selling ACA individual/family plans in Texas for 2026 (and has already exited)

Your clients may be confused because Aetna offers:

Medicare Advantage PPOs
Employer-based PPOs
First Health networks tied to group/other products

But Aetna does NOT offer ACA individual/family plans in Texas for 2026.

So if someone believes they have an “Aetna PPO” under an ACA plan, they are mistaken. It is either not an ACA plan, or they are misinterpreting the network type.

✅ 3. If their plan is marketed as “PPO-like,” it is almost certainly:

a) A short-term medical plan

These frequently use PPO networks—including Aetna’s First Health—but they are:

NOT ACA-compliant
Do NOT cover pre-existing conditions
Can cap benefits
Can deny claims based on underwriting

b) A health-sharing ministry

Often marketed as “PPO plans” because they use rented networks, but also:

Not insurance
Not regulated as insurance
No claim guarantees
No ACA protections

c) A fixed-benefit plan that uses First Health or MultiPlan PPO

Again:

Not insurance
No ACA protections
No out-of-pocket maximums
No guaranteed coverage

d) A direct primary care + medical indemnity bundle

These are sometimes misrepresented as “PPO plans,” but they are not.

✅ 4. How to confirm instantly whether the client is on ACA-compliant coverage

Ask for one of the following:

A) The name of the carrier.

If it’s not:

BCBSTX
Cigna
Ambetter
UnitedHealthcare (UHC Marketplace)
Aetna CVS (in some states, but NOT Texas 2026)
Moda
Oscar (until exit)

…then it’s almost certainly not ACA-compliant.

B) A copy of the Summary of Benefits & Coverage (SBC).

All ACA plans must include an SBC — short-term plans and sharing ministries do not.

C) Their monthly bill or ID card.

If it says things like:

First Health Network
MultiPlan PPO
PHCS PPO
Aetna PPO
United Healthcare Choice/Choice Plus PPO

…that is almost certainly a non-ACA plan.

✅ 5. Bottom line for you:

If you believe you they are on an ACA-compliant “Aetna PPO” for individual/family coverage:

You are not. No such product exists in the Texas ACA market. You are almost certainly on a short-term plan, health-sharing product, or fixed-benefit plan using a rented PPO network.

This is an excellent opportunity for ne to help you transition to true ACA coverage, where you will regain:

Pre-existing condition protection
Essential health benefits
No annual/lifetime caps

And – perhaps most importantly – Out-of-pocket maximum protection

Please feel free to call me with any questions you may have or for assistance in obtaining 2026 ACA compliant health insurance. I will make the quoting and application process go as quickly and smoothly as possible whether you quailify for a subsidy or not.

The Open Enrollment Period for a January 1 effective date ends December 15th. You have until January 15th to obtain an effective date of February 1.

D. Kenton Henry
Office: 281-367-6565
Text my cell 24/7@ 713-907-7984
Email: Allplanhealthinsurance.com@gmail.com

What Texas Consumers Must Know as the 2026 Individual & Family Health Insurance Market Evolves

Posted on October 30, 2025 by thehealthinsuranceanswerman

By D. Kenton Henry, Editor / Agent / Broker — TheWoodlandsTXHealthInsurance.com, AllPlanHealthInsurance.com, HealthandMedicareInsurance.com 30 October 2025

Each November in Texas marks more than just the start of the new health insurance year—it’s your gateway to securing coverage for the year ahead. This time around, the 2026 individual and family health insurance market is undergoing noticeable changes. Here’s what you need to know—and how you can be ready.

1. Why 2026 matters

Open enrollment for 2026 policies begins November 1, 2025, and runs until January 15, 2026 for most Texas consumers. If you don’t act in this window, you could be locked out of making changes until next year unless a qualifying life event occurs. Given major shifts among carriers and plan options, early action is more important than ever.

