This article was last updated on May 2018
The health insurance landscape in America has changed over the past eight years thanks to the passage of the Affordable Care Act in 2010. Still, you might not be familiar with how the law impacts your everyday life. How does Obamacare work, exactly? You're not alone if you're somewhat confused about how to sign up for insurance or how to take advantage of the subsidies that everyone keeps talking about. In the following article, we'll explain how to participate in the new system. Please note that regardless of what takes place under the new President with respect the ACA, we will always provide our visitors with factual information and news about Obamacare and healthcare reform within the United States of America.
Rights and Protections
In a nutshell, Obamacare works on the premise of affordable coverage and better health care options. People with pre-existing conditions won't be denied access to insurance, insurers will be held accountable for their actions, and consumers will have more rights to medical services such as mental health care, pediatric services and prescription drugs. However, nothing in life is free, and there is a cost to these new benefits and protections. Taxes pay for many of the new provisions of the ACA. Fortunately, widespread participation ensures that more people will also benefit from the new law.
Low-Cost Plans on the Marketplace
You've probably heard about the ACA marketplaces. Under the law, states can create their own health insurance exchange sites or direct people to use the federal one at HealthCare.gov. The marketplace makes it easier to sign up for health insurance, especially if you don't have access to coverage through your employer or private plans cost too much. By filling out some information about your income and household, you'll be shown a list of options for coverage in your area.
More important, the marketplaces enable millions of people to get low-cost coverage through advance premium tax credits. In fact, 85 percent of the people who signed up for health insurance on the marketplace in 2018 used subsidies to lower their premiums. To qualify, you need to earn between 100 and 400 percent of the federal poverty level and be ineligible for work-based coverage. Subsidies help to offset your monthly premiums. The amount that you can get depends on factors like income and family size. The most direct way to get a subsidy is through a state exchange or the federal marketplace, but you may be able to get federal subsidies via a private broker or an insurer directly. Don't be afraid to ask about your options when enrolling.
When you enroll in an employer-sponsored health plan, you follow a set of guidelines for updating or renewing your coverage. Obamacare works the same way, but private insurers also follow the same timetable now. Whether you buy health insurance on the marketplace or enroll through a private company directly, you'll have to adhere to an annual enrollment period. For insurance year 2018, the open enrollment period ran from November 1, 2017 through December 15, 2017. For 2019, the open enrollment period will start on November 1, 2018 and end again on December 15, 2018. You must sign up for health insurance during this time frame if you want to avoid the penalty fees discussed in the next section.
You can sign up for Medicaid and the Children's Health Insurance Program (CHIP) at any time if you qualify. The federal marketplace will show you how to apply for these programs. Medicare enrollees also follow a different sign-up schedule for insurance, and if you participate in an employer-sponsored plan, then you'll follow your company's enrollment guidelines.
Penalty Fees and the IRS
If you don't sign up for health insurance during the open enrollment period, then you'll be charged a non-compliance penalty fee. This is how Obamacare really works: Everyone needs to participate so that coverage stays affordable. It's a concept known as the individual mandate, and the fee associated with not participating is called the individual shared responsibility payment. The IRS is responsible for collecting the individual shared responsibility payment each year when people file their taxes. If you can't prove that you were covered and you don't qualify for any exemptions, then you'll owe a fee.
The tax penalty has been in effect since 2014 and the penalty is increasing every year. For tax year 2018, you'll pay $695 per uninsured adult and $347.50 per uninsured child in your household, or 2.5 percent of your household's taxable income, whichever is higher.
In late 2017, Congress passed a tax bill that eliminated the individual mandate, which means that starting in 2019, anyone who goes without qualifying health insurance will not be penalized for not complying with the law. Starting in 2019 (or during the 2019 open enrollment period) people can enroll in health insurance that does not meet the requirements of the law like a short term health insurance plan.
Employers must also participate in the new system, an idea referred to as the employer mandate. We discuss the responsibility of employers in a separate article, but suffice it to say that large companies now have to provide insurance options for full-time workers if these businesses meet the necessary qualifications.
