6 Obamacare Facts You Need to Know

Love it or loathe it, the Affordable Care Act has many Americans scratching their heads and asking, “What will it mean for me?”

About two-thirds of the uninsured polled said they don’t understand how the health care reform law, commonly known as Obamacare, will impact them, says the Kaiser Family Foundation.

This is something they’ll need to figure out, and fairly quickly: Uninsured Americans will be required to obtain health insurance as of Jan. 1, 2014, or face penalties. The penalty in 2014 will be $95 per person or 1 percent of income, whichever is higher, and will increase to $695 or 2.5 percent of income in 2016. (This FactCheck.org story provides more details.)

But don’t let your blood pressure spike. Here are some quick facts to help you understand what’s going on:

Will I be affected?

Anyone who doesn’t have access to affordable health insurance through their job or through a government program like Medicare or Medicaid can apply to buy health insurance through the insurance marketplace or exchange in their state, beginning on Oct. 1. That includes:

  • Those who don’t have insurance. Last year, nearly 34 million Americans had been without insurance for at least a year, the U.S. Centers for Disease Control and Prevention found.
  • The 15 million Americans who currently buy insurance on their own and not through a work-based plan.
  • Workers whose work-based insurance is not affordable, meaning their share of the cost for their coverage (not family coverage) exceeds 9.5 percent of their income.

People will still be able to buy individual policies without going through an exchange — for instance, directly from an insurance company or an insurance broker.

What if I’ve been turned down before?

Under Obamacare, no one can be denied insurance or charged a higher rate because they have a pre-existing condition. That will help the estimated 12.6 million Americans who can’t currently get coverage because of their medical history.

What kind of coverage can I get?

The exchanges will offer four levels of coverage:

  • Platinum, which will have the highest cost and lowest out-of-pocket expenses.
  • Gold
  • Silver
  • Bronze, which will offer the least expensive monthly premium but highest potential out-of-pocket costs.

All plans are required to provide a new minimum standard of service, which is higher than some plans provide today. CNNMoney explains:

Starting next year, nearly all individual plans — both in and out of the exchanges — will be required to cover an array of “essential” services, including medication, maternity and mental health care. Many plans don’t currently offer those benefits.

How much will insurance cost?

How much insurance bought through an exchange will cost depends on several factors:

  • Your age. Older people could pay as much as three times the rate charged to young adults.
  • Location. You’ll likely face higher premiums if you live in an area where the cost of providing health care is high, and lower premiums where health care is not as expensive.
  • Size of your household. Obviously, the more people you’re insuring, the higher the cost.
  • Use of tobacco. Smokers will pay up to 1.5 times the premiums of people who don’t use tobacco. Some think this is unfair to low-income people, who are more likely to smoke, and some states have already banned a smoker’s surcharge.

Will I be eligible for a subsidy?

Only those buying health insurance on the exchanges will be eligible for a subsidy. The subsidies generally will be applied when you buy insurance on the exchange, reducing the premiums you pay each month.

Will you be receiving one? The Kaiser Family Foundation has provided a calculator to help you figure out your potential eligibility for subsidies. Michelle Andrews of Kaiser Health News provided this explanation:

To be eligible for subsidized coverage, your income would have to be between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for a single person in 2013). “Income” in this case means modified adjusted gross income — basically the total of your adjusted gross income from your tax return and any tax-exempt interest income you have as well as certain foreign income.

Many people will be helped by the subsidies. A new study by consulting firm Avalere Health found that two-thirds of young adults who are uninsured now will be eligible for subsidies, The Hill reports. (People with lower incomes may be eligible for Medicaid.)

Families USA estimates that nearly 26 million Americans will be eligible for subsidies.

California recently released information about what people will pay for insurance on the exchange there. “The cost to a 40-year-old who needs coverage would vary from about $40 to $300 per month for a mid-level plan, depending on the person’s income. Some young adults, who are less expensive to cover, could pay nothing, depending on how much they earn,” reports Reuters.

Is my employer required to provide insurance?

Another component of Obamacare is that companies employing at least 50 full-time workers will be required to provide affordable health insurance or face financial penalties. (Remember the definition provided above: The employee share of the cost can’t exceed 9.5 percent of their income.) However, that requirement was recently delayed until 2015.

According to the Kaiser Family Foundation, 94 percent of companies of that size already provide health insurance to workers.

Still have questions?

Need more help to figure this out? The Washington Post has an interactive questionnaire that can help you determine the impact of the Affordable Care Act. Simply fill in your information.

This is the final big rollout of the provisions of the Affordable Care Act, which, since its passage in 2010, has allowed, among other things:

  • Children to remain on a parent’s health insurance policy until age 26.
  • Access to standard preventive health care tests at no out-of-pocket cost.
  • The elimination of the lifetime cap on health services.