2. Carrier changes you should track

One of the major headlines: Aetna will exit the Texas individual and family market beginning in 2026. That means if you currently have an Aetna plan, your policy will not renew for 2026. You’ll need to select a different carrier in the upcoming enrollment period.

Other carriers are repositioning their offerings, adjusting networks, benefits, and rates. Even if your carrier is staying, plan names and design may change. As your broker, I’ll review all available options from multiple carriers and ensure you’re not simply renewing by default.

3. What this means for you

No automatic renewal: If your carrier exits the market, your current plan will not carry over. You’ll receive a Notice of Change—or termination—and need to select a new plan.
Shop your options: Differences between plans are not only about monthly premiums. Review networks, cost-sharing, deductibles, out-of-pocket maximums, and whether benefits match your healthcare needs.
Subsidy changes: The federal subsidy rules continue to evolve. Even small changes in income, household, or eligibility can shift your subsidy level. I’ll help you analyse eligibility for Advance Premium Tax Credits (APTC) and other cost-saving tools.
Timing matters: Beginning November 1, I’ll be available to assist you through the selection process—not just on carriers and plans, but on ensuring accurate enrollment to avoid coverage gaps.

4. Why working with a broker matters

As an independent broker specializing in medical insurance since 1986, I work with virtually every major carrier licensed in Texas. My services to you are free of charge. My goal is to ensure you get the best plan that fits your health needs, budget, and preferences—especially in a year of significant market change.
Rather than navigating dozens of plan names on your own, let me do the heavy lifting and help you make an informed choice.

5. What to do now

Gather your information – your current health plan, recent premium receipts, summary of benefits, and any health changes.
Schedule your review – open enrollment kicks off November 1. If you’d like early preparation, I’m available now to pre-review your situation so you’re ready to act.
Act during the window – November 1 through January 15 is your open period. Plans go into effect January 1, 2026, or, depending on carrier rules, as early as December 1, 2025.
Don’t wait – with carrier exits and plan redesigns in motion, the sooner you start the review, the better your chance of finding the optimal match.

Working together, we’ll turn these market shifts into an advantage—so instead of scrambling when notices arrive, you’ll move confidently into 2026 with coverage aligned to your needs. Let me handle the complexity so you can focus on your life, your health, and your goals.

If it’s after hours, or you simply prefer, you can do preliminary research before calling me by obtaining quotes from my quoting engine. You do NOT have to log in to obtain them but be certain to call me afterwards with questions, and assistance in finding your providers within the networks, as well as applying. CLICK HERE: https://allplaninsurance.insxcloud.com/get-a-quote

D. Kenton Henry

Editor · Agent · Broker
TheWoodlandsTXHealthInsurance.com * AllPlanHealthInsurance.com * HealthandMedicareInsurance.com

https://TheWoodlandsTXHealthInsurance.com
https://Allplanhealthinsurance.com
https://HealthandMedicareInsurance.com

KEY CHANGES TO MEDICARE PART D DRUG AND ADVANTAGE PLANS IN 2026

Posted on September 30, 2025 by thehealthinsuranceanswerman

D. Kenton Henry
Editor, agent, broker
30 SEPTEMBER 2025

Medicare 2026: Welcome clients and prospective clients! Before reading this (if you have not already), you should go to your mail box and retrieve your 2026 Annual Notice of Change from Medicare. You were due to receive it no later than today per Center For Medicare Rules and Regulations. If will give you a good idea if you need to re-shop your Medicare Advantage or Part D Drug plan for the coming calendar year. If not, the following changes may.

10 changes to review before the Annual Election period, often referred to as the Open Enrollment (Oct 15–Dec 7)

If you’re on Medicare, 2026 brings important updates—especially to prescription drug coverage. The Part D out-of-pocket cap rises to $2,100, the standard deductible becomes $615, and Medicare’s first negotiated drug prices start on January 1, 2026. Medicare Advantage also gets new guardrails around prior authorization and appeals, and some supplemental “perks” are being narrowed. Check your Annual Notice of Change (ANOC) (it should arrive by Sept 30) and compare your plan options—small differences can mean big savings. If you’d like help, I’ll review your medications, doctors, and benefits to make sure you’re in the right fit for January 1.