What the Law Accomplishes
If you're wondering how the new law accomplishes the task of providing better and more affordable coverage to the American people, then consider the marketplaces. Before the government marketplaces opened in 2013, your options for buying insurance were limited to your employer or a private source directly. Now, you can browse through plans online and even apply for cost assistance to make premiums less burdensome. Of all the changes implemented by the ACA, the federal and state exchange sites are among the most novel and useful in actually purchasing coverage. Medicaid expansion, spending cuts to Medicare and other changes also radically alter the healthcare industry in America.
Opponents of the ACA classify the new law as an overreach of the government's powers, claiming that all Obamacare does is meddle with an individual's right to buy health insurance as he sees fit. In reality, over 44 million people in America lacked health insurance before the ACA became law, and not everyone could choose whether to purchase it or not. Some people simply didn't have any affordable options even if they wanted to buy coverage. Obamacare works to correct this issue, and it's been meeting many of its goals over the past six years.
This article was last updated on September 1, 2014
Do You Really Understand Obamacare?
When it comes to the day-to-day life of American citizens and to landmark laws of the last few years, the Affordable Care Act is one of the most important pieces of legislation that can be found. With the advent of the ACA, also known as Obamacare, the rules have changed for just about every aspect of insurance, but what many people are asking is “How does Obamacare work?"
There has been a great deal of press about Obamacare, but as has become increasingly obvious, some of the facts out there are simply not true. Before you make a decision regarding Obamacare, make sure that you get all of the facts.
Whether you are concerned for yourself alone, a family or a business, it is essential for you to make sure that you know the basics. Obamacare affects us all, and the more you know about it, the better you will understand what you need to do and how you can keep yourself protected.
How Obamacare Works - Updated for 2015
Obamacare became a law in March 2010. It stated that United States citizens have to have insurance by March 31, 2014. In 2014, Medicaid would be expanded, and by 2016, all large businesses would need to insure their full time workers. Unfortunately, a Supreme Court case in June 2012 held that the government could not require the states to expand Medicaid; however it could recommend eligibility expansions and, as a result, many states have heeded the recommendation.
Starting in 2014, every person must have a current health insurance plan that offered the minimal Essential Health Benefits (which excludes short-term health plans), to apply and be approved for an exemption or to pay the tax penalty for every month that you went without health coverage. This requirement is known as the Individual Mandate and it means that as a legal adult, it is your responsibility to make sure that you are covered in some way or to explain or account for why you are not. This requirement is still in effect in 2015 and will be in effect indefinitely.
The law also makes it very clear how you can acquire insurance if you have never had any before. According to the legislation, insurance may be purchased directly from a provider, through a licensed insurance agent or broker, obtained from an employer, through government programs like Medicaid or Medicare, purchased through the state or federal Marketplace or through a website like this one that allows people to shop and review all of the plans available in their geographic region.
Am I Eligible For Obamacare?
Some people have doubts about Obamacare because they are not sure if it is for them, or if they are even eligible. However, the standards for being enrolled in the program are very simple and very straightforward.
First, you must be a citizen of the United States or an otherwise lawful resident of the United States, which may include time requirements in the United States or living outside of the United States. Second, you must not be incarcerated. Third, you cannot already be receiving insurance coverage through Medicare or Medicaid.
These are the major qualifications that you need to meet in order to make sure that you can take advantage of this program. If you are part of other smaller categories of people you may be exempt from getting insurance as well, but these circumstances are less prevalent. You can find a full list of the categories of people exempt with complying with the law on this website.
What Doctors Can I See?
There is a persistent rumor that states that enrolling in Obamacare means that you will not be able to see the doctor that you want to see. This is completely false.
If you enroll in a plan on the state or Federal Marketplace, the plans offered to you will very in level from bronze to platinum and will also vary in type. The different types of plans that may be offered and available to you in your geographic location may be HMO or PPO plans. If you enroll in a HMO plan, you may be limited to visit the doctors in your network. "In-network" means that the doctor or facility is on an approved list of medical providers accepted by your plan. If you choose to see a doctor or facility that is out-of-network, your insurance plan may not cover the bill at all or as much as it would have if you had stayed "in network". PPO plans are more flexible and generally allow patients to visit anyone that they like. In either instance, you can shop for a insurance plan that includes your doctor so that you do not have to worry about making new relationships and getting new recommendations.
