The Ten Essential Health Benefits
No More Discrimination
No Need to Fear a Pre-existing Condition
What is Obamacare? Understanding The Affordable Care Act
One of the most controversial pieces of legislation in our time, the ACA was intended to help all Americans escape the prohibitive cost of healthcare. To date it has helped a little over nine million Americans gain affordable health insurance. It protects and provides for them against the staggering costs of the healthcare industry. This article will help you understand what your rights, protections and privileges are under ACA.
The Patient Protection and Affordable Care Act, or the ACA or Obamacare for short, was signed into law in March 2010. Over a period of ten years, certain portions of it will be introduced and implemented so that the overall costs of healthcare in America will be reasonably priced, maintained, and some parts phased out. This benefits Americans who will no longer have to decide between eating and seeing a doctor for an illness. The ACA was also enacted to prevent gender discrimination, age discrimination, ethnicity discrimination and discrimination based on your medical history, which are all practices formally engaged in by insurance carriers, but for which are now illegal under the Affordable Care Act. It was also passed into law so that children and those with pre-existing conditions like asthma or diabetes could gain affordable healthcare. The ACA exists so that you cannot be dropped when you get sick, just so the insurance company doesn’t have to pay out.
Basic Facts About Obamacare For 2014/2015 Enrollment Period
Even though the Affordable Care Act has been a law since 2010 and Americans have already been through one enrollment season, there is still a lot of information out there that is not accurate and people have a hard time deciphering fact from fiction. To make things more simple for you, here are the facts about Obamacare.
Obamacare does not replace private insurance, Medicare, or Medicaid.
Obamacare is not a healthcare insurance policy or carrier. It is a law that regulates health insurance and exercises some control over the for-profit healthcare industry.
Obamacare includes the requirement that most non-grandfathered health insurance plans cover preventive services and provide the ten essential health benefits.
Many Obamacare provisions have been enacted since its inception. The remainder will roll out gradually every year until 2022.
Over 100 million Americans have already benefited from Obamacare in one way, shape or form. These benefits include receiving free preventive services that people previously had to pay for out-of-pocket, saving money for seniors who are dealing with the Medicare Part D “Donut Hole” and the money saved from the new accountability measures imposed on insurance companies.
Most new healthcare–related taxes only affect high-earners, large businesses, and the healthcare industry. Big business owners are also taxed if they do not provide their full-time employees will health insurance that meets the minimum standards of the law by 2016.
The Individual Mandate and Subsidies
The Individual Mandate Requirement of the Affordable Care Act
Part of the costs of Obamacare, even though it is categorized as a responsibility, is the individual mandate. In the actual document of the law, the individual mandate is actually referred to as the shared responsibility payment. All these terms mean is that you must either sign up for healthcare insurance on the health insurance marketplace or you pay a tax penalty. The mandate originated in the idea that if all Americans were covered by health insurance, then healthcare spending would decrease because everyone would be healthier. Another point in its inception was that the more people who buy health insurance, the less it would cost.
Although the law went into effect in March 2010, the individual mandate provision of the law did not require that everyone have health insurance until the 2014 calendar year. The open enrollment period for 2014 began on October 1, 2013 and closed out on March 31, 2014, which means that any person who did not have health insurance by March 31, 2014 and did not otherwise qualify for an exception to the law or a Special Enrollment Period, would be penalized with a tax that would be assessed when they paid their 2014 federal income taxes.
The tax penalty for 2014 would be $95 per adult in a household and $47.50 per child under 18 or 1% of the family’s household income, whichever is higher. The family’s household income is calculated by taking the annual household income and subtracting the tax-filing threshold, which is the amount of money that a person must make a year in order to be required to file federal income taxes. In 2014, the tax-filing threshold for an individual is $10,150 This amount will change in the future. The 2014 tax penalty is capped at $285 no matter how many people are in the family.
Perhaps what people need to know the most about are the financial subsidies available to them. When the ACA was enacted, it provided many free health benefits and expanded others. It also made it a law that every person get health insurance even if a health insurance bill was not one that the person or family could afford. In order to make sure that the millions of people who cannot afford healthcare on their own comply with the law and get health insurance, the ACA created a system whereby the federal government would help people who fell within a certain range of the Federal Poverty Level pay for their monthly premiums. Despite the fact that premium caps are established by the law depending on income and that these caps range from two percent up to nine percent for individuals and families, some families and individuals need additional help paying for the monthly premiums. A person who lives in a state that relies on the federal health insurance marketplace on Healthcare.gov could be eligible for a federal subsidy if they make between 100% and 400% of the Federal Poverty Level. You can refer to the table below for the rates in 2015. If a person lies in a state that has their own state exchange health insurance marketplace, they would rely on their state’s rules to determine if they are eligible for financial assistance. If a person wants subsidy help, they will need to ask for this help when filling out their application, because the assistance is not automatic.
|Family Size||100% of the Federal Poverty Level in 2015||400% of the Federal Poverty Level in 2015|
Obamacare Costs and How to Apply
Questions About What Obamacare Will Cost In 2014?
