Yup, it's here. The guide below should answer your questions, but if I missed something, please leave your question in the comments.
Do I buy my health insurance from the government now?
If you currently receive Social Security or Medicare, you already ARE getting your health insurance through the government, and it won't change. However, open enrollment is this fall for 2014 Social Security. You should check and make sure that your current carrier is still participating (if you have Medicare Advantage) and use the SSA tool to find the best drug provider.
If your employer provides health insurance, and will continue to do so in 2014, you are not affected by the ACA. Some small employers may (not will, may) elect to cancel their coverage, give you a stipend, and send you to the exchanges. There is one caveat: some employers currently offer junky insurance. For example, insurance that caps payouts at $10,000, or costs employees more than 9,5% of their income, or excludes maternity care or other essential services. The employer will either have to provide a plan that conforms to ACA regs, or cease offering insurance.
If you are currently uninsured, or buy insurance on the individual market you will be able to use the exchange provided your income is above 138% of the poverty level. If you are between 100% and 138% of the poverty level and in a state that accepted the Medicaid expansion, you'll now be covered by Medicaid. If you are in one of the red states that turned down the expansion, you are out of luck.
I know the exchanges open today. Do I have to sign up today?
No. You have until the end of March 2014 to enroll. What you'll want to do is set up an account, and start looking at your options. You'll probably want to wait to enroll for a month or so. The insurance will not become effective until 1 January 2014, so you have time, and some insurance companies will want the first premium paid after you enroll, which may also cause you to delay enrollment.
What kind of health plans are available?
There are four kinds: Bronze, Silver, Gold, and Platinum. Bronze is set to pay about 60% of total health care costs, Silver 70%, Gold 80% and Platinum 90%. The premiums are lowest for Bronze, and highest for Platinum.
Remember that total costs include premiums, co-pays and deductibles. The premiums for Bronze plans are lowest, but the co-pays and deductibles are highest. Thus, if you're relatively healthy, you could consider a Bronze plan understanding that the deductibles would be higher. Alternately, if you have a chronic condition and know you need a lot of medication and doctors visits, you may want to consider a higher plan where your premiums will be higher, but your other out of pocket costs will be lower.
Note: if you're under 30, or meet certain low-income levels, you can also choose a catastrophic plan.
What do I get?
All health plans in the exchange are required to cover the following at a minimum:
- Preventive, wellness and disease management services
- Emergency care
- Ambulatory services
- Maternity and newborn services
- Pediatric services, including dental and vision
- Prescription drugs
- Laboratory services
- Mental health, behavioral health and substance abuse services
- Rehabilitation services
How much will I pay?
It depends on your income, your age, whether you use tobacco and where you live. The site will be able to tell you what you'd pay for the different plans from the different providers. You can use this tool from Kaiser for a general idea, although you need to remember that premiums vary in different locations.
OK, I'm ready to look, where do I go?
Click here for healthcare.gov. You can also call 800.318.2596. If your state has a state-run exchange, you'll be directed to that specific state's site, otherwise, you'll be able to use healthcare.gov. If when you put in your income information, you qualify for Medicaid, the site will direct you to the appropriate portal for that.
Why did you say I probably want to wait to enroll?
A couple reasons. First, you'll want to do some research before you actually enroll. You'll need to know your total income for this year, your likely total income for 2014, what you and your family's medical expenses are, and have handy a list of all medications taken on a regular basis. And don't worry, the site is set up to allow you set up an account, fill in some information, and come back later.
At healthcare.gov, you'll be able to compare the different plans from the different insurance companies who are providing coverage. What you'll then want to do is call your doctor and see if he/she is participating in the exchange. Some will, some won't, and it may depend on the level of insurance (Bronze, Silver, Gold or Platinum) you choose, and which provider you select. You'll also want to check whether your preferred hospital is participating. Finally, you'll want to check the formulary to see whether or not your specific drugs are covered. The formularies, by the way, are not ready yet in most cases.
If you have a job (like commission sales or self-employment) with variable income, you'll want to wait as long as you can to be as accurate as possible with your 2014 income. That's because one of the underwrites is in the form of a tax credit that can be immediately applied to monthly premiums but will vary if your income changes. However, you can let the exchange know if your income rises, and they'll cut the credit during 2014 (or increase it if you income falls) because otherwise, it will affect your refund or payment when you pay your 2014 taxes in 2015.
What if I need more help?
Every state has navigators to help you figure things out. These are NOT individual people. They are people employed by various state agencies, NGOs and other non-profits to serve the public. They are not yet licensed in all states. If you need help finding one, drop me an email with your name and 9-digit zip code and I'll help you find the organization in your area. If anyone tells you they're a navigator, or you see ads for individuals helping you figure out ACA choices, they're lying and it's a scam.
A number of large insurance companies will be sending out letters, holding open houses and public events to let people know about their offerings. While this is a good source of information, remember that's ONE insurance company and you'll likely have more than one choice.
In addition, a lot of churches, synagogues, mosques and temples are in the process of setting up outreach. Contact your local house of worship.
Finally, this past Sunday, many newspapers put out sections on the local options for the ACA. This information is still on-line if you didn't see a paper on Sunday.
What else should I watch out for?
All the insurance companies listed on the state and Federal exchanges are licenses to do business. Some, like My Oscar (NY only) are interesting and very atypical. Some insurers are large and well known, some are new regional start-ups. If you're looking at an insurer you've never heard of before, and their rates are half of everyone else's, think about it.
What happens if I do without health insurance next year?
You'll get fined. The fine is low next year: $95 or 1% of your income, whichever is higher. The fine and the percentage both rise in successive years. If you think that you don't need insurance, make sure not to leave your house to avoid car accidents, broken legs while jogging, and other accidents. Also make sure that you don't end up with cancer or a heart attack. Without insurance, these things can definitely bankrupt you. A few years ago, I was bitten on my hand by a dog. Luckily, I had insurance and the owners covered my out of pocket costs. But who would have known that a seemingly friendly dog would get spooked from the reflection of my ring and chomp on my hand? Bottom line: ER visit, 2 visits to the hand surgeon, x-rays, medication, and surgery could have been needed. Even without the surgery, without insurance, the bill to me would have been over $10,000.
The penalties come into play if you're uninsured for 91 days or more.
I don't have insurance now, but what if I change jobs next year and get employer coverage?
You'll be able to drop off the exchange.
I'm on COBRA, is there still COBRA?
There's still COBRA, although accepting COBRA is not mandatory, and you may find a better price on the exchange.
If I make too much money to get a subsidy, but I can't afford insurance, can I still buy it on the exchange?
Yes. It won't be subsidized, but if your premiums are high based on age or a chronic condition, your premiums will likely decrease if you buy via the exchange.
Will you answer more questions?
Yes, put them in the comments.