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How Does ObamaCare Work?
How ObamaCare Works For You, Your Family and Your Business
How does ObamaCare work? With the Insurance Exchange Pools opening in 2013, the question on our minds is, "How does ObamaCare work for me, my family and my business?" The first thing you need to know about ObamaCare (The Affordable Health Care Act) is that, come 2014, you will either need to keep your current insurance plan, purchase coverage, face a penalty tax or get an exemption. The requirement to have insurance is known as the Individual Mandate. Health plans can be purchased through a broker, direct from a provider, obtained through work, obtained through Government healthcare program like Medicare or Medicaid, or can be bought on your State's online health insurance marketplaces (also known as an health insurance exchange pools).
Don't just assume you like or dislike Obama's Health Care Reform under the Affordable Care Act based on what other people say. Find out the facts about how ObamaCare works for you, your family and your business.
What Does ObamaCare Mean for Me? Do I have to Buy Health Insurance?
85% of Americans already have health coverage and won't have to do much of anything. In other words if you have Medicare, Medicaid, Private insurance or are one of the nearly 50% of Americans who get's their coverage through their employer are you are safe.
The 15% of Americans who don't currently have health insurance will either have to obtain health insurance, get an exemption, or pay a per month fee on their tax returns for every month they are without health coverage starting in 2014.
In 2015 all large employers will have to provide their workers with health benefits (see employer mandate). So if you work for a large employer and don't currently have health coverage make sure to check out the marketplace to see your options in the meantime.
The 85% of Americans who already have insurance won't have to do anything in regards to ObamaCare, but they will be able to enjoy most of ObamaCare's new benefits, rights and protections.
The following video contains How ObamaCare Works in 2013 - 2014:
When Does ObamaCare Start?
ObamaCare was signed into law in March of 2010, requires you to have insurance by 2014, expands Medicaid in 2014, and requires large employers to insure full-time workers by 2015. Open enrollment in ObamaCare's marketplace goes from now until March 31st, 2014. Apply to the marketplace today and see if you qualify for subsidies. Insurance purchased through the marketplace before December 23rd kicks in January 1st, 2014. Marketplace insurance can't start before 2014 since insurers would not be required to offer all the new benefits, rights and protections.
How Do I Sign Up For ObamaCare?
There are three ways to get insurance for 2014: 1) the marketplace 2) a broker 3) direct from the provider. You can sign up for ObamaCare's marketplaces by finding your State's health insurance marketplace or going directly to healthcare.gov. Each method will have it's advantages and all plans sold after 2014 will be held to the same standards of quality. Although only marketplace plans offer subsidies, they won't always be the cheapest. In the marketplace cost depends on income. note: HHS approved insurers can enroll you in a marketplace plan
How Does Health Insurance Work 2014?
Health insurance works like this: you pay a monthly premium rate for every month you have coverage. The higher the rate the less out-of-pocket expenses you are responsible for and the larger network of doctors and providers you can utilize. All plans starting after 2014 are required to offer the same minimum benefits, rights and protections. Learn more about how to buy health insurance for 2014.
Understanding Your Health Insurance Options
Some insurance companies were canceling plans or raising prices due to the changes in the Affordable Care Act. Although new rules allow insurance companies to extend non-grandfathered plans until 2015, and many consumer protections are guarding you against unjustified rate hikes, nothing is truly stopping your insurance company from trying to get an "upsell" in over the confusion of the law. In other words, if you got a letter telling you about a drastic rate increase, your insurance company may not be telling you the whole story. By shopping the marketplace, talking to brokers, and speaking directly with providers you can "shop around" for the best insurance option for you and your family. Learn more about how to buy health insurance for 2014.
Americans making less than $45,960 as individual or $94,200 as a family of 4 may be eligible for free or low-cost health insurance due to cost assistance subsidies like Tax Credits that reduce premium costs and cost sharing subsidies that lower cost sharing on copays, coinsurance and deductibles. You can only get cost assistance through your State's Health Insurance Marketplace. (note: In some States brokers and providers can sign you up for a subsidized marketplace plan.)
