Obamacare Questions Answered

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With Obamacare officially upon us, Turlockers may still be looking for answers about the new, oftentimes confusing government-mandated healthcare.

But does it have to be so confusing? Visiting the healthcare.gov site, it seems that part of the problem is there are too many answers. So which are the right ones?

First of all, what does government-mandated healthcare really mean?

Government-mandated healthcare does not mean everyone must enroll in government health plans for insurance.

It does mean, though, that under the Affordable Care Act (the formal name of the law, commonly referred to as Obamacare) U.S. citizens are required to have health insurance.

What kinds you might ask? A healthcare plan must have minimum essential coverage and the plan must provide actual coverage, not just discounts.

How is Obamacare going to affect me?

The core of the Affordable Care Act affects those who are uninsured or individually insured as a part of the non-group market. For the other 80 percent of Americans insured through their employer or the government, few changes will be seen in regards to Obamacare’s coverage expansion.

What is Covered California? Is it the same as Obamacare?

Obamacare is usually used to refer to the new federal Patient Protection and Affordable Care Act but some people refer to the new government health insurance plans themselves as “Obamacare.”

Whatever you call it, the law has implemented a new healthcare marketplace that allows citizens to compare health insurance plans to find the best and most affordable option. Many states, including California, have created their own health insurance marketplaces for its citizens to compare health plans that are more specific to where they live.

Covered California is California’s health insurance marketplace. It provides Californians a way to compare health coverage options in order to choose the best one for each individual. Covered California allows Californians to shop the marketplace online, in person, or over the phone.

I already have insurance. Will a government health plan be cheaper for me?

It depends.

California’s health insurance marketplace, Covered California, is called a marketplace for just that reason. They encourage you to shop around for the best plan at the lowest price.

Covered California helps Californians compare plans to see if switching to a new insurance would be cheaper.

I don’t have insurance. What does this mean for me?

The ACA has an individual responsibility requirement that means everyone must be insured by 2014 with a plan that offers minimum essential coverage.

If a person chooses not to enroll in an insurance plan, they will be charged with the individual responsibility payment – a fee that acts as a penalty for being uninsured.

Being charged the fee does not mean you are then insured, but it also does not mean you are a criminal. The fee will be charged when a person files for their 2015 taxes and for every subsequent year they go uninsured. These fees will increase annually.

What happens if they charge me the fee and I don’t pay?

The fee will be withheld from your tax return.

I don’t have insurance and I have a reason. How do I know if I am exempt?

Some people may apply for exemptions from the fee depending on economic standing and several other specific cases, such as recent bankruptcy or homelessness. Also, if your individual insurance plan was canceled and you believe that other Marketplace plans are unaffordable, you can file for the exemption as well.

Other exemptions from the individual responsibility payment include: if you’re uninsured for less than three months of the year, the lowest-priced coverage available to you would cost more than 8 percent of your household income, you don’t have to file a tax return because your income is too low, you’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider, you’re a member of a recognized health care sharing ministry, you’re a member of a recognized religious sect with religious objections to insurance (including Social Security and Medicare), you’re incarcerated and not awaiting the disposition of charges against you or you are not lawfully present in the U.S.

The act also provides a list of hardship exemptions, such as: you were homeless, you were evicted in the past six months (or were facing eviction or foreclosure),
you received a shut-off notice from a utility company, you recently experienced domestic violence, you recently experienced the death of a close family member, you experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property, you filed for bankruptcy in the last six months, you had medical expenses you couldn’t pay in the last 24 months, you experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member, you expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP (Children’s Health Insurance Program) and another person is required by court order to give medical support to the child, you were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act, or your individual insurance plan was canceled and you believe other Marketplace plans are unaffordable.

Another exemption comes if, as a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.

Comments 4

  1. Silence DoGood says:

    An explanation of the ACA cost structure. Good luck.

  2. Silence DoGood says:

    An explanation of the ACA cost structure. Good luck.

  3. chris says:

    Just think of all the fun we are going to have…

    1. You’ll at last get to read the Encyclopedia Britannica in its entirety
    while waiting in your doctor’s office.

    2. You will experience the thrill of waiting to find out whether you’ll die
    before you finally have your surgery.

    3. People who have long dreamed of becoming doctors will have incentive to
    avoid massive co-pays and deductibles by performing surgery on
    themselves.

    4. No more concern about seeing a good doctor as all the good doctors retire
    and smart people opt not to go into medicine.

    5. With maternity care covered for everyone, men can finally start to have
    babies.

    6. Since Obamacare’s authors did nothing about medical malpractice reform,
    you can easily sue your doctor if he actually demands payment.

    7. It seems reasonable to ask your doctor to classify quadruple bypass open
    heart surgery as a free “wellness” visit.

    8. With your daughter on your plan until age 26, you can threaten to revoke
    her health insurance if she marries that guy with the tattoo.

    9. Surprisingly enough, in Federalist Paper 74, James Madison wrote, “I
    think it would be a good idea for the federal government to take over a
    business that represents a fifth of the economy.”

    10. Obama, Harry Reid, Nancy Pelosi, and Hillary Clinton all have enough
    money to see doctors and go to hospitals that are out of network, so you can
    stop worrying about them!

  4. SatisfiedCustomer says:

    My husband and I signed up in October. It was pretty simple. You fill out the application online. You enter your income and upload your taxes. At the end of the application, you find out how much of a tax credit you qualify for (or not). Then you selection a plan. Anthem Blue Cross had some of the least expensive. Kaiser plans were the most expensive. The plan we opted for is an Anthem plan without high deductibles, with reasonable copays, and our current doctors are covered. The premium was something like $780 or $790/month for our family, but our tax credit covered most of it, so we only pay about $30/month. It is much cheaper than the Blue Cross plan offered through my husband’s employer which cost us about $500/month without adding the kids to it. I think there is a lot of misinformation out there, mainly to deter people from applying, but I could care less about the politics. I’m just trying to save a buck. $470, actually 🙂

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