Where Do I Enroll For Health Insurance?
If you are like many of the people who have never purchased insurance before, it can be a little bewildering. You may not know what to do or who to talk to. In most cases, if you have never had insurance before and need information before enrolling, this website contains a lot of helpful information about the law, the requirements imposed on Americans under the new law and the facts about insurance in general.
If you are past the research stage and are ready to enroll, you have lots of options to apply and enroll in health insurance. If you are new or newer to health insurance and want some personable help, your best option may be to enlist the aid of a licensed health insurance agent. An agents' help is free to the consumer and they can help you review and choose every plan available to you in your geographic region. This includes plans on your state or the federal Marketplace if you believe you are eligible for a federal subsidy. Additionally, a licensed insurance agent can give you recommendations based on your personal financial and medical needs.
The second place that a person can go to shop and enroll in health insurance is through a website like this one, which will use the criteria that you input to create a list of all of the healthcare plans that are available to you in your geographic region.
If you are comfortable with applying and enrolling in health insurance on your own and want access to a federal Subsidy, you can enroll on your state exchange or the Federal Marketplace at Healthcare.gov. If you're unsure whether your state has its own exchange, you can use the drop down menu on the "Get Coverage" tab on Healthcare.gov to determine whether you should continue on Healthcare.gov or move to a different website. Healthcare.gov allows you to sign up for health insurance and to get covered during periods known as open enrollment.
- The open enrollment period for 2015 started on November 15, 2014 and ended on April 30, 2015 after an extension was granted to everyone who filed their taxes and realized that they were penalized for not being insured and would face the same tax for 2015 -
- The open enrollment period for 2016 starts on November 1, 2015 and ends on January 30, 2016 -
How Will Obamacare Help Me?
It is a exaggeration to believe that Obamacare forces people who do not have money to pay for insurance that they cannot afford. The law takes several steps towards making insurance more affordable to people who are living at or below the poverty line. For example, healthcare for people who make less than 400% of the Federal Poverty Level is subsidized, reducing the amount of money that they will pay for their monthly bills, which is also called a premium. For individuals and families that make below 250% of the Federal Poverty Level and who enroll in a silver plan on the federal or state Marketplaces, a tax credit is also available to help offset the overall costs of healthcare. This tax credit can go to reimburse a family for the annual deductible, co-pays and coinsurance requirements of most health insurance plans. The Affordable Care Act also recommends that states expand the existing eligibility requirements for the Medicaid program, which would allow more citizens to enroll than ever before.
Furthermore, Obamacare goes on to assert that insurance companies cannot refuse to sell insurance to citizens who have previous health issues or injuries, and that the insurance companies cannot be dropped once they become ill.
Obamacare also affects the way that businesses treat their workers. All large businesses are required to insure their Full-time Employee by 2016, and small businesses are offered extremely generous tax credits in order to bring their policies in line with the Obamacare goals. The government cannot ultimately force companies to provide insurance but larger businesses who choose not to insure their full-time employees will be financially penalized.
All of these things go towards providing more of a safety net for people who were previous uninsured and for whom the price of simply being healthy was very high indeed!
What Has Changed For The Health Insurance Industry?
There is a lot of press saying that Obamacare will change the way that insurance works for everyone, that suddenly everything will be in turmoil and that people will no longer be able to make coherent health insurance choices. As a matter of fact, Obamacare only changed things significantly for less than 20% of the people out there, and you should read on to find out why!
Obamacare will not affect anyone who already had insurance. That means that if you are someone who has Medicaid, Medicare, private insurance that was compliant with the Affordable Care Act's guidelines or you have insurance through your workplace, nothing changes for you at all.