Use the tool below to get an idea of what marketplace plans cost after subsidies in your States marketplace and to request quotes from a variety of qualified providers and brokers. Learn more about how to buy health insurance for 2014.
All health plans starting after 2014 cover a number of essential health benefits and free preventative services. All plans also have to offer all the protections contained within the ACA's provisions including the requirement to cover people with pre-existing conditions.
ObamaCare doesn't create health insurance, it regulates private health insurance increasing the benefits, rights and protections offered by insurers.
• The ACA expands access to quality insurance by creating Federally regulated and subsided health insurance marketplaces and expanding Medicaid to over 15 million men, women and children who can't currently afford coverage.
• Marketplaces are price comparison websites that individuals, families and small businesses can use to buy subsidized health plans that meet all of ObamaCare's standards like, 100% coverage for pre-existing conditions at no extra cost.
• Due to the marketplaces Americans now have three options to buy private health plans 1) the marketplace 2) a broker 3) direct from the provider. You can still sign up for public healthcare programs like Medicare and Medicaid through the official .gov sites or obtain coverage through your employer if they offer it. Find out more about minimum essential coverage required for 2014 by learning about the Individual Mandate.
• ObamaCare also improves the quality of Medicare and CHIP.
• Insurance companies can no longer charge you more for or deny you health insurance based on health status or gender
• ObamaCare does away with annual and life-time limits on coverage.
• Americans making less than 400% of the Federal Poverty Level can use the health insurance marketplaces to get reduced premiums and lower out of pocket costs on health insurance for 2014.
• All employers with over 50 full-time equivalent employees have to insure their employees by 2015.
• Small businesses with under 25 full-time equivalent employees can get tax breaks of up to 50% of their employees premium on the marketplace.
NOTE: this page discusses how ObamaCare works in regards to individuals and families, please check the left side navigation to learn about other aspects of the Affordable Care Act such as how it will affect small businesses.
How Does ObamaCare Work: How to Get Health Insurance for 2014
By now it should be obvious that all Americans will benefit from the new benefits, rights and protections and many will now have access to quality affordable health insurance by 2014. Let's do a quick overview of how Obamacare works for those of us without insurance and discuss the health insurance marketplace.
Everyone without health coverage must obtain coverage by January 1st, 2014 if they can afford to, get an exemption or pay a fee.
The fee in 2014 is 1 percent of your annual income or $95 per person, whichever is higher. The fee for uninsured children is $47.50 each, with a maximum of $285 per family. Learn more about the the Individual Mandate.
If you already have health insurance or have insurance through your employer than you can keep it. You'll still enjoy all the rights and protections offered by ObamaCare like the elimination of pre-existing conditions. Please note that if you have a plan that was issued before 2010 (a plan with Grandfathered status) you may not be offered all of the new rights and protections. Find out more about your Healthcare Rights and Protections.
There are four types of plans you can buy on the marketplace. They are bronze, silver, gold and platinum. The platinum plan has the highest premiums, or monthly costs, while the bronze plan has the lowest premiums. The higher of the premium cost, the lower the out-of-pocket costs or copays.
The cost of plans sold on the marketplace work on a sliding scale. Low income Americans may get free or low cost plans, those paying full price will pay more and may find their best deal by shopping outside of the marketplace.
Remember if you make less than 400% of the Federal Poverty Level you and your family may be eligible for reduced premium rates and lower out-of-pocket costs through the marketplace.
Am I Eligible for Obamacare?
Almost every legal resident of the U.S. is eligible to shop for health insurance on their State's Health Insurance Exchange Marketplace and most Americans with non-grandfathered health plans are eligible for ObamaCare's new rights and protections. However, only those meeting certain eligibility requirements can receive subsidies through the marketplace. The following video explains ObamaCare eligibility:
How Does ObamaCare Affect What Doctor I Can See?
