The Patient Protection and Affordable Care Act has been the subject of constant, unrelenting political attacks, but few efforts to explain this complex legislation, known more briefly as the Affordable Care Act (ACA) or “Obamacare,” after the president who pushed it through in 2010.
Here are some basic concepts of the ACA or Obamacare, simply explained.
Open enrollment
ACA open enrollment began Oct. 1 and continues until March 31, 2014. The new coverage begins January 1, 2014.
Health insurance shopping
Health Insurance Marketplaces and Health Insurance exchanges are one in the same.
Marketplaces, created under the ACA, is where you select and purchase private health insurance coverage.
States have the option to create and run their own health insurance exchanges. In states like Missouri where the legislature did not accept federal funding to expand Medicaid, health insurance plans can be purchased through the federal health exchange.
This may be done through four different ways:
- Online at HealthCare.gov
- Via paper applications that can be downloaded at HealthCare.gov and mailed.
- In person through navigators or certified application counselors, who use HealthCare.gov to help others find private health insurance options. Government agencies – such as state Medicaid and Children’s Health Insurance Program (CHIP) offices, hospitals, health centers, clinics and many social service agencies – have trained staff onsite to assist. Visit LocalHelp.HealthCare.gov to find one near you.
- By calling (24/7) 1-800-318-2596 or TTY: 1-855-889-4325.
HealthCare.gov
On the website, HealthCare.gov, you will need to set up an account, with basic information about yourself, your family members and current health coverage information.
Important: If your household files more than one tax return, it is very important to call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) before you start an application in order for representatives to provide directions to make sure the application is processed correctly.
Once the account is established, visitors can see which options they qualify for, including Medicaid and CHIP. The marketplace will inform you if you qualify for lower monthly premium and out-of-pocket costs.
There are five categories of marketplace health insurance plans: Bronze, Silver, Gold, Platinum and Catastrophic, each with the same essential health benefits but different cost-sharing levels between you and the health plan. As posted on HealthCare.gov, the maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
In general, when choosing your health plan, keep this in mind: the lower the premium, the higher the out-of-pocket costs when you need care. Conversely, the higher the premium, the lower the out-of-pocket costs when you need care.
Find out more at HealthCare.gov/how-d-i-choose-marketplace-insurance.
Estimate of savings
You can use the Kaiser Family Foundation subsidy calculator to estimate costs savings under the Affordable Care Act online at http://kff.org/interactive/subsidy-calculator.
Penalty
If you can afford health insurance coverage and you choose not to purchase it, the penalty fee you will pay is called the Individual Shared Responsibility Payment, which in 2014 will be 1 percent of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016, it will be 2.5 percent of income or $695 per person, whichever is higher.
In 2014, the payment for uninsured children will be $47.50 per child. The most a family would have to pay in 2014 is $285.
Payment for not having health insurance will be made when you file your 2014 taxes, which are due in April 2015.
In addition to the fee, the person is responsible to pay for all of their health costs.
Avoiding the penalty
Special circumstances – such as being of very low income, being uninsured less than three months out of the year, having religious objections, being incarcerated, receiving Indian Health Services and being a member of a federally recognized tribe – may exempt you from the penalty for not buying health insurance coverage. Hardship exemptions exist for homeless persons and others who have recently undergone other catastrophic financial, domestic hardships. For more information, visit www.http://www.HealthCare.gov/exemptions.
You are already considered covered with health insurance and don’t need to enroll via the ACA if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or other kinds of health coverage.
Federal poverty level
The 2013 federal poverty guidelines are $11,490 for a single adult and $23,550 for a family of four for the 48 contiguous states and Washington, D.C.
Family# Threshold
1 $11,490
2 15,510
3 19,530
4 23,550
5 27,570
6 31,590
7 35,610
8 39,630
For households with more than eight people, add $4,020 for each additional person.