Before Obamacare stepped in, about 45 million people lacked insurance entirely, which equated to approximately 15% of the nation’s population. Now the percentage of the population that lacks insurance is down to about 13%. If you are in that 13%, you will either need to pay a per month tax penalty on your federal income tax return for as many months as long as you are without insurance, you need to obtain insurance, or you need to apply and be approved for an exemption.
Remember that to avoid the monthly tax penalty, you must have health insurance that at least meets the guidelines for minimum essential coverage. Short-term plans and supplemental insurance plans do not fall into this category, so check the plans you have. Remember that minimum essential coverage is ongoing.
How Do I Get Assistance Under Obamacare?
First, you need to find out what kind of insurance you qualify for. There are three major ways for you to get insurance under Obamacare and it is important that you understand what your options are.
First, you might be eligible for Medicaid, which is available to people who fall below a certain income bracket. About half of the people who are currently uninsured will meet the new requirements for Medicaid, or they will be able to get assistance subsidies that allow them to pay lower premiums. If you find that your coverage costs more than 8% of your total income after subsidies, you may be considered exempt due to the cost.
Second, you might choose to go through the exchanges, as discussed above, or you can go through a private health insurance company. Many Americans have already gone through this process. If you do not believe you are eligible for a federal subsidy, you can bypass the state or federal Marketplaces entirely and enroll with an insurance Carrier directly. This can be done by through a licensed insurance agent, through a website like this one that will provide you a list of all plans available to you in your geographic region or through a particular carrier. The perk of enlisting the aid of a licensed insurance agent is that they can help you enroll in a plan with or without a subsidy and can provide you recommendations and advice on plans that will work best for you based on your financial and medical needs.
Finally, you may choose to buy health insurance through your employer. Even if this has never been feasible before, it is worth a second look at this point. According to Obamacare, it is required that large employers start offering insurance to all full-time workers, and tax credits are making it possible for small businesses to offer insurance for the first time. Though these laws are going into effect in 2016, many businesses are taking initiative and choosing to implement these changes earlier.
By 2016, all large employers will need to provide their employees with health insurance that meets the minimums set by Obamacare. Make sure that you know what a large employer means. In this case and for the purposes of this legislation, an employer is considered large if they have 50 or more full time employees and if they do not currently provide health coverage.
If you decide that you want coverage through your employer, remember that you cannot also acquire cost assistance through the Marketplace. These savings are not relevant to your plan. Finding the amount saved between the two situations is an important part of your deciding on which plan is right for you!
Even if you are someone who is currently insured, it is absolutely worth going over your plan again and seeing what you are paying. Insurance is something that many people think of as out-of-sight, out-of-mind until they need it, but with the new legislation and the new requirements for companies, it may be that you can get a better plan simply by doing a little bit of research.
When Do I Need To Enroll For Obamacare?
The 2015 open enrollment period begins on November 15, 2014 and will close on February 15, 2015.
If you want a plan that will begin coverage on January 1, 2015, you must enroll in a plan on or before December 15, 2014. If you enroll in a plan after December 15th, your plan will kick in 45 days later. For instance, if you enroll on December 17, 2014, your plan will take effect on February 1, 2015.
How Do I Sign Up For Obamacare?
There are four ways to sign up for healthcare under the Affordable Care Act if you are not going through your employer. You may choose to get it from the exchanges, from an agent broker, from a website like this one or directly from a carrier.
To get your healthcare from the exchanges, you will go to either Healthcare.gov or you will go to your state's health insurance Marketplace.
To get your insurance from a licensed insurance agent or broker, you can either call using the telephone numbers listed on this website or you can use the Get Assurance™ agent communication tool also available on this website. This is a great choice for someone who is feeling nervous about getting all of the information on their own or who is nervous applying for insurance through the computer. The benefit of using an agent is that they can enroll you in a plan through a private carrier or through the Marketplace, which means that you can get a federal subsidy as well. Additionally, a licensed insurance agent can provide you recommendations based on your financial and health needs.
To get your insurance directly from a provider, you simply need to find an insurance provider that you favor and go through the process that they have. This means contacting an insurance company and going from there.