Here is an itemized list of the 10 Key Changes:

Medicare changes your 2026 plan review should cover

1) Part D’s annual out-of-pocket cap rises to $2,100.
Once a member’s 2026 Part D out-of-pocket spending reaches $2,100, they’ll pay $0 for covered Part D drugs for the rest of the calendar year.

2) The standard Part D deductible increases to $615.
Plans can’t set a deductible higher than $615 in 2026 under the redesigned Part D rules.

3) Drug price negotiations start showing up at the counter.
Medicare’s first set of negotiated Maximum Fair Prices (MFPs) for 10 widely used Part D drugs take effect January 1, 2026. Members should review their ANOC and plan formularies to determine how these prices impact their medications.

4) Insulin and adult vaccines: protections continue.
Part D insulin remains capped and no-deductible; starting in 2026, the cap is the lesser of $35, 25% of the MFP, or 25% of the negotiated price. ACIP-recommended adult vaccines remain $0 under Part D.

5) “Pay-over-time” for prescriptions auto-renews.
The Medicare Prescription Payment Plan (monthly billing instead of paying large amounts at the pharmacy) auto-renews in 2026 unless the member opts out. It smooths payments but doesn’t lower total costs—good to remind clients who tried it in 2025.

6) Medicare Advantage prior-auth and appeals guardrails tighten.
For 2026, CMS says MA plans must honor previously approved inpatient admissions (can only reopen for obvious error or fraud), and CMS closes appeals loopholes so members and providers receive required notices and can appeal adverse coverage decisions. Expect fewer mid-stay reversals. Centers for Medicare & Medicaid Services

7) Limits on certain “extra perks” in MA (SSBCI) take effect.
CMS codified non-allowable Special Supplemental Benefits for the Chronically Ill—examples include non-healthy food, alcohol, tobacco, and life insurance. Some plans may rebalance extras as a result.

8) Star Ratings update: new/returning measures.
2026 Stars add or reintroduce measures like Kidney Health Evaluation for Patients with Diabetes plus Improving/Maintaining Physical and Mental Health (weight = 1). Tougher cut points in 2026 may shift plan bonuses and benefit richness—worth watching locally.

9) Part D benefit design shifts behind the scenes.
Liability shares change across phases (plans, manufacturers, CMS), and there’s a new subsidy for selected (negotiated) drugs. Members may see formulary/tier adjustments—another reason to compare plans.

10) ANOC timing: what to tell clients.
Remind everyone: Annual Notice of Change (ANOC) letters arrive by September 30 each year; if they didn’t see one, call the plan. Open Enrollment runs Oct 15 – Dec 7 for Jan 1 effective dates.

Check your Annual Notice of Change (ANOC) (it should arrive by Sept 30) and compare your plan options—small differences can mean big savings. If you’d like help, I’ll review your medications, doctors, and benefits to make sure you’re in the right fit for January 1.

Other Developments

Some Medicare Advantage supplemental benefits (i.e. nutrition support, OTC medicine) may be reduced in favor of core services.
In six states, prior authorizations for certain Original Medicare services will be tested.
Part B and Part D premiums and deductibles are both set to increase—Part B premium up ~11.6%, and Part D premium by about 6%.

Who Am I?

In addition to being the editor of this blog I have has been helping individuals and families navigate the health and Medicare insurance landscape since 1986. With nearly four decades of experience, he specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D prescription drug plans.

As an independent broker, I am appointed with virtually every competitive, A-rated Medicare insurance company in Texas, Indiana, Ohio, and Michigan. This broad access allows him to recommend the plan that truly best fits each client’s needs.

