PRYOR, OK —
Randy Quattlebaum, owner of Cross Pharmacy, has made it his business to know a thing or two about the Affordable Care Act.
Whether he agrees with the health care reform or not, he wants to be able to guide his customers through the ins and outs of the new act.
“The big thing to remember about the Affordable Care Act, often called Obamacare, is that it is intended to make it where health care is affordable for everyone,” said Quattlebaum. “The reform accounts for all income brackets, from those making $0 up to those with a Bill Gates’ level income.”
He said the groupings start with those on Soonercare.
“Next is the group the government knows cannot afford even the reduced premiums, so they are given government subsidies,” said Quattlebaum. “Then there are those on a higher tax bracket who don’t get government assistance but can access the Marketplace.”
The Marketplace is an online guide to shopping for insurance.
He said a key objective to the reform is to make large insurance companies of the world willing to make plans available for small businesses.
“Essentially they want to make it more competitive with lower prices for consumers,” said Quattlebaum.
One key change the legislation implemented was to eliminate the phrase “pre-existing condition” said Quattlebaum.
He explained that insurance is unlike any other product because premiums are the main source of revenue for the insurance companies.
“One of the issues it creates is that to make it work they need to convince the younger, healthier generation to get coverage so that the insurance company has more revenue than expense,” said Quattlebaum.
He said there are ACA exemptions available for different groups, namely Native American Indians. Quattlebaum said he has heard from numerous reliable sources that in Oklahoma Native Americans qualify for exemption, but it is unclear if the exemption is automatic or if individuals need to fill out an exemption application.
Quattlebaum said that contrary to rumors Muslim individuals are not exempt, but Amish individuals are.
“In addition, individuals and families with household incomes between 100 percent and 400 percent of the Federal Poverty Level who are not eligible for certain other types of coverage may qualify for tax credits to make premiums more affordable,” according to the Department of Health and Human Services.
Exemption is also given to members of a Healthcare Sharing Organization.
“The Healthcare Sharing Organization is not for everyone but it may be worth researching,” said Quattlebaum. “Members are exempt because it shows that are you doing something to protect yourself.”
Members of a Healthcare Sharing Organization pay money into the system, in case of medical emergency, but are not always guaranteed a 100 percent return on their money.
The reform does not apply to individuals on Medicare, he said.
“As far as individuals who are currently insured, your employer should have notified you already if you will have a change in your coverage,” said Quattlebaum. “If you have not heard from your employer yet it could mean you are not seeing immediate changes, but you could contact your employer's insurance representative and find out for sure.”
He said in the ACA there are pricing constraints and the act is divided into four categorie; bronze, silver, gold and platinum.
“In the bronze category, you'll have the highest deductible with the lowest premiums,” said Quattlebaum. “On the other end in the platinum category you'll have a low co-pay and deductible, but high premiums.”
He said insurance companies are throwing the exact numbers around in an effort to make a sale.
“Another constraint is that the highest age bracket, 50 years old and higher, can only be three times the premium for someone in their 20s,” said Quattlebaum. “Older individuals can expect to pay more because they have, on average, more health concerns.
Now that the Marketplace has officially opened, Quattlebaum said it is crucial to look out for fraud.
“There are individuals called navigators. These individuals are trained by the government to help navigate the reform and provide you with all-inclusive information. They cannot recommend one company over another, they can only give you the facts,” said Quattlebaum.
These navigators are non-biased and not do not represent any individual insurance company. Quattlebaum said because of the uncertainty surrounding the reform, people need to be aware of scams.
“Unfortunately there could be people trying to take advantage of the situation. There could be people trying to get your information, so it is important to know that there are designated navigators and that they typically do not seek out and contact individuals,” said Quattlebaum, who said to be wary of anyone requesting information.
Quattlebaum said he is doing his part to help guide anyone he can through this reform, but he is not a trained navigator.
“Something I've been doing for years is helping individuals on Medicaid Part D figure out their options. They can come to me with a list of their medications and I can help them look at their best choices,” said Quattlebaum, who would like to help people who are not on Medicare.
Cross Pharmacy just celebrated its fifth year in business. Quattlebaum grew up in Texas and went to school at Southwestern Oklahoma State University. He managed another pharmacy in Pryor before opening his own.