You can also shop for health insurance on a website like this one, which will take the information and criteria that you input and find all of the plans that meets your needs in your geographic region, from all carriers, and present those for you to compare. As soon as you pick the right plan, the steps to enroll are simple.
The thing to remember is that there is no single method for getting insurance that is better than another at this point. According to the regulations put in place by Obamacare, all of the plans need to meet certain minimum standards for quality and coverage.
The plans from the exchanges are the only ones that offer subsidies, and though you should absolutely look at them, this does not mean that they are least expensive or the ones that cover the least. Remember that the amount you pay on the subsidies is determined by your income and that a licensed insurance agent or broker can also enroll you in a subsidized plan.
Another thing to keep in mind is that Medicare is not part of the Marketplace and if you are interested in Original Medicare or Medicare Advantage with a private carrier, you should visit Medicare.gov for more information. This website also contains an article on Medicare as well. For your information, the open enrollment period for Medicare Advantage plans runs from October 15th to December 7th.
Avoid Getting Charged For Not Having Health Insurance Coverage
If you are looking at getting health insurance, of course what you want to avoid is getting charged for not having it. There are a few things for you to consider as you move forward to make sure that those fees do not affect you.
First, if you purchase your insurance through the Marketplace during the open enrollment period, there will be no tax penalty because you can rest assured that the insurance that you purchase there will give you the benefits, rights and protections required by the law, which means that the plan meets the minimum essential coverage. You will not have to pay a fee for not having the right type of coverage because the only plans offered on the Marketplaces are those that meet the requirements of the law.
If you have employer insurance, CHIP, Medicare, Medicaid or TRICARE, you will also be meeting the minimum eEssential Health Benefits. There will be no tax penalty as well.
There are some plans that do not meet the minimum essential coverage, but for one reason or another, they have been grandfathered in under the Affordable Care Act. Having a plan like this will help you avoid the tax penalty, but they will need to be replaced with a plan that does meet the minimum essential coverage by 2017. In addition, if that plan changes its benefits too much or takes some other action that takes it out of the grandfathered category, everyone enrolled in that policy will have to pick up new insurance or fear being taxed for not complying with the law.
Remember that there are several common things that do not meet the minimum essential coverage and these things will not protect you from having to pay the tax penalty. For example, supplemental insurance, fixed benefits plans and temporary health insurance, or short-term health plans, are not minimum essential coverage and they will not prevent you from having to pay the tax penalty.
Understanding How Health Insurance Works
Though health insurance was one of the big items under discussion in the news, there are many people who do not understand how it works or what it really does for them. Because health insurance is now such an important part of all of our lives, it is essential for you to understand what you are paying for.
With any insurance plan, whether you get it through an agent or broker, through the Marketplace or through an independent provider, you will need to pay a monthly fee or bill, which is known as a premium. The premium may be paid on a monthly basis, though some people choose to pay it all at once or twice a year.
The higher your premium is, the better your coverage tends to be, leaving aside the issue of subsidies, of course. There is a factor called a copay in play as well. A Copayis the amount you have to pay for each event of medicare care. The copay is usually due to the medical provider when you receive the service. For instance, a copay for a general practitioner could be $25.00 and a copay for a specialist could be $60.00.
In addition to having to pay monthly premiums, many plans also require the insured to pay an annual lump sum amount that renews and must be paid again every year before certain types of coverage will kick in and your plan will pay for certain types of claims. This is called an annual Deductible. For instance, if your annual deductible is $2,000.00 a year, you must pay that amount before your plan will cover certain claims. Oftentimes, plans with higher monthly premiums will have lower annual deductibles.
The last type of cost associated with health insurance is the coinsurance. A Coinsurance payment is the portion or ratio that the insured person shares with the health insurance company for certain types of claims. For instance, sometimes emergency care will require the insured person to pay 20% of the claim and the insurance policy will pay the remaining 80% of the bill. Although this coinsurance amount is not usually due on or before the day that the care is received, it is the responsibility of the insured person to pay the bill.
While all plans are certainly not created equal, they are all forced to meet a minimum standard regarding rights, protections and benefits after 2014.
