Exploring Common Misconceptions about the Affordable Care Act

There’s no way around it: securing medical insurance—for yourself, your family, or your practice team—can be a challenging process to navigate. At the AVMA Trust, we frequently receive inquiries from members asking about healthcare options and how they can secure coverage that’s both effective and affordable. We also field questions from members who are confused about the Affordable Care Act (ACA) or who are looking for information about the AVMA Trust’s Practice Healthcare Solutions (PHS) program.

The goal of this article is to debunk some of the myths surrounding healthcare coverage for veterinarians, provide useful information about the options available to AVMA members, and get DVMs on a path to securing appropriate coverage for themselves and their teams.

The AVMA Trust and Individual Healthcare: The Journey So Far

Throughout much of its 60-year history, the AVMA Trust offered healthcare coverage for individual AVMA members and their families. Until 2014, veterinarians could purchase this coverage directly from the AVMA LIFE Trust (then known as AVMA GHLIT) as long as they remained active AVMA members. However, when the Affordable Care Act passed in 2010, it introduced new regulations and requirements for health insurance. These regulations included mandates for certain coverage benefits, limits on premium variations based on health status, and requirements for essential health benefits. Many organizations—including the AVMA Trust—found it challenging or cost-prohibitive to comply with the new regulations and, as a result, made the difficult decision to discontinue offering health insurance to individual members and their families.

But the Trust did not give up on our commitment to provide healthcare solutions for AVMA members. In September 2019, we began offering group healthcare coverage to practice owners and their employees in 12 states through the AVMA Trust Association Health Plan (AHP). The Trust planned to expand the AHP to additional states; however, the expansion of AHP entities was stalled by a federal judge’s ruling that ultimately affected the viability of such programs.

Frustrated but undeterred, we continued to look for ways to provide members with health insurance options. In January 2022, we launched AVMA Trust Practice Healthcare Solutions, making group healthcare solutions available to AVMA members and their staffs in all U.S. states as well as the District of Columbia and Puerto Rico. The PHS umbrella encompasses the existing 12-state Association Health Plan and expands our reach to include other group healthcare options in the states and territories not served by the AHP.

Today, PHS is available as a member benefit to veterinary practices with at least two employees (one of whom may be the practice owner) who work at least 30 hours per week and whose practice owner(s) and all participating DVMs are AVMA members. In addition, 75% of all eligible employees (not counting those covered by a qualified health plan) must participate in the program, and the practice must contribute at least 50% to the employee rate on the lowest-cost plan.

We are not stopping there, however. The Trust is committed to expanding our group healthcare offerings to ensure that all members have access to a solution that fits their needs.

Exploring Common Misconceptions about the Affordable Care Act 

The AVMA Trust no longer offers healthcare coverage for AVMA members. False.
The Trust offers group healthcare plans through the AVMA Trust Practice Healthcare Solutions program. Enrollment in this program is a member benefit available to active AVMA members who operate veterinary practices and to AVMA-affiliated entities* with at least two employees.

Being an AVMA member makes me part of a “group,” which means I am automatically eligible for group healthcare through the AVMA Trust. False.
In the context of the AVMA Trust’s PHS program, “group” refers to a practice owner and their employee(s). Being an AVMA member does not automatically make you part of a qualified grouping.

The Trust no longer wants to offer individual healthcare plans for AVMA members. False.
Due to ACA coverage mandates and regulations, association health plans are no longer a viable option for most organizations. While this reality is disappointing to many associations and trade organizations, ACA does offer many benefits. The intent of the ACA was to provide patient protections and health coverage to millions of people without access. As of 2021, 20 million consumers were covered under ACA plans. If legislation ever changes to allow associations to provide individual health insurance again, the AVMA Trust will revisit this option on behalf of its members.

Veterinarians cannot get healthcare coverage under the ACA if their income exceeds certain benchmarks. False.
Regardless of annual income, anyone can get healthcare coverage under the ACA. The only impact income has on coverage is access to subsidies. The cost of ACA marketplace plans varies based on participating insurance companies in a geographic area, networks, and whether or not the applicant is eligible for a premium subsidy.

If you don’t qualify for a subsidy but find the premium too expensive, you may consider other alternatives, including:

·       Catastrophic plans. These plans offer lower premiums but higher deductibles and are mainly used for serious medical emergencies.

·       Off-exchange plans. Plans offered outside of ACA may have different coverage options and pricing, so it is worth comparing them to ACA plans.

·       Short-term health insurance. These policies can provide temporary coverage but, in some cases, do not provide the same level of coverage as ACA or off-exchange plans and most exclude coverage for pre-existing conditions. Some are renewable for up to three years, which may fill a gap before Medicare eligibility or between full-time jobs.

I cannot get healthcare coverage under the ACA because I have a pre-existing condition. False.
The ACA ensures that everyone—including individuals with pre-existing health conditions—can get access to healthcare.

The myths above only scratch the surface of the confusion surrounding healthcare coverage. Securing a health insurance plan for yourself is a process that no one should have to navigate alone. Be sure to evaluate your insurance needs to make sure you are considering all options available to you. If you have questions or need help with your healthcare options under the ACA or your eligibility for the AVMA Trust’s PHS program, our representatives are only a phone call away.

For information about the AVMA Trust PHS program, visit our program webpage, email us at info@AVMATrust-PHS.com, or call 833-454-5433. For questions regarding ACA, contact AVMA Trust Member Advocate Belkys Llanes at BelkysLlanes@AVMALife.com or 847-241-5083.

*For a complete list of AVMA-affiliated entities, click here.