The Patient Protection and Affordable Care Act (PPACA), commonly known as ObamaCare, is a national health care plan aimed at reforming the American health care system.

 

  • The Affordable Care Act (ACA) offers new benefits, rights and protections such as:
  • Young adults can stay on their plans until 26.
  • Insurance companies cannot drop you when you are sick.
  • There can be no gender discrimination in costs.
  • Insurance companies must cover people with pre-existing conditions.
  • No annual or lifetime dollar limits.
  • And more…

 

The ACA also requires that all non-grandfathered health insurance plans cover preventive services and provide new essential health benefits.

 

* A grandfathered plan is a group or individual health plan that was created or purchased on or before March 23, 2010.

 

Essential health benefits include emergency care, hospitalization, prescription drugs, maternity, and newborn care.

 

Preventive services include yearly check-ups, immunizations, counseling, and screenings with no out-of-pocket costs.

 

In exchange for the new rights and protections, most Americans must obtain health coverage by 2014, get an exemption, or pay a per-month fee.

 

Qualified Health Plans

 

There are four types of health insurance plans available through the marketplace: Bronze, Silver, Gold and Platinum.

 

Aside from the 4 basic Qualified Health Plan types, people under 30 and people with hardship exemptions can buy a “catastrophic” health plan through the marketplace.

 

Percentage of Benefits paid

 

  • Up to 90% for Platinum Plans.
  • Up to 80% for Gold Plans.
  • Up to 70% for Silver Plans.
  • Up to 60% for Bronze Plans.

 

Medicaid may be available to people under 133% of FPL (federal poverty level).

 

Catastrophic Available Plans for People under 30

 

  • High Deductibles.
  • Essential Benefits.
  • More Affordable.

 

*This information is subject to change.

 

The Marketplace

 

Health insurance plans are available through online state marketplaces. In here individuals, families and small businesses can shop for subsidized health insurance.

 

To check your options visit https://www.healthcare.gov/

 

What if I already have insurance?

 

If your plan satisfies the Minimum Essential Coverage requirement, then you won’t need to pay a Tax Penalty or fee.

 

These plans fulfill the requirement:

 

  • A Marketplace plan.
  • An individual insurance plan.
  • Any employer plan with or without “grandfathered” status.
  • Medicare.
  • Medicaid.
  • The Children’s Health Insurance Program (CHIP).
  • TRICARE.
  • Veteran health care programs.
  • Peace Corps Volunteer plans.

 

Other Insurance options

 

  • Purchase private health plans from a broker or direct from the provider.
  • Obtain insurance through your employer.
  • Qualify for Government based insurance like Medicaid or Medicare.

 

Costs

 

Cost assistance is only offered through your State’s Health Insurance Marketplace.

 

The Affordable Care Act provides two programs to help individuals afford coverage through the Marketplace:

 

  • Premium tax credits.
  • Cost-sharing reductions.

 

Subsidies are aimed at people with incomes between 139% to 400% of the FPL.

 

Exemptions

 

Several groups are exempt from the requirement to obtain coverage or pay the penalty.

 

These include:

 

  • People whose health coverage may cost more than 8% of their household income.
  • People with incomes too low for filing taxes.
  • People with religious exemptions.
  • Undocumented immigrants.
  • People who are incarcerated.
  • Members of Native American tribes.

 

Tax Penalty

 

If someone can afford health insurance and decides not to have coverage in 2014, they may have to pay a fee known as Tax Penalty.

 

The penalty can be any of the options explained below (whichever is higher):

 

  • 1% of your yearly household income.
  • $95 per person for the year ($47.50 per child under 18).

 

This fee increases every year.

 

Coverage Gap exemption

 

You are exempt from the per-month fee if you you’re uninsured for less than 3 months of the year in 2014.

 

FAQs

 

1.  What if I need coverage that starts right away?

 

You have several options:

 

  • Apply for Marketplace coverage online https://www.healthcare.gov/
  • Direct Enrollment. Buy a Marketplace plan directly from an insurance company, with the help of a broker or agent, or using an online service.
  • Individual insurance outside of the Marketplace online, with the help of a broker or agent.
  • Community Health Centers. If you can’t afford a health plan or can’t wait until coverage begins, you can get low-cost care at a Community Health Center near you.

 

If you enroll in a Marketplace plan by the 15th of the month, your coverage can start as soon as the 1st of the next month. If you enroll after the 15th, your coverage can start as soon as the month after that. Open enrollment in the Health Insurance Marketplace ends March 31, 2014. The next open enrollment period starts November 15, 2014 *This information is subject to change.

 

2. What if I have Medicare?

 

If you have Medicare, you don’t need to do anything. If you have Medicare, you’re considered covered. The Marketplace won’t affect your Medicare choices or benefits.

 

3.  What do military veterans need to know about the Marketplace?

 

If you are a military veteran this is what you need to know:

 

  • You don’t need to get additional coverage if you have: Veterans health care program, VA Civilian Health and Medical Program (CHAMPVA), Spina bifida health care benefits program or TRICARE.
  • If you’re a veteran who isn’t enrolled in VA benefits or other veterans’ health coverage, you can get coverage through the Health Insurance Marketplace.
  • Depending on your household size and income, you may be able to get lower costs on monthly premiums and out-of-pocket costs on private insurance. Or you may qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
  • If you don’t have health coverage, you may have to pay a fee.
  • If your dependents aren’t covered, they may use the Health Insurance Marketplace to get coverage.
  • Depending on household size and income, they may get lower costs on monthly premiums or out-of-pocket costs. Or they could be eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). If they don’t have health insurance coverage, they may have to pay a fee.
  • TRICARE’s young adult coverage rules are different from the Affordable Care Act’s version.
  • If you’re a veteran without VA health care, visit the VA health care website http://www.va.gov/health/

 

4.  Are my children eligible for CHIP?

 

If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). If they qualify, you won’t need to buy a Marketplace plan to cover them.

 

CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.

 

Each state offers CHIP coverage, and works closely with its state Medicaid program. Each state provides different benefits, but all states provide comprehensive coverage, including: routine check-ups, immunizations, doctor visits, prescriptions, dental and vision care, inpatient and outpatient hospital care, laboratory and X-ray services and emergency services. Some services are free of charge and some may have copayments. Some states charge a monthly premium for coverage. The costs vary by state, but you can’t be asked to pay more than 5% of your family’s income for the year.

 

To check what CHIP offers in your state and if you qualify visit http://www.insurekidsnow.gov/, fill out the application or call 1-877-543-7669.

 

5. What if I already have insurance?

 

If you already have insurance you can stay with your plan if it satisfies the Minimum Essential Coverage requirement. Please see the list below for plans that fulfill this requirement. You can also compare new plans in your State’s Health Insurance Marketplace. To visit the Marketplace https://www.healthcare.gov/

 

These plans fulfill the requirement:

 

  • A Marketplace plan.
  • An individual insurance plan.
  • Any employer plan with or without “grandfathered” status.
  • Medicare.
  • Medicaid.
  • The Children’s Health Insurance Program (CHIP).
  • TRICARE.
  • Veteran health care programs.
  • Peace Corps Volunteer plans.
ObamaCare By State