What does the Affordable Healthcare Act do?
1. Bars pre existing condition limit.
The only exception is for grand fathered individual health insurance plans--the kind you buy yourself, not through an employer. They do not have to cover pre-existing conditions. If you have one of these plans you can switch to a Marketplace plan during open enrollment and immediately get coverage for your pre-existing conditions.
2. Bars catastrophic limit.
A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. Costs for essential health benefits over that are generally paid by the insurance company. In the Marketplace, catastrophic policies cover 3 primary care visits per year at no cost. They also cover free preventive benefits. If you buy a catastrophic plan in the Marketplace, you can’t get lower costs on your monthly premiums or out-of-pocket costs based on your income. Regardless of your income, you pay the standard price for the catastrophic plan.
3. Adult children can remain on their parents policy up to 26 years old.
If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old.
4. Mandates every individual must have insurance or else pay fine/tax.
Most people must have health coverage in 2014 or pay a fee once per year. If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. Some people may qualify for an exemption to this fee.
5. Who is eligible to not pay for the Obama Care fee?
Under certain circumstances, you won’t have to make the individual responsibility payment. This is called an “exemption, you may qualify for a “hardship” exemption:
6. Offers 3 kinds of plans to choose from increasing competition between plans.
Plans come in 3 versions; Bronze, Silver and Gold and states offer different company plans. Bronze is the cheapest plan and provides the least coverage where as Gold is more expensive and offers the highest level of coverage.
7. Gives subsidy if individual can't afford insurance (must show w/proof of income).
When you get health insurance coverage in the Marketplace, you may be able to get lower costs on monthly premiums. This depends on your income and family size. In the Health Insurance Marketplace you may be able to lower the costs of your health insurance coverage by paying lower monthly premiums. You'll see the amount of savings you’re eligible for when you fill out your Marketplace application. Prices shown for insurance plans will reflect the lower costs.
8. Gives tax credit to everyone for premium payment.
These lower costs are handled with a tax credit called the Advance Premium Tax Credit. But these tax credits can be applied directly to your monthly premiums, so you get the lower costs immediately.
9. Gives the states option to expand Medicaid.
Some states are not expanding their Medicaid programs starting January 1, 2014. In these states, some people with limited incomes may have fewer coverage options.
10. Provides for free preventive care.
Most health plans must cover a set of preventive services like shots and screening tests at no cost to you. This includes Marketplace private insurance plans. All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.
11. What are the costs of the bill, and where is the funding coming from?
ObamaCare is paid for through collected taxes, penalties, spending cuts and reformations to the health care industry.
12. By when do we have to have individual coverage?
Beginning January 2014, the Affordable Care Act requires each individual to have minimum essential health coverage, qualify for an exemption, or pay a fee. You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.
13. How to we locate the exchanges and apply for insurance coverage?
Apply through https://www.healthcare.gov/marketplace/individual/
14. What doctors can we go to? How do we access the free preventive care?
Once you are enrolled in a healthcare plan you can access the preventative care.
15. By when do we have to have individual coverage?
Beginning January 2014, the Affordable Care Act requires each individual to have minimum essential health coverage, qualify for an exemption, or
pay a fee. You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.
16. What is the time period people within which can apply for coverage each year?
The period of time during which individuals who are eligible to enroll in a Qualified Health Plan can enroll in a plan in the Marketplace. For 2014, the Open Enrollment Period is October 1, 2013–March 31, 2014. For 2015 and later years, the Open Enrollment Period is October 15 to December 7 of the previous year. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. (See Special Enrollment Period and Qualifying Life Event) However, anyone can apply for Medicaid at any time of the year.
17. Individuals must have coverage by Jan 1st, 2014.
Most people must have health coverage by January 1st, 2014 or pay a fee. Some people may qualify for an exemption of this fee. For instance if you are uninsured less than 3 months of the year you are exempt from this fee so really you must have coverage before March 31st.
18. Do I have to register to find out my premium?
Registering is required to submit an application, but you can use a tool to calculate how much your premium may be and if you qualify for medicaid.
19. How is income considered for subsidy?
Program uses the Federal Poverty Guidelines
20. What is the 800 number for the federal marketplace? 1-800-318-2596
21. How do you find the walk in centers?
Go to the website https://www.healthcare.gov/contact-us/ and enter your zip code and a list will come up. However when I did it for DC – they send me to the DC healthcare website.