The health care reform landscape is changing often. As an insurance broker (and even those of us knee-deep in reform), you probably have a hard time keeping up.

The velocities at which legislation and dates change can often make your job feel like an episode of Mythbusters. When you’re meeting with your clients and their employees, be sure you’re aware of the information…and misinformation surrounding the Affordable Care Act (ACA).

Myth:    Exchanges don’t work.

Fact:      The state and federal exchanges are now up and running. It took a little while to get there and exchanges experienced some technical difficulties, but over seven million people have already enrolled in coverage.

Myth:    Health care costs are more expensive now.

Fact:      The short answer is true and false. The generalization that all healthcare costs are higher is inaccurate because it depends on a number of variables: the member’s state, age, coverage preference and so on. A recent study by the Manhattan Institute shows that medical premiums could increase by up to 41 percent. However, that’s not across the board. Some people will find that coverage is more expensive while others will be paying less. Unfortunately, there is a lot of grey when it comes to premium costs.

Myth:    All smallbusinesses must “pay or play.”

Fact:      The “pay or play” tax rule applies only to small businesses that employ 50 or more employees who work 30+ hours a week. There are a whole host of other factors to consider when advising a group to pay or play. We posted a recent blog that covers what your employer groups may need to know about pay or play requirements.

Myth:    Dental is not required.

Fact:      Pediatric dental coverage is one of the 10 mandated Essential Health Benefits (EHBs). Insurance policies must include the pediatric dental EHB in order to be ACA certified and sold on exchanges. This requirement can be satisfied with a stand-alone dental plan. Each dental requirement varies by state so check out this dental EHB map to be in the know.

Myth:    All ACA mandates apply to everything.

Fact:      Not all mandates were created equal. For example, many of the mandates and provisions for medical don’t actually apply to dental. When it comes to applicable mandates, dental is typically the largest outlier. The National Association of Dental Plans is a great resource for the nuances of reform and dental, so subscribe to its e-newsletter for the latest news in dental.

Myth:    Open enrollment is closed.  

Fact:      Individual open enrollment has closed, that’s true, but the SHOP (Small Business Health Options Marketplace) is open for business. What this means to you as a broker – and to your groups – is that you can sell small group plans on the federal and state exchanges. Remember: if you’re going to sell SHOP or individual plans, you’ll need to be an ACA-certified broker. Here are some tips to getting ACA-certified in your area.

 In my experience, finding trusted, credible sources on ACA info is the biggest trick to staying ahead of the reform curve, and deciphering what reform regulations are true and false.

Heard any more health care reform myths you want busted? Leave a comment and we’ll do the fact finding for you!

The information in this blog is based on Solstice's review of the national health care reform legislation and is not intended to provide legal advice. While we make every effort to present and update accurate information, interpretations of the reform legislation vary. The overviews provided here are intended as an educational tool only and should not be relied upon as legal or compliance advice.

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