Your Finance: Preparing for Affordable Care Act

New nurses at the Lawrence & Memorial Hospital

New nurses at the Lawrence & Memorial Hospital in New London, Conn. participate in a training program that helps health care workers adjust to the difficult job. (Nov. 21, 2012) (Credit: AP)

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In a post-Obamacare future, expect more employers to adopt defined contribution health care plans. Instead of providing coverage, they will throw a set amount of cash at workers and have them buy their own coverage on private employer-sponsored exchanges.

That future isn't here yet. Right now only about 5 percent of companies are using this approach, according to Alan Cohen, chief strategy officer of Liazon, a firm that sets up private exchanges for companies.

But Cohen expects that in five years half of all companies will be offering these private-choice dollar benefit plans.

Major elements of the Patient Protection and Affordable Care Act are approaching even faster than that. On Oct. 1 the first massive open-enrollment health insurance season in history starts, when the state and federal exchanges open for business.

Here's an early take on what to expect and what to do about it now:

This tax season matters. Take a look at your 2012 tax return to see if you're going to qualify for subsidies. People who earn 400 percent of the federal poverty level or less will have their premium costs capped and excess premium covered by tax credits.

Those figures do get adjusted annually, but using 2012 numbers, that means that even families earning four times the poverty level -- roughly $44,680 for singles and $92,200 for that family of four -- would see their health insurance costs capped. At that income level, premiums couldn't cost more than 9.5 percent of family income. Lower levels of income would qualify for lower caps and higher subsidies.

People with incomes up to 250 percent of the poverty line also will qualify for lower deductibles and co-payments subsidized by the federal government.

Married couples who have been filing separately should give very strong consideration to filing jointly, suggests Cheryl Fish-Parcham, deputy director of Families USA, a consumer advocacy organization.

Get educated. Fish-Parcham and her colleague, Claire McAndrew, a senior policy analyst, say they worry most about newcomers to the health insurance buffet getting scammed or misled once they are both required to buy health insurance and be responsible for choosing their own. Beginning on Oct. 1 there will be public exchanges featuring health insurance plans that meet minimum federal guidelines. That means they won't exclude people with pre-existing conditions, and they won't have lifetime spending limits, for example.

For now, it's good to look at your family and analyze your use of the healthcare system. Do you have lots of well-child visits? Chronic conditions? Do you want to pay higher premiums for first-dollar coverage or less for higher-deductible plans? If you know early what your health spending patterns are, it will be easier for you to shop for health insurance.

Save money now. If you currently have a high-deductible plan with a health savings account, max out your contribution for 2012 and 2013. It's not clear that these programs will all survive in their current form going forward; you may find yourself with other choices that don't allow you to use an HSA, and that money could come in handy later.

As more employees are nudged to cheaper high-deductible plans in the future, they will want to learn more about the healthcare they are buying, suggests Ceci Connolly, managing director of the PwC Health Research Institute. She said that after being switched to a high-deductible plan herself, she started questioning her healthcare costs more carefully.

For more information, visit the government's website www.healthcare.gov/compare to see data on doctors and hospitals