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Obamacare Facts

Open Enrollment For Obamacare Started November 1st, 2017. Avoid Wait Times And Any Delays – Enroll Now.

The Ten Essential Health Benefits

The Affordable Care Act now requires all insurance policies to include coverage for ten particular essential health benefits. Before the ACA, people with lesser insurance policies often had to pay out-of-pocket for these services .

No More Discrimination

The ACA now prohibits insurance companies from considering certain discriminatory factors when calculating the monthly cost of an insurance policy. For instance, insurance companies can no longer consider age, medical history or gender when assessing a monthly premium.

No Need to Fear a Pre-existing Condition

Even if you have a long previous medical history, have made many claims to insurance carriers in the past and have a pre-existing condition that needs medical attention right now, you can still get great health coverage at an affordable price under the new requirements of the ACA.

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.
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Basic facts about the 2015-2016 ACA enrollment period

Since its establishment in 2010, the Affordable Care Act (ACA) has provided millions with quality healthcare and prescription medications. While Americans have already been through one enrollment season, there’s still a lot of information out there, and not all of it is accurate. It can be difficult to decipher fact from fiction, so to make things simpler, here are the facts about the ACA.

1.) The ACA does not replace private insurance, Medicare or Medicaid.

2.) The ACA 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.

3.) The ACA includes the requirement that most non-grandfathered health insurance plans cover preventive services and provide the 10 essential health benefits.

While benefits may vary by state, small differences between health insurance plans may exist. Specific plan benefits are provided when you fill out your application and compare plans. These 10 essential benefits include the following items and services:

  1. Outpatient care—the kind you get without being admitted to a hospital
  2. Trips to the emergency room
  3. Treatment in the hospital for inpatient care
  4. Care before and after your baby is born
  5. Mental health and substance use disorder services, including behavioral health treatment, counseling and psychotherapy
  6. Your prescription drugs
  7. Services and devices to help you recover if you’re injured or have a disability or chronic condition, including physical and occupational therapy, speech-language pathology and psychiatric rehabilitation
  8. Lab tests
  9. Preventive services, including counseling, screenings and vaccines, to keep you healthy and care for chronic disease management
  10. Pediatric services, including dental and vision care for kids

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The Individual Mandate and Subsidies

The Individual Mandate Requirement of the Affordable Care Act

Thanks to the Affordable Care Act (ACA), a vast number of men, women and children have access to healthcare providers and prescription medications. But this coverage is not automatic; beneficiaries have to actually sign up. If an individual or family fails to purchase a policy before the end of the open enrollment period (OEP), they’ll pay a tax penalty.

Known as the Individual Mandate Requirement (or, the shared responsibility payment), it was designed with certain logical concepts in mind. The first was that if all Americans were covered by health insurance, then healthcare spending would decrease, as everyone would be healthier. And second, the more people who buy health insurance, the less it would cost.

This law first went into effect in March 2010. However, the actual individual mandate’s requirement that everyone have health insurance didn’t kick in until the 2014 calendar year. And in regard to 2016 coverage requirements, the upcoming OEP will run from November 1, 2015 to January 31, 2016. So, anyone not purchasing coverage by January 31 of next year — either through the government’s insurance marketplace (known as exchanges) or a private, third-party health plan — will face a tax penalty. But you may not have even known you owed a penalty until you paid your 2015 federal income taxes.

However, potential beneficiaries may have a safety net or two. You may qualify for an exception to the law (more on that below). You may also be able to enroll later, within a Special Enrollment Period (SEP). These are special extensions provided by the Centers for Medicare & Medicaid Services (CMS), the agency overseeing the healthcare law. The SEP was designed for individuals and families who went without health coverage in 2015. SEPs are also set up for those who were unaware or confused about the fee for not enrolling in coverage. Should you face a tax penalty, you’ll pay the higher of the two options below:

  • 2.5 percent of your yearly household income.This penalty’s calculated using the amount of income above the tax filing threshold; about $10,150 for an individual. The maximum penalty is the national average premium for a “Bronze” plan (offering the lowest premiums; you pay 40 percent of medical costs).
  • $695 per person for the year ($347.50 per child under 18).

The individual mandate’s penalty changes with each new year and is adjusted for inflation. Beginning in 2017, this penalty will increase as the cost of living increases. As in 2014, the IRS will collect the penalty with everyone’s federal income tax returns. The tax will either be added to the amount you already owe to the IRS or deducted from the refund calculated.

