ObamaCare 101
We get a lot of questions about how the Affordable Care Act, aka ObamaCare, affects people like you. So, we figured we’d explain a few of the key details of the new law. While this is a quick overview we have included links to allow you get more detailed information on each topic below. The information below is geared for individuals and families. If you have a small business you will want to visit our Small Business ObamaCare page.
What is ObamaCare?
ObamaCare is the nickname for The Patient Protection and Affordable Care Act that was passed in March 2010. Most people just call the act the ACA, for short. This law overhauls how we buy health insurance, who can be covered and what benefits it must cover. Under the law, most Americans are required to have health coverage and will pay a tax penalty if they choose to go without insurance. Also the government is offering subsides to help lower income people pay for these plans. Finally, under ObamaCare no one can be turned down for health insurance regardless of previous health history.
What are the New ACA Plans?
There are 4 types of health plans for individuals and families to chose from. The plans are called Bronze, Silver, Gold, and Platinum and you can compare the 4 Affordable Care Act’s plans here. Bronze is the least expensive but requires more upfront cost sharing than the other plans. The Platinum plan is the most expensive but requires less of your money up-front should you get injured. There is a low-cost ObamaCare catastrophic plan available to some young people and/or those with financial hardship, in addition to the four “Metal” plans listed above.
What are the Exchanges?
Since lower-income people may get a subsidy to help pay for the above plans, each state is setting up an Exchange (or Marketplace) to purchase a plan with subsidies. Some states chose not to set up an exchange. So, those will be run by the federal government. If you do not think you will qualify for a subsidy you can purchase an off-Exchange plan to avoid extra paperwork and questions about your income. Agents, such as the team at Medicoverage, will be able to sell plans both on and out of the exchange at no charge to customers.
Individual Mandate: What Does That Mean?
In the plainest language possible, it just means that the majority of Americans are required to have health insurance. There are a few exemptions like financial hardship or religious conviction. If you decide to forego insurance, there is an ACA penalty. This penalty is up to 2.5% of your income in 2016 and should stay the same through 2017.
What Subsidies are Available?
There are two types of subsidies available for those that qualify:
1) Premium Subsidies reduce the cost of your monthly insurance bill (which is called a Premium for some reason). People who make between 100% to 400% of the Federal Poverty Line (FPL) may qualify for this subsidy.
2) Cost-Sharing Subsidies help pay additional costs once you are insured such as deductibles, copays, and coinsurance. People who may qualify for this coverage fall between 100% to 250% of the FPL.
Some low income Americans will be able to qualify for both subsidies while individuals making roughly over $46,000 a year may not qualify for either.
When do I sign up?
For most Americans, you’ll sign up during Open Enrollment: November 1st thru January 31st. The earliest plan coverage will begin is January 1st, but if you wait too long to sign up for an ACA your start date will be pushed back.. Some people might qualify for a Special Enrollment Period. Examples of a Special Enrollment Period are if you released from incarceration, lose your insurance, give birth or adopt a child, or get married.
We hope this has cleared up any of your basic questions about the Affordable Care Act, however if you have any further questions or would like to get a quote to see how much the new plan will cost, please call 800-930-7956 or contact Medicoverage.
Comments and Questions
Click to leave a CommentComment from Edward on May 31, 2016
I am looking to sign up for the ACA coverage. I turn 64 on 6/7/16 and feel I cannot continue, and will apply for Social . disability. I have Major Depressive Disorder past 7 years. Real name not Edward, I don’t want my real name splashed over the internet at this point. I understand that it is very hard to be approved for SS disability, so looking at Obamacare. Do I apply for ACA prior to leaving my work job, or do I have to wait to apply. Where can I find assistance with Social Security and ACA?
