On October 1, the Affordable Care Act begins its six-month-long open enrollment period, with coverage officially beginning on January 1. Republicans in Congress are doing everything possible to defund the president’s health care reform law, but it is still the law of the land, and in just a few months it will, in large part, go into effect.
Because of the Affordable Care Act, health insurance providers can no longer refuse coverage because of pre-existing conditions, and can’t cancel or take away your coverage without notice. In addition, preventive care will be at no cost to you, young adults can remain covered under their parents’ health insurance until the age of 26, and you can also have your choice of doctors.
There are still many questions about the law and how it will affect us, but luckily resources abound to help you better understand it all, including Healthcare.gov.
Here are the answers to some common questions about Obamacare, without the Republican mendacity.
Official White House Photo/Samantha Appleton
Am I Eligible for Obamacare? How Do I Enroll?
The Affordable Care Act can help you if you need health insurance — or if you already have your own. If you are insured through your employer or through Medicaid/Medicare, you’ll remain on your current plan. If you have your own insurance, you might find more affordable options through the ACA. And if you’re uninsured, you may even qualify for federal assistance to help you access quality, affordable health care.
To enroll, visit the Health Insurance Marketplace and apply. If you qualify, you’ll be able to pick a plan and begin receiving coverage on January 1.
Based on your household income and where it falls within the Federal Poverty Level (FPL), you may be eligible for subsidies or tax credits — or possibly even completely subsidized Medicaid coverage, if the Republicans in your states aren’t blocking it. You’ll also be able to choose between bronze, silver, gold, and platinum plans. Here you can see how much of your health care costs each plan will cover.
Official White House Photo/Pete Souza
What is the Individual Mandate?
The individual mandate is a very simple idea: Everyone must be covered under some form of health insurance policy. If you and those you claim as dependents haven’t already purchased insurance through work or school, aren’t covered under Medicare or Medicaid, or aren’t covered under parents’ insurance (for young adults under the age of 26), then you’ll need to go to the Health Insurance Marketplace and shop for coverage.
Why is the mandate necessary? According to Topher Spiro, the vice president of health policy at the Center for American Progress, “This individual mandate is to keep premiums low for everyone. If you don’t have incentives for everyone to sign up for coverage, then only the sick people will enroll, which will drive up premiums.”
Individuals who can afford a plan that would cost no more than 8 percent of their monthly income must have health insurance; others who fall below that bracket may be eligible for an exemption. Those who wish to apply for an exemption must do so when filing their 2014 taxes.
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What is the Penalty if I Don’t Have Insurance?
At the end of the upcoming tax year, if you don’t have minimum health coverage you may see a penalty of $95 for an adult and $47.50 for a child or 1 percent of family income, whichever is greater.
If you don’t have insurance, aren’t eligible for an exemption, and don’t buy insurance before 2016, then you can expect to pay a fine to the IRS of either $695 per year for each adult and $347 per child or 2.5 percent of your income, whichever is greater.
Since the penalty is considered a tax, the Treasury Department will oversee it. What can the Treasury Department do if you don’t pay the penalty? The Washington Post reports, “Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine. If this actually leads to a world in which large numbers of people don’t buy insurance and tell the IRS to stuff it, Congress could change that. But for now, the penalties are low and the enforcement is non-existent.”
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I Already Have My Own Insurance. How Will the ACA Affect Me?
If you have your own private health insurance that you purchased independently or through work, school, or your parents, the Affordable Care Act has some benefits for you, too.
It’s worth noting that your health insurance must be a grandfathered health insurance plan for this to apply. A grandfathered plan must have existed on March 23, 2010 and not made any major changes to benefits, premiums, copays or deductibles since. To find out if your plan is grandfathered, you can contact an administrator, if they haven’t already notified you.
Insurance companies are now required to cover women’s wellness visits and preventive measures like mammograms, as well as immunizations for children.
They also can no longer limit the amount of care they’ll provide to you over the course of your lifetime.
An informational video released by the White House explains, “If your insurance company spends over 20 percent of your premium dollars on overhead — stuff like CEO salaries, marketing, administrative costs — they have to send you a refund for the difference.”
Once the law fully goes into effect in January, it will be illegal for insurance companies to charge you higher premiums or refuse to provide coverage because of pre-existing conditions, and to charge women more than men for equal coverage.
Watch the video here:
Official White House Photo/Pete Souza
I’m Enrolled In Medicare. What Changes Should I Expect?
Again, if you’re enrolled in Medicare, you don’t need to apply for coverage through the Affordable Care Act in the Health Insurance Marketplace, and you won’t see a change in your coverage as the ACA goes into effect.
Kaiser Health News reports that seniors will still receive health coverage through Medicare’s traditional fee-for-service program and the Medicare Advantage plans.
Medicare beneficiaries will also “receive more preventative care services–including a yearly ‘wellness’ visit, mammograms, colorectal screenings, and more savings on prescription drug coverage.” Kaiser Health News also reports, “By 2020, the law will close the Medicare gap in prescription drug coverage, known as the ‘doughnut hole.’ Seniors will still be responsible for 25 percent of their prescription drug costs.”
Those receiving coverage under Medicare Part D who have yearly incomes equal to or greater than $85,000 or $170,000 for a couple will now pay more for their prescription drug coverage.
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Does My State Have its Own Health Insurance Marketplace?
Some states took the option to run their own marketplace. Unsure where your state stands? You can find out using this interactive map from The Commonwealth Fund.
If your state has a state-run marketplace, you will need to enroll there. Some states have a state-federal partnership, which means that individuals will need to enroll through the federal marketplace and the states will oversee plan management and consumer assistance.
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