Affordable Care Act, Good, Bad & the Ugly

My Comments: According to WebMD, a trusted source, the following highlights of what has commonly known as Obama Care:

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By law, you need to have health insurance by 2014. If you already get insurance through your employer or your partner's employer, you're all set. But what happens if you don't follow this requirement from the Affordable Care Act?

Who Has to Pay and How Much Is It?

If you can afford health insurance and don't buy it, you'll pay a fine when you file your 2013 income taxes in April 2014.
For the first year of the new law, 2014, the fine for not having insurance is the lowest it will be. After that, it goes up steeply in 2015 and again in 2016.
In 2014: There are two ways the government calculates what you owe. You have to pay whichever amount is higher.

• One way is to charge you $95 for each adult and $47.50 for each child, but not more than $285 total per family.
• The other way is to fine you 1% of your family income. If your family makes $50,000 a year, the fine will be $500.

In 2015: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.

• One way is to charge you $325 for each adult and $162.50 for each child, but no more than $975 total per family.
• The other way is 2% of your family income. If your family makes $50,000 a year, the fine will be $1,000.

In 2016 and beyond: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.

• One way is to charge you $695 for each adult and $347.50 for each child, but no more than $2,085 per family.
• The other calculation is 2.5% of your family income. If your family makes $50,000 a year, the fine will be $1,250.

Don't Assume You Can't Afford Insurance

You can avoid having to pay the penalty by finding affordable insurance. See if you're eligible for financial help from the government by reading How to Avoid the Penalty & Afford Insurance.

Make Sure the Law Applies to You

Some people are exempt from the health care law. That means they don't have to buy health insurance and don't have to pay a penalty.  To learn more, see Who Won't Have to Pay for Insurance or a Penalty?

 

WebMD Medical Reference

View Article Sources

        

SOURCES:

Community Catalyst & Georgetown University Health Policy Institute: "Individual Requirement to Purchase Healthcare in the Affordable Care Act," "Standardizing Health Plans," "Federal Subsidies: Helping People Afford Health Care."

FamiliesUSA: "Help is at Hand: New Health Insurance Tax Credits."
Henry J. Kaiser Family Foundation: "The Requirement to Buy Coverage Under the Affordable Care Act."
Jennifer Tolbert, director of state health reform, Henry J. Kaiser Family Foundation.
Centers for Medicare and Medicaid Services: "Fact Sheet: Individual Shared Responsibility for Health Insurance Coverage and Minimum Essential Coverage Proposed Rules."

Reviewed by Dean A. Rosen, JD on June 25, 2013

 

Under the Affordable Care Act, each state must have a health insurance Marketplace, also called an Exchange. This web site is for people who don't have insurance from an employer. On it, you can compare health plans. And you can find out whether you qualify for a subsidy, which is money from the federal government to lower your insurance costs. You can enroll in a health plan on your state's Marketplace starting Oct. 1, 2013.

 

Before the act was passed, health insurance plans could deny coverage or limit benefits if you had a pre-existing condition like diabetes, or a heart condition, or asthma. Starting with new plans issued in 2010, insurers can no longer deny coverage to children with pre-existing conditions. That protection will extend to everyone, regardless of age, beginning with new plans issued in 2014.

Under the Affordable Care Act, many preventive care services now must be fully covered by health insurance. That means you don't have a copay, owe  coinsurance, or have to meet a deductible first. These services include screening tests like colonoscopies, pap smears, and mammograms, as well as breastfeeding support and supplies. And there are more.

 

If you're happy with your health plan, you can keep it. What’s more, even if you keep the same plan, the Affordable Care Act will add some extra benefits and protections that you didn't have before.

On the other hand, if don't like your current plan, or you want another type of insurance, the Affordable Care Act lets you choose a different one. It's up to you.

 

Your state's new online Marketplace, also called an Exchange, was created mostly for people without insurance from an employer. But anyone can use it to check out their options. The Marketplace aims to make it easy to compare health plans -- sort of like an online travel site for booking tickets.
  

As long as you live in the U.S., are a citizen, and aren't in jail, starting Oct. 1, 2013, you can buy a policy on the Marketplace. The insurance starts Jan. 1, 2014.

 

In the past, insurance companies didn't treat men and women equally. For instance, a 22-year-old woman might pay 150% more than a man for the same coverage. In 2014, the Affordable Care Act will prevent insurance companies from charging higher rates based on your gender.

 

In the past, some insurance companies considered pregnancy a pre-existing condition and could turn down pregnant women. Beginning in 2014, the Affordable Care Act will prevent companies from charging you more or denying you insurance because you have a pre-existing condition. Whatever your health history, insurance companies won't be able to keep you from enrolling.

The federal government runs Medicare. State governments run Medicaid, with federal financial support. But the Affordable Care Act does not create any government-run insurance plans. Most people will still enroll in an insurance policy through work, like they do now. If you don't, you can buy a policy from the Marketplace. All the plans on your state's Marketplace are offered by private companies and not directly by the government.

 

The Affordable Care Act takes full effect Jan. 1, 2014. That's when most of the major changes happen -- like extending coverage to millions of Americans using tax credits to make health care more affordable, and expanding Medicaid in some states. You can enroll in a health plan on your state's Marketplace starting Oct. 1, 2013. The coverage and your payments start Jan. 1, 2014.

Before health care reform, young adults often went without health insurance. They were less likely to have a job that offered benefits. Now, a young adult can stay on their parents’ insurance policy until they turn 26, if the plan covers dependents. This part of the Affordable Care Act is already in effect. Beginning in 2014, young adults up to age 26 can stay on their parents’ plan even if they are offered coverage through their own employer.

 

The Affordable Care Act doesn't cut benefits. Seniors on Medicare actually receive improved benefits, like better prescription drug coverage and yearly wellness exams.

 

The Affordable Care Act does cut Medicare spending. Here's how: It reduces payments to some providers and private insurers that offer coverage to people with Medicare. It also creates steps to prevent fraud and waste in government programs.

 

If you don't have health insurance in 2014, you won't  have  to buy it. But you'll probably have to pay a penalty when you file your 2015 taxes. There are two ways your fee may be calculated. You may owe $95 per adult and $47.50 per child, up to $285 for a family. Or you may owe 1% of your gross income for the year. You’ll owe whichever amount is higher. The penalty greatly increases over the next few years.
 

Why the penalty? It's incentive to get people who can afford health insurance to buy it. A mix of healthy and sick people covered by insurance helps keep the costs down.

It’s hard to know exactly what to expect. Some people will see their costs go down, like people with pre-existing medical conditions, some women, and older people.

 

 However, some healthy people -- especially younger adults -- may see their costs rise. Since insurance companies won’t be allowed to charge sick people more, they may even out the costs by raising prices on the healthy.

 

There's already a shortage of doctors in the U.S. And since up to 32 million more people will get coverage in 2014, the problem will most likely get worse.

 

The Affordable Care Act does try to help. For instance, it rewards doctors who work in underserved communities and funds training for new primary care doctors. However, even with these incentives, some people may still have trouble finding doctors.

 

The Affordable Care Act requires health plans that began covering people on or after Sept. 23, 2010, to cover preventive services. Those include mammograms, a prescription for birth control, and breastfeeding support. If you get any of these services, as well as several others, you won't have a co-pay, co-insurance, or a deductible. However, older policies -- from before that date -- may still charge for preventive care.

 

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