Are you planning to buy health insurance through one of the exchanges? What do you think of Obamacare? Share your comments on our Facebook page.

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Comments & discussion

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  • lerose55

    How are they going to monitor who smokes and who doesn’t. Let face it smokers are not going to tell them they smoke, not with a 50% increase in premiums.

    • jean janeri

      But if it is discovered that they have a history of smoking and were told that they do not smoke, most insurance companies can drop you and your family. Don’t be a liar, it’s wrong.

      • lerose55

        I personally don’t & never smoked, to me its disgusting, but I have overheard people talking, so I was thinking how will the insurance com. will know.

    • maryp32806

      They can tell whether you smoke from a urine test, blood test, and maybe now from a mouth swap – just like on life insurance policies.

  • maryp32806

    I ran how much they can charge me to cover my family (2 incomes AGI=92000, 3 children) … 800 / month! Really! How is that “affordable”. I understand that I can keep my employer based insurance, but who do you think the insurance companies are going to get the money from to cover all these extra people? My family coverage has already increased 300%. Oh yeah, I forgot, it’s not supposed to be affordable for me, it’s supposed to be affordable for those free loaders and illegal aliens.

    • lerose55

      Our insurance went up a lot this year, my fiance’ has me on his, only because he is a manager I was able to stay on his policy, the rest of the company its the employee only that is insured, they cannot no longer pay the difference to keep the family on.

      You got that right we are still going to be paying for uninsured & illegals just as we have been doing. And in Jan. I don’t know if I will be able to stay on, I recently stopped working so I would be without insurance and no income to pay for any. I am pending SSD for over a year now, my diseases have taken over my health, and unable to work. What is a person like me to do. I have always had insurance w/ my jobs for 30 something years.

      Its bad enough to be paying for one person, but I feel sorry for the people who have a family. This Obamacare is NOT AFFORDABLE. I don’t know why our President & Congress cannot STOP paying out Foreign-Aid and use our tax money to give every Citizen FREE HEALTHCARE. Its our tax dollars we should have a SAY on how it is spent. What better way than to keep us healthy w/out stress of Healthcare premiums, co-pays, deductibles. This would take the biggest burden off of our Citizens.

      I spoke to someone in Canada she pays 65.00 a month, lower copays for pharmacy, she loves their insurance. She said they pay until they retire, anyone retired stops paying insurance and the state pays for them and they have lower pharmacy costs. She said, she has not seen any limitation in her care. So how can they do this and the rest of the US, is drowning in Insurance premiums?

      I ask why, GREED, GREED, GREED. This Country does not do anything for the people unless they can make PROFIT on us. They do not care how everyone is suffering w/ incomes. Its a shame President & Congress do not understand the Citizens they represent, they are all out of touch w/ the American people.

      Some people, like Gov’t Christy in NJ and some don’t but I can tell you this. He will fight for the citizens of the USA he is like one of us, the everyday hard working citizen. There is no silver spoon in his growing up. He hears the people, he will do the best he can to try and make our lives livable and not on the welfare line. If there is a way that makes sense to help us, he is the one to do it. He will stop excess expenses in Gov’t and where ever else. Stop most of the perks.
      So I will be voting Christy in 2016. You will not be sorry if you decide too.

      • Randy_S

        The structure of our health care system is the problem, both with our health and economy. We pay 2x what the rest of the world pays, for poorer results. Germany has 157 physicians/ 100,000. people and the U.S. has 10/100,000. The drain of our system is destroying us.

      • Debra Burkart

        Your friend in Canada pays about 50% of her pay in taxes…What this amounts to is if she is making $20 an hour she brings home $10 per hour…Just thought you should know. A friend of my son’s showed him her pay stub.

        • Sherrie Ludwig

          As to Canadian taxes, European Union taxes, etc. the only logical response is: tax me whatever you are going to tax me, but give me VALUE FOR THE MONEY. I would consider access to medical care value. Drones, Iraq war, Gitmo……not so much. I consider not having children starve on the street, regardless of the actions of their parents, to be value. I have never had children but support good public education for the good of the society as value. Maintained and improved roads,bridges, clean water and safe waste disposal are all value for tax money. The health of the people is part of the health of the nation.

  • Delia Winn

    I am on Medicare and a second insurance with a high deductible ( covers medicine) how much more will I have to pay?I pay around $100/ Medicare and $193.for second insurance.

    • Sherrie Ludwig

      The answer, not given by the detractors and naysayers is: nothing. Your Medicare and co-insurance will not change due to ACA. Please go look at the website and see this.