If You Get Confused About Obamacare Don't Give Up - Ask For Help
There are many people who do not understand how insurance works or what Obamacare now requires of insurance companies, policies and Americans and there are people out there who want to take advantage of this.
For example, there are some insurance companies that are canceling plans and raising prices since Obamacare was passed. These plans do not meet the minimum requirements and for a few years, these plans are still legal. According to the writing in the legislation, it is legal for insurance companies to offer these plans until 2017. These plans do not cover you the way that they should and though it is unscrupulous for these plans to be sold or continued, they can be both sold and continued for the next few years.
How can you keep yourself from getting tricked? First, watch out for sudden rate hikes in the months to come. If you are suddenly informed that your plan is more expensive, it is time to look around for a plan that suits you better and that is more affordable. It will be much harder for insurance companies to take advantage of you if you know your rights!
If you are a citizen who makes less than $46,680 on your own or less than $95,400 as a family of four, than you are someone who makes less than 400% of the Federal Poverty Level (rates for 2015 only and may change in 2016). This means that you may be eligible for a low-cost health insurance plan thanks to the subsidies that are offered. These subsides will be applied to your monthly bill for your policy (your premium). If you make less than $29,175 as a single person or $59,625 as a family of four it means that you make less than 250% of the Federal Poverty Level and if you enroll in a silver level plan, you may be eligible for a tax credit that will you offset the costs of copays, coinsurance and deductibles.
If you are interested in and believe that you make the right amount of money to qualify for a premium subsidy or a tax credit, you should enroll in a health insurance plan either through the state or federal Marketplaces or with a licensed insurance agent or broker.
Should You Obtain Healthcare Off Exchange?
The term "Off-Exchange" refers to a policy that is not offered on the state or federal Marketplaces. People who do not qualify for or do not want a federal subsidy have the freedom to either enroll in a policy "On-Exchange" (on the state or federal Marketplaces) or "Off Exchange" (directly through an insurance provider with or without the aid of an agent or broker or a website like this one).
The list of On Exchange plans are limited to those that were approved by the federal or state government. This limits your options. Off Exchange plan options are must more vast and are only limited by a person's geographic region. Buying Off Exchange will allow you the ability to compare and contrast the plans. In times past, comparing insurance company rates would have been tedious. Now you can do it at the click of a button and with absolutely no problem s at all! This allows you to do your budgeting accordingly and to make sure that you get a plan that suits your needs. For example, you can find a plan with low co-pays and higher premiums if that is what suits your needs well.
One of the great things about the shopping online either on the Marketplace or Off Exchange is that there is usually a one-stop process. In a single session, you will find that you are eligible for the plan you want, and then you can enroll in the plan that is right for you immediately. This can take you less than an hour if you know your way around computers! If you are applying for insurance on the state or federal Marketplace, you will fill out one application that allows you to figure out what discounts and subsidies you will get. You will also find out if you are eligible for Medicare or Medicaid, though you should keep in mind that these programs are not part of Obamacare.
Another perk of applying online is that typically you have a login and password and can make changes to your application or your account after you have enrolled, which may affect your plan. Perhaps you get married, or you get a job. These things can change your coverage, and in the end, making the changes will allow you to adjust the plan you have to suit your needs and the kind of life that you are living.
Obamacare is all about opportunity, and if you have never considered getting insurance before, there has never been a better time for you to jump in. The subsidies alone can make it more affordable than it has ever been. In fact, in 2014 the government dished out approximately $17 billion in subsidies to over 5 million people. These numbers are going to drastically increase in 2015 as the total enrollment of On Exchange sign ups are set to increase from 8 million in 2014 to 13 million in 2015. In addition, the non-discrimination clauses included in the Affordable Care Act that prevents insurance companies from rejecting you over pre-existing conditions, open enrollment in the healthcare program of your choice is something that you should absolutely take advantage of.
What Does Obamacare Cover?
One of the great things about the minimum requirements is that everyone will be able to enjoy a baseline of medical care once they have bought in. As of 2014, the plans that meet this baseline will offer essential health services and most preventative services are offered free of charge.
