How ObamaCare Works For You, Your Family and Your Business

How does ObamaCare work? With the new marketplace and mandates, 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 Care Act) is that, as of 2014, you either need to keep your current plan, obtain health insurance (called minimum essential coverage), get an exemption, or pay a fee for each month you go without coverage.

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 programs like Medicare or Medicaid, or can be bought on your state’s online health insurance marketplace (also known as a health insurance exchange).

Healthcare.gov is the official marketplace for health insurance, you can sign up during open enrollment each year. Open enrollment for 2015 started November 15th, 2014 and ends February 15th, 2015.  The only time you can enroll in a plan, switch plans, or apply for cost assistance is during open enrollment.  This is true both inside and outside of the marketplace, but please note cost assistance is only available through the marketplace.

The new law also contains some much needed new benefits, rights, and protections that help consumers. This includes making subsidized health insurance available to most Americans making under 400% of the Federal Poverty Level, expanding Medicaid, ensuring Americans can’t be denied insurance based on health status or dropped when they are sick, requiring large businesses to insure full-time workers by 2016, offering generous tax credits to small businesses, and lots more.

Of course the requirement to have insurance and a few key benefits is only a fraction of what the Affordable Care Act (sometimes referred to as ObamaCare) does. Keep reading to find out more about the health care law.

Don’t just assume you like or dislike 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.

where do americans get their health coverageWhat Does ObamaCare Mean for Me? Do I have to Buy Health Insurance?

Today, in part due to the new law, over 87% of Americans already have health coverage and won’t have to do much of anything under the Affordable Care Act. In other words if you have Medicare, Medicaid, ACA-compliant private insurance or are one of the nearly 50% of Americans who gets their coverage through their employer, are you are safe.

The 12.9% of Americans who don’t currently have health insurance (the estimated uninsured rate as of 4/28/2014, which had been nearing 18% before the Affordable Care Act) 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. You can learn more about the specifics on the individual mandate shared responsibility fee here.

To be considered covered you’ll need to get health insurance that is considered minimum essential coverage. Keep in mind short term plans and other supplemental insurance isn’t considered minimum essential coverage.

Getting Assistance Through ObamaCare

Many people who get insurance under ObamaCare will find they qualify for Medicaid, cost assistance through the marketplace, or will be offered insurance through an employer due to the 2016 employer mandate and tax credits offered to small businesses who offer coverage.

About half of uninsured Americans will be able to get cost assistance subsidies for lower premiums and lower out-of-pocket costs or Medicaid using their States’ health insurance marketplace and some who find coverage costing more than 8% of their families income after subsidies will be exempt due to cost.

In 2015 (pushed back to 2016) all large employers will have to provide their workers with ACA-compliant health insurance (see employer mandate). So if you work for a large employer with 50 or more full-time employees and don’t currently have health coverage make sure to check out the marketplace to see your options in the meantime. NOTE: Many employers have elected to offer benefits as a response to the looming mandate. Remember if you covered through work you can’t get cost assistance through the marketplace. However these savings are often off-set by your employers contribution toward your plan.

The law affects everyone differently. If you would like to better understand your specific situation find out, “How Will ObamaCare Affect Me?

Over 87% 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 2014 and beyond:

When Does ObamaCare Start?

ObamaCare was signed into law in March of 2010, required you to have insurance by 2014, expanded Medicaid in 2014, and requires large employers to insure full-time workers by 2016. Open enrollment in ObamaCare’s marketplace started November 15th, 2014 and ends February 15th, 2014. If you miss open enrollment you won’t be able to obtain coverage unless you qualify for a special enrollment period.

Apply to the marketplace early and see if you qualify for subsidies, shopping around is the only way you’ll ensure you are getting the best plan for your needs.

When Can I Sign Up For ObamaCare?

Open enrollment for 2015 starts November 15th, 2014 and ends February 15th, 2014.  You must obtain coverage during the annual open enrollment period. Moving forward if you sign up for coverage in the first half of the month your insurance will start on the 1st of the next month after you pay your premium. If you sign up during the second half of the month your coverage won’t start until the second month.

Learn about special enrollment for those who miss the ObamaCare deadline.

How Do I Sign Up For ObamaCare?

There are three ways to get private insurance under the Affordable Care Act: 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 qualified health 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 during each years open enrollment.

Also see our Medicare enrollment  page for information on enrolling in Medicare, Medicare isn’t part of the marketplace.

Avoiding the ObamaCare Fee

Marketplace insurance starting after 2014 is required to offer all the new benefits, rights and protections of the law and counts as minimum essential coverage (ie you won’t owe the per-month fee for not having coverage in 2014). Public health options like Medicaid, CHIP and Medicare, employer insurance and other insurance types like TRICARE all count as minimum essential coverage and will help you avoid the fee. Some grandfathered plans will help you avoid the fee as well, but you’ll need to switch to a new plan before 2017. However, temporary health insurance, supplemental insurance, and fixed benefit plans won’t exempt you from the fee for not having insurance as they do not count as minimum essential coverage.

All ACA-compliant insurance provides all the new benefits, rights and protections offered by the Affordable Care Act, regardless of the plans cost! Please see our section on minimum essential coverage to better understand what types of insurance comply with the law.

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.

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 2017, 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.

Americans making less than $46,680 as individual or $95,400 as a family of 4 (400% of the Federal Poverty Level in 2015) 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 reduction 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 2015.

obamacare-benefits

What Does ObamaCare Cover?

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.

Get a full breakdown of ObamaCare’s benefits, rights and protections and find out how they apply to your health insurance plan.

How Does ObamaCare Affect Health Insurance

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.

• Each State created a Health Insurance Marketplace where uninsured Americans can buy health insurance and may receive cost assistance. Find your State’s Health Insurance Marketplace now.

• 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.

ObamaCare and Taxes

We won’t go over all the new taxes on this page. Most of the taxes that affect the majority of Americans like tax credits and the mandates are already covered on this page. You can find the rest of the new taxes (almost all of which exclusively affect the healthcare industry and large firms on our ObamaCare taxes page.)

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.

The Health Insurance Marketplace

Health insurance will be made available through the ObamaCare Health Insurance Exchange Pool commonly known as the Health Insurance Marketplace (healthcare.gov). 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 marketplace is meant to be competitive, so this will help drive the quality up and cost down. Tax credits and up-front assistance will be available to low and middle income Americans and small businesses.

Please see our page on the ObamaCare Health Insurance Exchange for more detail on how the exchanges work.

How the ObamaCare Online Marketplace Works

• You can 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 can choose among plans with higher or lower deductibles and co-pays, and higher or lower premiums.

• A streamlined “one stop” process lets 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. Please note: Medicare isn’t part of the marketplace, but you’ll be made aware if you qualify when you apply to the marketplace.

• In many cases, in a single session you can receive an eligibility determination and enroll in a health insurance plan that’s right for you or your family.

• You can 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 after January 1, 2014, you can buy subsidized health insurance using the State-based health insurance marketplaces, which are also called exchanges at any time during open enrollment. 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 started as early as January 1, 2014. Open enrollment ended on March 31st, 2014 and opens again November 15th, 2014. Find out what to do if you missed the deadline.

Starting in 2015 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.

Sign Up for Health Insurance

Now that we’ve answered, “How Does ObamaCare Work?”, you can either keep learning more about the program or apply for your states health insurance marketplace today.

 

How ObamaCare Works for You and Your Family
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