However, there are exceptions for paying the penalty, including those for economic and insurance reasons:

  • You already have insurance through an employer, are retired or use COBRA (the Consolidated Omnibus Budget Reconciliation Act). COBRA ensures that health coverage provided by an employer continues after you leave the job.
  • You already have private coverage
  • You already have Medicare, Medicaid or CHIP (the Children’s Health Insurance Program). CHIP is a joint federal-state program, offered through Medicaid and separate CHIP programs, providing health insurance for low-income children whose families earn too much money to qualify for Medicaid.
  • You’re a veteran and covered under the VA or TRICARE; this health care program provides civilian health benefitsfor military personnel, retirees and their dependents and some members of the Reserve Component.
  • You’re currently in the military and covered under TRICARE

Other exemptions deal with economic and personal circumstances:

  • Those who cannot afford coverage
  • If coverage costs more than 8 percent of a family’s income
  • Income below the filing threshold
  • Members of Indian-American or Alaskan tribes
  • People who are part of a federally recognized religious group that objects to health insurance
  • Members of a healthcare-sharing ministry
  • People who are incarcerated in jail or prison
  • People not living in the United States lawfully without a temporary, legal status.
  • Those who were not insured for three months or less
  • Those who qualify for a hardship exemption (life situations preventing you from purchasing health insurance)

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ACA-Compliant Subsidies

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.

To ensure 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 (FPL) pay for their monthly premiums. Despite the fact that premium caps are established by the law, some families and individuals need additional help paying for the monthly premiums. These caps depend on the beneficiars’ income and range from 2 to 9 percent for individuals and families.

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 percent of the FPL. You can refer to the table below for the rates in 2016.

If a person lives in a state with its own state-run 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
1 $11,770 $47,080
2 $15,930 $63,720
3 $20,090 $80,360
4 $24,250 $97,000
5 $28,410 $113,640
6 $32,570 $130,280
7 $36,730 $146,920
8 $40,890 $160,360

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Obamacare Costs and How to Apply

Questions About What Obamacare Will Cost In 2017?

The purpose of subsidies and tax credits is to make sure that your monthly health insurance bills are not more than you and your family can afford. If it is, the tax credits and subsidies are supposed to bring the bill down to something more affordable so that the requirement to have health insurance is not debilitating financially.

Due to tax credits and monthly premium subsidies, in 2015  Americans are paying, on average $105 a month for health insurance. Eighty-percent of Americans are paying $100 or less a month for their monthly premium. 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. Prices vary by insurance company and state, but generally it was reported that the average premium before applying a tax credit or subsidy in 2015 was $374 a month and the average subsidy in 2015 was $268 a month.

The following qualification form will help you determine pricing, as well as connect with a licensed health insurance professional who can answer any of the questions that you might have.

Obamacare Costs For 2015 and 2016

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 2015 deductible and out-of-pocket expenses. They researched typical deductibles, doctor visit copays, specialist copays and caps on out-of-pocket expenses.

Keep in mind, this is pricing without subsidies. So if you qualify for a subsidy, the pricing is literally a fraction of the overall estimates for a family of four below.

1.) Bronze plan

  • An individual can expect to pay a deductible of $5,181; a family can expect to pay $10,545.
  • The copay, whether for a doctor’s office or a specialist, should be 34 percent of the cost of the services (charged as the coinsurance fee).
  • The cap on out-of-pocket spending will be $6,373 for an individual and $12,749 for a family.

2.) Silver plan

  • An individual can expect to pay a deductible of $2,927; a family can expect to pay $6,010. 
  • Copay — for a doctor, $29; for a specialist, $57
  • Out-of-pocket cap — $5,775 for an individual; $11,555 for a family

3.) Gold plan

  • An individual can expect to pay a deductible of $1,198; a family can expect to pay $2,626.
  • Copay – for a doctor, $23; for a specialist, $4.
  • Out-of-pocket cap — $4,298 for an individual; $8,986 for a family

4.) Platinum plan

  • An individual can expect to pay a deductible of $243; a family can expect to pay $489.
  • Copay – for a doctor, $18; for a specialist, $29
  • Out-of-pocket cap — $1,971 for an individual; $3,942 for a family

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. Having 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 1, 2015 and ends on January 31, 2016. If you enroll by December 15, 2015, your coverage will begin on January 1, 2016. If you enroll by January 31, your coverage will begin March 1, 2016.

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.

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