One of the most important factors of Obamacare and one of the biggest changes is that the plans will be required to cover pre-existing conditions. This means that if you have a health issue that was diagnosed prior to signing up, you will not be prevented from getting health insurance. This is an important option for people who have not been able to get health insurance for years due to conditions like heart issues and diabetes.
Is Obamacare A Specific Kind Of Health Insurance?
Neither Obamacare (or the Affordable Care Act) nor the government creates a specific health insurance plan or company. Instead, the terms Obamacare, or the Affordable Care Act, refer to the actual law that was passed, which simply forces existing health insurance polices (and health insurance carriers) to live up to certain standards with regards to the benefits, rights and protections. That is what has been created by the government-- basic requirements that improves and reforms the healthcare industry. The following are just some of the requirements imposed on insurance carriers who wish to offer ACA compliant healthcare plans.
- There is now federally regulated and mandated health insurance Marketplaces. The government recommends that all states expand Medicaid so that it is available to more Americans.
- The Marketplaces offer people who do not have insurance through their employers a chance to shop for quality healthcare while comparing prices and being offered subsides that will help ease the financial burden. Further, the Marketplaces serve as gatekeepers in terms of service; any insurance policy on those Marketplaces meets the bare minimum requirement to be considered legitimate healthcare insurance, though of course many go beyond those services.
- All Pre-existing Condition are covered at absolutely no extra cost. There is also no way for a consumer to be rejected y a carrier for having a pre-existing condition.
- You as an individual now have the ability to purchase your insurance from the Marketplaces, an agent, or directly from the provider if you do not get your insurance through your employer. You also still have the ability to seek Medicaid and Medicare on their own respective sites.
- Businesses that have more than 50 people working full time must offer these people insurance. This is something that needs to be in place and operational by 2015.
- Businesses that have less than 25 full time employees can get up to 50% of their employees' health benefits covered in the form of a tax credit when they purchase on the Marketplace.
- Obamacare also brought Medicare and CHIP up to the new minimum standards.
- Because of the non-discrimination clause in the Obamacare legislation, insurance companies are no longer permitted to increase the premiums or deny coverage based on gender, age, ethnicity or on pre-existing conditions. The insurance provider can only base the premium amount on whether the person uses tobacco products, the person's family size and the person's geographic location (because not every insurance provider offers coverage in every state).
- There are no longer any annual and lifetime limits on the coverage that is provided. This means that if your medical costs go up, the insurance company cannot simply remove you from their services.
- If you are a citizen that makes less than 400% of the Federal Poverty Level, you will be able to get reduced premiums when you purchase insurance from the Marketplace.
These are simply some of the differences for changes made if you are an individual or a family. If you are looking for how Obamacare has affected things like businesses, it is worth your while to look up the rules regarding your specific situation.
Where Do I Fit Into All of This?
For many people, Obamacare is something that will change the way that they look at their health care. Something that was out of the question because of cost or because of a pre-existing condition will now be available for them. If you are in a spot to pick up health insurance, how are you going to go about it? What are the essential facts that you need to have in mind before you proceed?
First, if you do not have coverage by the end of an enrollment period in any year, you will need an exemption or you will need to pay the tax penalty. More information on exemptions can be found in the Individual Mandate article on this website.
The tax penalty for 2015, which we have not discussed yet in detail, is 2% of your annual income or $325 per uninsured adult and $162.50 per uninsured child, whichever is higher.
There is nothing wrong with keeping the insurance that you have, but this is a good time to look around and to see if there are some better options out there. Even if you do not purchase a new plan, however, you will still have the ability to take advantage of all of the improvements. You will not need to worry about pre-existing conditions. The only place where you need to worry about old rules is if you have a plan that has been grandfathered in. Make sure that you know what your old plan is doing before you proceed.
There are four plans that can be purchased on the Marketplace. They are designated as platinum, gold, silver, and bronze, ranked in order of most to least amount paid in premiums. Therefore, the platinum plan costs the most in premiums, and the bronze plan costs the least. Remember that the higher the premium is, the lower the cost of what you pay when you go to the doctor's office.
