Get Informed!
Affordable Care Act
by Maya Bryant, edited by Akiim DeShay
You may be wondering what the new Affordable Care Act (aka Obamacare) is and how it affects you. This new act affects everyone in the United States: if you need coverage, you can use the marketplace to find some; if you have coverage, you gain new protections; if you refuse coverage you may have to pay a fee. The Health Insurance Marketplace will give you more choice and control over your health coverage regardless of your situation and operates in all states.
What is it?
The Affordable Care Act was created to ensure all Americans have access to affordable health care by eliminating some of the past barriers such as pre-existing conditions as well as offering reasonable options to those who have historically been left out. It allows Americans to compare coverage options based on price, benefits, quality, and features much like other types of insurance (car, home, etc.). Those who like the insurance they have can keep their coverage and may still benefit from the additional protections such as a ban on lifetime limits and additional coverage for college aged children up to age 26.
Which Plan is Right for Me?
The ACA created a system of five plans bronze, silver, gold, platinum, and catastrophic coverage. These plans are based on the average amount of health expenses that will be paid for by each plan.
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| http://www.healthpocket.com/affordable-care-act/metal-plans |
These plans balance out the monthly premiums with out-of-pocket costs. For example, the Bronze option has the lowest monthly premium, but covers the least amount of expenses (60%) whereas the Platinum choice has the highest monthly premium and covers an estimated 90% of health care expenses. Some companies will offer a catastrophic plan which will cover 100% of the costs but at a much higher monthly premium. If you expect a lot of doctor visits or need regular prescriptions, the Gold or Platinum plan may be best for you. If not, you may be better off with the Bronze or Silver plans.
If you aren't sure which plan is right for you, there will be plenty of help in your area to get personal assistance in finding a plan. Lines are open 24 hours a day, 7 days a week by phone at 1-800-318-2596. Navigators, application assisters, certified application counselors, and government agencies (State Medicaid and CHIP Offices), insurance agents, and brokers can be found to help at localhelp.healthcare.gov.
How Much Will All of This Cost?
The health exchange marketplaces are different for each state. Each state has a certain number of insurance companies who offer some or all of the plans described above under the ACA. It is important to compare plans and companies because some companies will have different prices for the same plans in the same states.
Depending on one’s income correlation with family size; one can get lower a cost on monthly premiums and lower out of pocket costs for private insurance.
Below is the range of incomes according to the size of
one’s family that sets the price of their insurance with respect to
income only in states where it is available. The lower the income within the
range, the more you save. If your income
is below the range that is matched up with your family size, you may be
eligible for Medicaid.
Income range according to family size
$11,490 to $45,960 for individuals
$15,510 to $62,040 for a family of 2
$19,530 to $78,120 for a family of 3
$23,550 to $94,200 for a family of 4
$27,570 to $110,280 for a family of 5
$31,590 to $126,360 for a family of 6
$35,610 to $142,440 for a family of 7
$39,630 to $158,520 for a family of 8
It is also possible to see if free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP) can be obtained. Benefits of the Affordable Care Act include doctor visits, preventive care, hospitalization, and prescriptions. Pre-existing conditions are covered. Plans can’t deny coverage or charge more due to earlier health conditions like pregnancy and disability.
Until you fill out a Marketplace application, you can use tools like the Kaiser Family Foundation calculator to get a rough estimate of how much health insurance may cost in 2014:
What if I Don't Get Health Insurance?
In 2014, people who can afford health insurance will have to have health coverage or will have to pay a fee. They also will have to pay the entire cost of all their medical care and are not protected from very high medical bills that may lead to bankruptcy. The fee would be 1% of their yearly income or $95, whichever is higher and it increases every year (in 2016 it will be 2.5% of income or $695). For uninsured children it is: $47.5 per child max $285.
How Can I Avoid Fees?
This fee can be avoided by having minimum essential coverage which includes: any marketplace plan (or individual insurance plan), an employer plan (including COBRA), Medicare, Medicaid, CHIP, TRICARE, Veterans health care programs, and Peace Corps Volunteer plans. Coverage only for vision or dental care, Workers’ compensation, Coverage only for a specific disease or condition, and plans that offer only discounts on medical services do NOT qualify as minimum essential coverage.
This is an attempt to simplify the explanation of how the Affordable Health Care will affect people. This is not an endorsement of the act nor has this page been endorsed or paid for this content by anyone. For further understanding of the Affordable Care Act and the health exchanges go to the government website: https://www.healthcare.gov/
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