No matter what type of health insurance you have, from subsidized health plans on the marketplace to high-end insurance plans, your access to doctor doesn't change in under ObamaCare. Your choice of doctors is still based on provider networks just like it is today. As a rule of thumb the smaller the network, the less doctor choices you have. However, competition on ObamaCare's marketplace may result in more aggressive marketing of plans meaning low priced plans may have wider networks moving forward into 2014 than they do today.
What If I Can't Afford Health Insurance?
Americans making under 400% of the Federal Poverty Level will be eligible for cost assistance through the marketplace. In other words, if you truly feel you can't afford health insurance, you are probably right and will likely qualify for lower premiums and out-of-pocket costs. Learn more about exemptions due to cost and cost assistance subsidies on the marketplace.
ObamaCare Exchange: The Health Insurance Exchange Pool
Health insurance will be made available through the ObamaCare Health Insurance Exchange Pool currently known as the Health Insurance Marketplace. The exchange is a group of health insurance providers that will offer coverage. Insurance can be purchased using tax credits that work on a sliding scale depending on your taxable income. You will choose the provider you want for you, your family or business based off of who offers the most attractive package in regards of affordability and quality of coverage.
The exchange pools are meant to be competitive, so this will help drive the quality up and cost down. Consumer Reports has provided a great breakdown of how to buy ObamaCare, we have provided this information on our site to help you better understand what the Affordable Care Act means for you. Tax credits and up-front assistance will be available to low and middle income Americans and small businesses.
Consumer Reports On ObamaCare's Online Marketplace
Here is what Consumer Reports says about Obamacare, "Individuals, families, and small business owners will be able to shop for health insurance in online marketplaces, similar to travel websites. These marketplaces, also called "exchanges," will make it possible to easily compare and buy private insurance and determine if you qualify for financial help."
The marketplaces opened for business October 1, 2013, selling coverage that begins January 1, 2014. You may qualify for discounts to help pay for premiums if your income is from $15,302 to $46,021 for an individual and $31,155 to $93,700 for a family of four. You can also find out if you qualify for extra subsidies to help with out-of-pocket costs or for government programs such as Medicare, Medicaid and the Children's Health Insurance Plan.
How the ObamaCare Online Marketplace Works
• You'll be able to easily compare and purchase health plans offered by private insurers, and in some states, co-ops of doctors and nonprofit organizations that meet state insurance regulations. You will be able to choose among plans with higher or lower deductibles and co-pays, and higher or lower premiums.
• A streamlined "one stop" process will let you fill out one application to find out if you qualify for premium discounts, subsidies for out-of-pocket expenses, or coverage under programs such as Medicare or Medicaid.
• In many cases, in a single session you'll be able to receive an eligibility determination and enroll in a health insurance plan that's right for you or your family.
• You will also be able to update any changes that might affect your eligibility (including marriage, divorce or a job change) and to keep your coverage from year to year through the exchange.
How To Buy ObamaCare Subsidized Insurance
For coverage beginning January 1, 2014, you can buy subsidized health insurance using the State-based health insurance marketplaces, which are also called exchanges. There are two big advantages to using the online marketplace.
Firstly, you can make side-by-side, "apples-to-apples" comparisons of all the available plans, and use an online calculator to find the best buy.
The second advantage being that you may qualify for an up-front discount in the form of a tax credit to help pay for your premiums, and you might also get help with your out-of-pocket costs.
Anyone without insurance through work can purchase private health insurance from the insurers participating in your state marketplace. You can also use subsidies if employee-only coverage costs you more than 9.5 percent of your families income or if your employer's plan does not meet the law's minimum standards.
The online marketplaces opened for business on October 1, 2013, offering coverage that starts January 1, 2014. States must decide whether to build their own or partner with the federal government. Some states will end up choosing to let the federal government run their online marketplaces.
Employers can use the marketplace to buy subsidized health insurance just like individuals and families. See our section on the SHOP marketplace for more information.
How ObamaCare Assistance Works
Now that we've answered, "How Does ObamaCare Work?", we'll talk about how you can get help paying for ObamaCare. Check out our section on ObamaCare assistance for more information on the Cost of Obamacare.