If you have a low income, you are eligible for free plans or plans that are low in cost. Remember that the more research you do, the better off you will be. Sometimes, depending on your situation, the cheapest plans may come from the providers themselves.
Make sure that you know where you stand with regards to the Federal Poverty Level. If you make less than 400% of the Federal Poverty Level, you will see reduced costs across the board, and this can make a huge difference to the amount of money you pay.
How Can I Afford This?
If you are worried that you cannot afford an insurance policy, remember that if you do not have the money, a 100% subsidized or reduced-cost plan can be a great option if you meet the minimum requirements. Overall you will be paying lower premiums and fewer out-of-pocket costs.
The Affordable Care Act is designed to help those who are struggling. It is not meant to punish you for something that you cannot help, and it is not designed to keep you from healthcare.
Getting Started Enrolling With An Obamacare Health Plan
No matter whether you enroll on the federal or state Marketplace, or whether you enroll in an Off Exchange plan through a private carrier, you have to apply for coverage. After you submit your application, the information that you input will be verified in order to ensure that you are receiving the plan that meets your needs and to ensure that there are no discrepancies or inaccuracies with the factual information (for instance, your Social Security number is incorrect). After submitting the application and before being approved, you will be presented with a number of different plans. If you are on the state or federal Marketplace, you will only be presented with the plans that were approved by the government. If you are working with a licensed agent or utilizing a website like this one to shop, you will be presented with every plan available in your geographic region, which meets your criteria. If you are on a particular insurance carrier's website, you will be presented with all of the plans that it offers only.
Remember, if you are interested in a premium subsidy or tax credit to help reimburse you for your out-of-pocket insurance costs, you must enroll either with a licensed insurance agent or on the state or federal Marketplace.
You have full control over the plan that you choose, whether you are representing a business, a family or simply yourself. Look into the offers that are being made and tailor the plan you choose to the needs of your family. Some kinds of coverage benefits may be more important to someone who is in their fifties with a few diagnosed health problems, than they would be to someone who is twenty and in the peak of health.
One of the best things about the insurance industry today is that it has to be competitive to try to attract your business. Health insurance providers want your patronage and because of this, they have to work for it. Tax credits and the assistance available to lower-income individuals and small businesses make it even easier to get the right kind of deal and because the premium subsidy don't come from the insurance providers, but are rather paid to the providers from the federal government, insurance providers do not care whether you are someone who is eligible for a subsidy or not.
When you look at the page with a list of insurance plans available to you, remember to be patient with yourself. There are a lot of details to keep track of, but you will discover that it is easily figured out with a little bit of work. Do not get frustrated. Simply take things slow and you will be just fine.
Do all of the research that you need and make all of the preliminary decisions before the open enrollment period begins on November 15, 2014. Some of these choices may include:
- How many people in your family actually need healthcare
- How much coverage you need
- What kind of prescription drugs does your family regularly need and are they available in generic form
- Whether you want to be restricted to only seeing healthcare professionals that are in a network (HMO) or whether you would prefer to have the freedom to see whoever you want for care (PPO)
- How much you want to spend a month on your monthly premiums
- How much you want to spend a year on your annual deductibles
- How much your family makes a year to determine whether you could be eligible for a tax credit or a premium subsidy
If you are a business, you will be able to use the Marketplace to purchase health insurance for your employees any time of the year. The SHOP Marketplace (Small Business Health Options Program) opened in 2014.
Okay, I'm ready To Enroll In A Health Insurance Plan That Is ACA Compliant. Now What?
At this point, you have the basic grasp of how Obamacare, or the Affordable Care Act, works. What are you going to do with this information? With the information that you now possess, you can learn more about the program, or you can look into applying for insurance as soon as you like. Remember, the open enrollment period for 2015 begins on November 15, 2014 and ends on February 15, 2015.
If you have more questions or would like to get started with the assistance of a licensed insurance agent, you can find links within this site, can utilize the Get Assurance™ agent communication tool, or simply use our toll free number to connect.