“Grandfather is gold,” I had always been told. TO HIS credit, it was my insurance broker who recommended we’d be better off buying our insurance through the Marketplace. ABOUT THE only things that come in about the same or are more expensive under SHOP are prescription drugs and emergency room visits. SO FORGET the “grandfather is gold.” When it comes to health insurance, the word grandfather is simply old.
So when it came time to review the health insurance policy for The Iola Register I had the mindset my long-term policy was not only the best I could afford, but also the best for my employees.
Sure enough, we were looking at a 13 percent reduction against last year’s premiums.
“As I said, grandfather is gold,” the broker told me with a wink, intimating our loyalty was being rewarded.
Truth is, that “granddaddy” of a policy is woefully out of date and lacks many of the benefits current policies offer at much better prices.
Probably like lots of small businesses, the Register has been slow to embrace the Affordable Care Act and its SHOP plan, which stands for Small Business Health Options Program and is for businesses with 2-50 employees.
I had been led to believe we’d lose a lot of our benefits if we switched over to the Marketplace, and to be honest I had been lazy in not doing the necessary homework myself.
The outcome? I’m losing a sizable tax credit for my business for 2014, my employees have been living with an outsized deductible and we’ve missed out on many free services now mandated by current plans.
“If you want lower deductibles, better coverage, and a tax credit, well, yes,” he said, somewhat sheepishly.
When comparing the two policies our current plan falls short in almost every category.
For the first two years after the ACA was passed, the Register enjoyed a generous tax credit for providing health insurance to our employees and their families. Unfortunately, it was only last week I discovered that credit has since expired for my current plan.
Though kicking myself for not knowing this was coming down the pike, I at least can look forward to an even more generous tax credit through SHOP.
My employees, too, will be able to enjoy much lower deductibles than what they have been paying. This means a stay in the hospital won’t break the bank.
Coverage, too, is much more comprehensive.
Our grandfathered policy requires us to pay out of pocket for things like a colonoscopy, urinary tract infections and contraception. All these are now free under the SHOP plan. A colonoscopy alone runs about $1,600.
For annual physicals — including the “Well Women” — pap smear and mammogram — we currently pay a $25 copay. Those, too, will be free under SHOP as will screenings for mental health, type 2 diabetes, cholesterol and osteoporosis.
“The goal is to get and keep people healthy,” said Lisse Regehr, who helped walk me through the SHOP offerings. Regehr is a certified Navigator who helps people sign up for the federal health plans.
Regehr, 34, also views the new plans as more fair, especially when it comes to women.
“Women were discriminated against,” she said flatly. “Their health insurance premiums were higher than a man’s; they were charged more for identical services, just because of their sex. Those days are gone with the Affordable Care Act.”
Generic drugs remain the same, $15, but the next tiers are more expensive than what we had. This encourages us to be smart shoppers and also ask for the generic version of a drug, if possible.
Charging more for visits to the ER should also prompt us to be more diligent in taking care of a health care problem before they turn into a crisis.
This grandfather is old, not gold