MEDICOVERAGE AGENT RESPONSE
“Edward”,
We’re happy to help! If you are approved for disability, you will need to be on that for 24 months to be enrolled in Medicare (for most disabilities), and you’ll be 65 before then, so an ACA plan looks like the way to go for you. All you will need is a letter on your company’s letterhead stating that your insurance is ending on a specific date to enroll in a plan outside of Open Enrollment. Once you receive that letter, if you need help finding a plan, give one of our Medicoverage licensed independent insurance agents a call at 800-930-7956.
-Amy from http://www.medicoverage.com/
Comment from wayne pinkerton on April 05, 2016
is there a plan that will cover me in in almost all states, I need it for Indiana and Florida mostly
MEDICOVERAGE AGENT RESPONSE
Wayne,
There are certain PPO plans that offer nationwide coverage, but they may not be offered in the zip code you do your taxes. To find out if one is available for you, you’ll want to call one of our licensed independent insurance agents at 800-930-7956.
-Michelle from http://www.medicoverage.com/
Comment from Maddie on June 12, 2014
This has helped me a lot, I always think that its important to get the best health insurance as young as possible so that you are covered as you get older
Comment from Tammy on December 29, 2013
I am trying to find out what the cost would be to upgrade to the Gold or Platnium plan. Also where can I find what all is covered? For example if I wanted a Bariatic surgery would any of that be covered?
MEDICOVERAGE AGENT RESPONSE
Tammy,
Thank you for questions. Bariatric surgery may or may not be covered in your state. It really depends on what your provider and state has decided. To learn about your specific costs for a Gold or Platinum plan, and to see if Bariatric surgery would be covered call 800-930-7956.
-Kelly at www.medicoverage.com
Comment from Jasbindar Dhillon on December 17, 2013
HI I have already sighed up with Kaiser Permanente and have been approved for Bronze 60HMO. I was told I will get the bill from Kaiser within few days- I got confirmation on 1/01/2013 but have still not heard from you. I am concerned as I want to be covered from Jan. 2014, which will not happen if I do not pay my first payment. Can you please check my status and send me the invoice.
Application# 1000334041
Case# 5000272079
Email: .(JavaScript must be enabled to view this email address)
Thanking you,
Jasbindar Dhillon
MEDICOVERAGE AGENT RESPONSE
Jasbindar,
Our understanding is that you will be getting a paper invoice from Kaiser directly. If you have not received one, you should contact them directly. We here at Medicoverage do not bill our clients. If we are listed as your agent we can look into the case for you and assist you with making a payment with the provider. You can also assign us as your agent to help you with this process.
Please note that CoveredCA is saying that you must get your first payment in by January 6th to activate your January 1, 2014 plan.
-Chris from www.medicoverage.com
Comment from Dixie Jones on November 01, 2013
Does the Obamacare rule that an insurance company cannot turn me down based on age or preconditions apply ONLY to policies offered on the ACA exchange, or to all health insurance policies? E.g. I’m over 65 and on Medicare and I wish to add a Medigap policy. Can the Medigap insurance company turn me down based on age/preconditions?
MEDICOVERAGE AGENT RESPONSE
Dixie,
Most ACA rules do not apply to Medigap. Medigap policies do not adhere to the ACA rule about preexisting conditions. Therefore you may be turned down for a policy if you sign up outside your open enrollment period.
Open Enrollment takes place within 6 months of your 65 birthday or (or your Part B effective day if you are over 65). Everyone who applies for Medigap during open enrollment will be approved regardless of health condition. Additionally there are a few special enrollment times where pre-existing conditions are not considered. If you sign up outside of open enrollment you would have to fill out a health questionnaire.
-Kelly from Medicoverage.com
Comment from Tiffany Hightower on September 26, 2013
In the state of Illinois, will in vitro fertilization be a covered benefit on all of the health plans or just certain ones?
MEDICOVERAGE AGENT RESPONSE:
Tiffany,
All health plans in Illinois will cover In vitro fertilization. Take a look at this article here: http://www.medicoverage.com/health-insurance-blog/news/is-in-vitro-covered-by-obamacare.
-Michelle from Medicoverage.com