October 1st marks an important date for ObamaCare, the nickname for the Patient Protection and Affordable Care Act that was signed into law in March 2010. Starting today, open enrollment begins for health insurance plans. Now, the more than 48 million Americans who are currently without health insurance will be eligible for coverage. Everyone (with some exceptions) must carry health insurance or face a fine.
The article below is aimed at individuals, not at employers looking for information on the Employer Mandate, the start of which was delayed from 2014 to 2015. Employers can find more information on how ObamaCare will affect their businesses here and here.
What Is Open Enrollment?
Open enrollment is the period in which individuals may sign up for a health insurance plan. It lasts from October 1st through March 31st, so there is no need to sign up for a plan immediately. For insurance to go into effect on January 1st, you must sign up by December 14th. If you sign in January, February, or March, coverage will start the following month. You can sign up online, by mail, or in person.
The federal government will now regulate health insurance. You can purchase approved health insurance plans either on the exchange or off. The exchange, also called the Health Insurance Marketplace, shows you insurance plans available in your area and allows you to compare features and price.
Many people will be eligible for subsidies and tax breaks on their plans, including those who make up to four times the federal poverty level (currently $45,960 for an individual or $94,200 for a family of four). To see if you’re eligible for a subsidy, check out this subsidy calculator from the Kaiser Family Foundation.
To access the subsidies and tax breaks, you must purchase your insurance plan on the exchange. However, you are not required to go through the exchange; you can purchase insurance off the exchange, through a broker or insurance company. For individuals who are not eligible for subsidies and who want to bundle different kinds of insurance, say, automobile, dental, and health, this option makes more sense.
What Plans Are Available?
You’ll have some basic categories of insurance plan to choose from, the so-called “metal” plans, each with a different cost and level of coverage. Bronze is the cheapest and most basic plan available, followed by the Silver and Gold plans, and finally Platinum, which is the most expensive and most comprehensive plan. A catastrophic plan will also be offered, which has a higher deductible and includes just three visits to the doctor per year. All plans include preventative care.
Like health insurance coverage that many Americans already have, these plans will charge a monthly premium, and many will have deductibles and co-pays. Premiums for the more comprehensive plans (Gold and Platinum) will be higher than for the less comprehensive plans (Bronze and Silver). The out-of-pocket costs are capped at $6,350 and $12,700 per family.
Smokers may pay a “tobacco surcharge,” or premiums up to 50% more than non-smokers, which will go into effect in 2015.
What If I Don’t Get Insurance?
If you don’t have health insurance in 2014, you will face a fine (unless you are exempt). The fine is set to increase over the next few years:
- 2014: $95 per adult and $47.50 per child, up to $285 per family, or 1% of your taxable income, whichever is higher
- 2015: $325 per adult and $162.50 per child, up to $975 per family, or 2% of your taxable income, whichever is higher
- 2016: $695 per adult and $347.50 per child, up to $2,085 per family, or 2.5% of your taxable income, whichever is higher
How Is This Different?
The Affordable Care Act makes it illegal for health insurance providers to deny coverage to people with pre-existing conditions, allowing millions of Americans access to insurance that they never had before. It also mandates that (nearly) everyone must carry coverage.
To cover the costs of the formerly-uninsurable, many people will see their insurance premiums go up. Those expected to see increases in premiums include young, healthy people who carried little or no insurance, and young men, who rarely go to the doctor. Older people and those with chronic conditions will pay less.
Despite the big changes, many people will not be affected. People enrolled in Medicare and Medicaid programs will not see any substantial changes, nor will people who receive adequate coverage through their employer.
Get More Information
This can be a confusing change for many people, but there’s plenty of information and help available to guide you through it. If you currently have health insurance coverage, start by contacting the company that provides it, and ask if and how your policy will be affected. Then try these resources:
By phone. Call 1-800-318-2596 (TTY: 1-855-889-4325) 24 hours a day with any questions on the Marketplace.
In person. You will find people trained to answer your questions and help you compare plans no matter what state you live in. They may be called navigators, application assisters, or certified application counselors. Enter your location here to find local help.