Above all, I work for my clients—not the insurance companies. You will never pay more by enrolling through me than you would if you purchased an insurance product directly from the carrier. My mission is to provide clear guidance, personalized recommendations, and ongoing support to ensure my clients get the coverage and peace of mind they deserve.

If you have any questions about 2026 Medicare Part D prescription drug plans, Medicare Advantage, or Medicare Supplement (Medi-Gap) policies, please give me a call.

D. Kenton Henry

Office: 281-367-6565
Text my cell 24/7 @ 713-907-7984
Email: Allplanhealthinsurance.com@gmail.com

For all the latest news on health and Medicare related insurance, please follow me on my blog @ Https://HealthandMedicareInsurance.com

https://TheWoodlandsTXHealthInsurance.com

**********************************************************************************

FEATURE ARTICLE 1

By: Elizabeth Casolo Friday, September 26th, 2025

Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program should remain relatively stable next year, CMS said in a Sept. 26 news release. But MA enrollment is projected to decrease 900,000 in 2026.

Despite a slight dip in available MA plans nationally, over 99% of Medicare beneficiaries will still be able to access an MA plan.

The agency estimates the premiums for MA plans to drop from $16.40 to $14.00. On average, the total premium for standalone Part D is estimated to fall $3.81.
CMS’ July forecast predicted elevated Medicare Part D base premium increases in the neighborhood of 6%.

NAVIGATING THE FRUSTRATIONS OF FINDING INDIVIDUAL AND FAMILY HEALTH INSURANCE

Posted on March 21, 2025 by thehealthinsuranceanswerman

By D. Kenton Henry
Editor, Agent, Broker

Finding Your Doctor and Understanding Subsidies in HMO Plans

Shopping for individual or family health insurance can feel like navigating a maze—with dead ends, confusing signs, and few clear answers. Two of the most common pain points for shoppers are (1) trying to keep your current doctor while limited to an HMO network and (2) figuring out whether you qualify for a subsidy, known as an advance premium tax credit (APTC). Both challenges can make the process frustrating and overwhelming, especially during open enrollment when time is limited.

The HMO Headache: “Will My Doctor Be Covered?”

One of the biggest shocks people face when shopping for health insurance is realizing that their trusted doctor or medical provider might not be covered under a new plan—especially if it’s an HMO (Health Maintenance Organization). Unlike PPOs (Preferred Provider Organizations), which offer broader provider access and out-of-network options, HMO plans restrict coverage to a specific network of doctors and hospitals. If your doctor isn’t in the network, you may have to pay the full cost of your visit out of pocket—or switch doctors entirely.

Unfortunately, trying to find this information is often easier said than done.

Outdated or Inaccurate Provider Directories: Online directories can be incomplete or outdated. It’s not uncommon for a provider to be listed as “in-network” only for you to find out later they’ve left the plan.
Hard-to-Navigate Insurance Websites: Many insurance carrier sites don’t make it easy to search by doctor name, location, or specialty. Even worse, each plan may have its own “network tier,” adding another layer of complexity.
No Universal Search: There’s no centralized tool that lets you enter your doctor’s name and see every marketplace plan that includes them. You have to check each insurance company or plan individually.

For people with ongoing care needs—like managing chronic conditions or continuing with a trusted pediatrician or specialist—the possibility of switching providers isn’t just inconvenient, it can feel risky.

The Subsidy Puzzle: “Do I Qualify for Help Paying My Premium?”

The Affordable Care Act (ACA) made health insurance more accessible by offering subsidies for people who meet certain income guidelines. These subsidies, officially called advance premium tax credits, lower your monthly premium based on your household size and income.

The good news is that many people qualify.

The bad news is that determining whether you qualify can feel like filling out a tax return just to get a quote.

