"Obamacare": Making Sense of the Affordable Care Act (ACA) passed in 2010
Changes are coming and we know it's confusing, and so we at A&B Financial are ready to help make sense of it all. We will try to answer a few common questions here:
If you're currently enrolled in a health plan... and you had that plan prior to March 23, 2010, your plan is considered a "grandfathered" plan. Such plans are exempt from many - but not all reforms. Your current plan may provide greater benefits to you than the plans that will be available after October 1st. Plans effective after March 23, 2010 are not "grandfathered" and will include various changes. For example, the new law eliminates annual limits on certain key health benefits and requires plans to include a new, mandatory package of "essential benefits." Those benefits may be important for you. They also could make your premiums somewhat more expensive.
If you don't have health insurance now... you MAY want to get it before October 1st when the new health insurance exchanges (also known as marketplaces) launch.
Either way... we can help you compare plans, determine if your income will qualify for a subsidy, find the plan that offers you the most benefits and get you enrolled. In Florida, there won't be a state exchange - individuals will need to go online to the federal exchange to select their healthcare coverage, or go through a licensed agency such as us at A&B Financial by calling (321) 775-0735 to sign up.
"I'm currently employed part-time, and I pay for my own health insurance, it's not through my employer. Will I be eligible to participate in the exchanges?"
This is one of the biggest misconceptions about the ACA - that it's only for people who don't have insurance. The big PR campaigns you'll be seeing in the coming weeks are aimed mostly at the uninsured, but the new health care plans are most definitely available to people who already buy their own insurance.
"I've heard that the amount for people to qualify for assistance in terms of income for individuals is as low as $11,000. I make more than that but I don't think that my income necessarily would be enough that I could afford insurance on my own. If I end up being in a pinch where I don't qualify for assistance by the government's definition, but still can't afford insurance on my own, what are my options?"
Within the exchanges, there's a sliding scale of assistance. The smaller your income, the more help you get paying your premium. The subsidies start for people whose "modified adjusted gross income" is $11,490 or above for a single person. The help is reduced for people who make more money, and is cut off altogether once your reach $45,960.
Bottom line: if you're an individual making up to $45,950 you should be eligible for at least a bit of a subsidy.
Now, there may be cases where someone doesn't qualify for help, or does qualify for help but still can't afford the premium. And those people won't be required to have insurance. The law says if you would have to spend more than 8 percent of your income on premiums, then you get a waiver and are excused from having to pay any penalty for not buying insurance. There are several other types of people who are excused. And you can always seek a hardship exception if you think you truly can't afford coverage.
How much will the premiums be? That information is just starting to come in from some of the states. It will depend on a lot of factors - where you live, how old you are, and your household income.
"What if I'm eligible but decide I don't want to purchase health insurance? If I choose not to get it, how does the government know if I have it or not? What are the penalties? What if I don't want insurance until I get sick?"
The penalty for not having health insurance for 2014 will be $95 (single), $285 (family), or 1 percent of your taxable income - whichever is greater. It does go up each year, eventually to a maximum of 2.5 percent of taxable income. It's assessed, if you owe it, on your 2014 income tax form that is due April 15, 2015. And that's how the government finds you - it asks on your income tax form if you had health insurance. People who have it will get some sort of certificate of coverage from their health insurers.
If you wait until you get sick, most likely you will be locked out of coverage until the next open enrollment period.
"I'm a veteran who has my regional healthcare plan through the military Tricare system. Would the ACA affect my health care?"
Not at all. The health law lays out several categories of what it considers minimum coverage that satisfies the requirement to have insurance. If you have any of these kinds of health insurance: employer coverage, including COBRA and retiree coverage, or a government program like Medicare, Medicaid, the Children's Health Insurance Program, VA benefits or Tricare, you don't have to do anything, and you will have satisfied the requirement to have coverage.
"I have coverage through my husband's job but the premiums are expensive and we really don't like the coverage. So I was wondering, will we be able to buy health insurance through the exchanges and maybe get a better deal?"
Probably not. You know how President Obama has been saying, "If you like the coverage you have you can keep it?" That was shorthand for saying that the law was intended to maintain the existing system, where people get insurance through a job or through a family member's job. And to make sure that didn't change - for the first several years at least - people who are offered health insurance through an employer or a family member's employer are not allowed to go to an exchange to get insurance, except in very limited cases. Or they can go to an exchange, but they won't be eligible for any help paying their premiums. However, there are some exceptions to this - we can help you sort through the details to see if you qualify.
We at A&B Financial are positioned to offer individuals and families all of the plan choices in our area, plus help navigate the exchange (if you qualify for a subsidy) or choose from the private insurers - whichever proves to be a better deal for you. Give us a call to learn more about how the ACA may personally impact you and your family - we'd love to help!