The general rule is that healthcare insurance premiums may not exceed four percent of an individual’s or a family’s annual income if they fall below 133 percent of the federal poverty line. For those whose annual income falls below 400 percent of the federal poverty line, the percentage rises to nine percent.
Due to tax credits and monthly premium subsidies, in 2014 millions of newly insured Americans are paying around $82 per month for health insurance. Millions more are paying $50 or less per month for health insurance. These prices are typical of the Americans within the limits of the Federal Poverty Level. Those more affluent, both single and families, will pay the usual monthly premium, which may go above $1,000 for families. Prices vary by insurance company and state, but generally the premiums have been running between $163 per month up to $363 per month for an individual in 2014.
Obamacare Costs For 2014 and 2015
Alternatively, when most people sign up for Obamacare, they are more concerned with what they will pay each month. Consequently, deductibles and out-of-pocket costs come in second place in the worry department. For help with these worries, research and comparison website Health Pocket compared the four metal health insurance plans for 2014 deductible and out-of-pocket expenses. They researched typical deductibles, doctor visit copays, specialist copays and caps on out-of-pocket expenses.
A Bronze plan for an individual carried a deductible of $5,081 for an individual and $10,386 for a family. Their copay at a doctor office as well as a specialist was 30 percent of the cost of the services. The cap on out-of-pocket spending was $6,267 for an individual and $12,569 for a family.
The Silver plan called for a deductible of $2,907 for an individual and $6,078 for a family. The copay at a doctor was $32 and at a specialist was $56. The out-of-pocket cap was $5,730 for an individual and $11,495 for a family.
For a Gold plan, the deductible was $1,277 for an individual and $2,846 for a family. The copay at a doctor office was $24 and a specialist was $46. The out-of-pocket cap was $4,081 for an individual and $8,649 for a family.
The Platinum plan had a $347 deductible for an individual, with a $698 deductible for a family. A doctor visit would cost $16 and a specialist $30. The out-of-pocket was $1,855 for an individual and $3,710 for a family. Health Pocket also found that each metal offered zero deductible plans for both individuals and families.
How to Apply for Health Insurance Through Obamacare
Remember that Obamacare isn’t an insurance policy, but rather it’s the law that regulates the insurance industry and policies. Keeping that in mind, if you still do not have health insurance and don’t want to pay the price of the penalty come tax time, you should be doing your homework and preparing to sign up for health insurance?
Best Ways To Apply For Obamacare?
There are several ways that a person can apply for health insurance and be in compliance with the law. A person can get health insurance through their employer, they can sign up for a policy through a private health insurance carrier, which they can either do directly through the carrier, a licensed insurance agent or broker or through a third-party website that can connect the person with rates from all carriers that offer plans in that geographic location. Finally, a person can get health insurance through their state or federal health insurance marketplace. A person can either apply directly on the state or federal website, can call the state or federal toll-free number and apply using the state or federal navigator (customer service representative) or they can enlist the help of a licensed insurance agent or broker to enroll through the state or federal marketplace. Using a licensed insurance agent or broker is free to the consumer because they are paid a commission by the insurance carrier.
Before you apply for health insurance through any of the above methods, you should make sure that you have the following paperwork available:
- Social security card
- Birth certificate or another official document showing citizenship
- Job and income information (previous tax filings, recent pay stubs, recent 1099 issued by your employer)
- Present healthcare information if you have coverage
Before you select and enroll in a healthcare plan, it is important to know your budget and your needs. Some people may be able to afford higher monthly premiums if it means that they have more health insurance benefits. Some people may want the flexibility of being able to see any doctor or specialist without concern of whether they are in-network or out-of-network or whether they have a referral first, which means that a PPO plan may preferable over a HMO plan. Additionally, a person may realize that they need financial assistance paying for healthcare and need to find a less costly plan. Have this information in mind before you sign up is important so that you can streamline the enrollment process. The next open enrollment period starts on November 15, 2014 and ends on February 15, 2015. If you enroll by December 15, 2014, your coverage will begin on January 1, 2015. If you enroll by February 15, 2015, your coverage will begin March 1, 2015.
If you found that the enrollment period has passed and you have experienced a particular event that qualifies you for a Special Enrollment Period, you will be given sixty (60) days from the date that the event occurred to enroll in health insurance on the federal marketplace and possibly get a federal subsidy. A Special Enrollment Period is triggered if one of the following events occurs: marriage or divorce, birth or adoption of a child, moving to a new state, a change in income that qualifies you or disqualifies you for a subsidy, Medicaid or CHIP or loss of your present health insurance policy due to reason such as you lost your employer-sponsored healthcare. It is important to know these things, so you don’t have to pay the penalty when tax time arrives.