Income Guesswork: Subsidy eligibility is based on your estimated household income for the upcoming year. That’s right—you must predict your future income, even if you’re self-employed or work variable hours.
Family Dynamics Matter: Your household size includes dependents—even if they don’t need insurance—and income from every working member. This means getting it right often requires gathering data from multiple people.
Mid-Year Changes Complicate Things: If your income or family size changes mid-year, you may need to report it or risk having to repay part of your subsidy at tax time.
The ACA “Cliff” and “Glide Path”: Previously, you could lose your subsidy entirely if your income was even $1 over the limit. Recent changes have smoothed this out, but they are still complicated and frequently misunderstood.

And while tools like Healthcare.gov’s calculator are helpful, they often rely on broad estimates. They can’t account for all variables, such as gig work, investment income, or multiple part-time jobs.

Why It Feels So Frustrating

When you shop for health insurance, you’re not just picking a product—you’re making decisions that affect your finances, your family’s well-being, and your access to care. The stakes are high, yet the process often feels opaque and unnecessarily complicated.

You’re expected to:

Compare dozens of plans with unfamiliar terms,
Check if your providers are covered (without reliable tools),
Predict your income a year in advance,
And hope you don’t make a mistake that costs you money or coverage.

Tips for a Smoother Experience

While the system isn’t perfect, there are ways to reduce frustration:

Use a Licensed Agent or Broker: Agents specializing in ACA plans can often help you find plans that include your provider and determine if you qualify for subsidies—all at no extra cost.
Call Your Doctor’s Office: Don’t rely solely on insurance directories. Call your provider’s office directly to confirm if they accept a specific plan.
Keep Documentation: If your income fluctuates, keep clear records. This will help you provide accurate estimates and support your case in the event of an audit or dispute.
Update Changes Promptly: If your income or household size changes mid-year, report it on your health insurance marketplace to avoid surprise bills or tax penalties.

In Summary

Shopping for individual or family health insurance can be a stressful process—especially when you’re trying to keep your doctor and figure out if you qualify for financial help. Between restrictive HMO networks and confusing subsidy rules, it’s easy to feel stuck. But with a little extra diligence, some expert help, and the right questions, you can find a plan that fits your needs without sacrificing peace of mind.

If the process still feels overwhelming, you’re not alone. Many Americans share the same frustrations—and continue to hope for a more user-friendly system in the future.

Below is a chart outlining estimated income thresholds for qualifying for an Advance Premium Tax Credit (APTC) in 2025. These thresholds are based on a percentage of the Federal Poverty Level (FPL), which is adjusted annually. For simplicity, the chart includes 2024 FPL figures (used for 2025 coverage) and the income ranges (100%–400%+ of FPL) where most people qualify for subsidies under the ACA.

📝 Note: Due to the American Rescue Plan and Inflation Reduction Act, subsidies may extend beyond 400% of the FPL, with a sliding scale that caps the percentage of income spent on premiums. These extended subsidies are currently in place through 2025.

2024 Federal Poverty Level (FPL) and APTC Income Guidelines for 2025 Coverage

Household Size100% / FPL400% / FPLTypical APTC Eligibility Range

1 (Individual) $14,580 / $58,320 / $14,580 – ~$58,000+

2 (Couple) $19,720 / $78,880 / $19,720 – ~$79,000+

3 $24,860 / $99,440 / $24,860 – ~$99,000+

4 (Family) $30,000 / $120,000 / $30,000 – ~$120,000+

5 $35,140 / $140,560 / $35,140 – ~$141,000+

6 $40,280 / $161,120 / $40,280 – ~$161,000+

Key Notes:

Minimum Income: You must earn at least 100% of the FPL to qualify for a subsidy in most states. In Medicaid expansion states, if you earn less than 138% FPL, you may qualify for Medicaid instead.
Upper Limit Removed: Thanks to temporary reforms, people earning above 400% FPL may still qualify for a subsidy if the cost of the benchmark plan exceeds ~8.5% of their income.
Household Size: Includes you, your spouse, and any dependents claimed on your tax return.

💡 What This Means for You

If your estimated annual income falls between the ranges shown above, you likely qualify for help paying your monthly health insurance premium.
Households earning more than 400% of the FPL may still qualify if their premiums exceed about 8.5% of income, thanks to current federal subsidy expansions.
Eligibility is based on your tax household — including you, your spouse, and dependents you claim on your tax return.
If your income is below 138% FPL, you may qualify for Medicaid (in most states).

DO NOT CALL AN 800 NUMBER and talk to some anonymous employee of an insurance company. Not only are they restricted to limiting you exclusively to their company’s options—but your personal information will be instantly sold and shared. Your phone is going to begin ringing off the hook!

I’ve been specializing in Medicare-related insurance for over thirty years, right here in The Woodlands, Texas, USA! I represent every Medicare-related product, including Supplement, Advantage, and Part D Drug plans, from virtually every “A” rated company doing Medicare-related business in Texas. And I CHARGE NO FEE for my services! Deal with a local agent/broker who values your business enough not to share it with anyone!

D. Kenton Henry
Editor, Agent, Broker
Office: 281.367.6565
Text my cell 24/7 @713.907.7984
Email: Allplanhealthinsurance.com@gmail.com

Your More Affordable 2014 Health Insurance Exchange Plan is Likely to Work Like an HMO or Medicaid

Posted on August 16, 2013 by thehealthinsuranceanswerman

By Kenton Henry

If you have ever been covered on an employer’s group health insurance plan, you may have had to select your medical providers from a Health Maintenance Organization (HMO). If you were enrolled in a plan of this type – it was probably because it was your only option or because you were young and thought yourself bullet proof. And the reason is – most older people would not elect an HMO if given a choice. Because if your plan utilizes one – you either see a provider within the network or you have no coverage at all. Most older people know that when your health problem is anything more than a common runny nose (which is all young people believe they’re ever going to suffer from) – a person wants to be able to select their own doctor or hospital.

Has your income ever been at the poverty level or below? If so then you probably qualified for Medicaid. That’s the government’s health plan administered by the states for the poor. And if you were covered by Medicaid, you know how difficult it was to find doctor’s to take Medicaid, get into an appointment or see a specialist.

Now comes Obamacare. And when the premiums for the new health care compliant plans become available for individuals and families to choose from October 1 for a January 1 effect date – be prepared for sticker shock. Without going into projections of an unknown quantity, suffice it to say, the word on the insurance street is the cost of these plans is going to make people in most states “have a cow”!

So naturally, you’re going to review the lowest cost plans – the bronze or “catastrophic” options and hope they meet your needs. And when you do – you best hope you ARE young and bullet proof because you are probably going to find your selection of providers is going to be what you had available in a larger group plan HMO divided by 10 . . . or more. Be prepared to wait a long time for appointments and heaven forbid you need to see a specialist or a special procedure because–if you do–you are probably going to have to get the President to issue another of his executive orders to make it happen.

And what if you’re not young and bullet proof? Get used to rationing. Because Obamacare doesn’t like specialists and who do you want to see when you have a serious problem? Who do you think is going to authorize a more sophisticated (expensive) procedure? I love my family doctor but when he thinks I need a more expensive procedure – he refers me to a neurologist or an orthopedic surgeon, etc. But be prepared for your new health plan pre-certification department to tell you – “There must be a pill for that.”

In conclusion, you’d better hope you qualify for the subsidy so you can add all or a portion of your premium to the national debt. If not . . . be prepared to pay Cadillac prices for what at best will be an Oldsmobile.

(For more a perhaps more objective take on this – go to:
THE WALL STREET JOURNAL; BUSINESS AUGUST 14, 2013:
Many Health Insurers to Limit Choices of Doctors, Hospitals
By Anna Wilde Mathews @ http://online.wsj.com/article/SB10001424127887323446404579010800462478682.html

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