Like most Americans, you’ve probably heard of “Obamacare”, but maybe you’re still not exactly sure what it is or how it affects you. And according to your uncle’s Facebook posts, it sounds pretty scary, like maybe it’s going to turn America into a Kenyan Soviet Union or something. Well, good news: Obamacare is probably not going to do that! What a relief, huh? What other mysteries about the new health care law can we help clear up for you?
What Exactly is Obamacare?
Am I Eligible for Obamacare?
How Much Will Obamacare Cost?
Will I Pay More if I’m Unhealthy?
How Does Obamacare affect my HSA?
Is Obamacare Still at Risk of Getting Repealed of Defunded?
Why is it Called Obamacare?
How Will the Government Help Pay for Health Insurance? What are Subsidies?
Do I Need to Be On the Same Plan as My Spouse?
How Do Gay Couples Factor into Obamacare?
Can My Application Be Declined?
What if I Make Too Much Money to Qualify for a Tax Credit/Subsidy?
Are Dental or Vision Insurance Plans Affected by the New Law?
Which Medical Services are FREE with Obamacare?
What Exactly is Obamacare?
Obamacare is simply a nickname for the Affordable Care Act signed into law in 2010. Although many are still fighting to kill it, the Supreme Court declared it constitutional in 2012. Its goal is to provide health insurance to all Americans, including the 48 million who are currently uninsured. Additionally, it aims to make getting insurance easier for those who buy and pay for their own insurance (i.e. those who are not provided insurance by an employer).
Obamacare also puts an end to some of the most shameful insurance practices such as excluding those with pre-existing conditions, kicking patients off their plan when they run up large medical expenses, and setting dollar limits on how much care they will cover. Under Obamacare consumers’ out-of-pocket expenses cannot generally exceed $6,350 for a single person or $12,700 annually. Any healthcare costs exceeding those maximums will be covered by the insurer. There are also 10 minimum essential health benefits (benefits itemized in How Much Will Obamacare Cost?) that will always be offered at no cost.
Am I Eligible for Obamacare?
The only eligibility requirements to qualify are:
- Must live in the U.S.
- Be a U.S. citizen or national, or be lawfully present in the U.S.
- Have a household income between 133% – 400% of the Federal Poverty Level
- Cannot be currently incarcerated
If you don’t meet these requirements, you may still be apply for health insurance, but you would not qualify for government subsidies to help pay for the coverage. If this is the case, please speak to one of our agents – we are happy to help guide to towards the best options for your particular scenario.
How Much Will Obamacare Cost?
There is no simple answer to this question. Insurance premiums will vary a lot per person. Rates are based on age, geographic location, family size and, if applicable, tobacco use. The good news is now women cannot be charged more than men and older people more than younger people as is the norm currently. What is also important to note is that beginning January 2014 every major medical plan must include coverage for the 10 essential health benefits:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventative and wellness services and chronic disease management
- Pediatric care
Will I Pay More if I’m Unhealthy?
Beginning January 1, 2014 insurance companies will no longer be able to charge higher rates for health insurance based on health status.
Insurers will only be able to price plans based on four factors:
- Age – the oldest person can only be charged three times more than the youngest person for the same plan.
- Where you live – the price to provide care changes from city to city and state to state
- The size of your family
- Your tobacco use – smokers can be charged up to 50% more for the same plan as a non-smoker
How Does Obamacare affect my HSA?
There are some changes to HSAs (Health Savings Accounts) and how they work. If you use an HSA or similar account, you may only save up to $2,500 pre-tax. Also, you may no longer use HSA funds to purchase over-the-counter drugs.
Is Obamacare Still at Risk of Getting Repealed of Defunded?
As much as some would like to think so, it’s nearly impossible at this point. The U.S. House of Representatives has voted 42 times to dismantle the law, but hasn’t succeeded once. The money designated to fund Obamacare’s most important provisions has been appropriated and can’t be removed unless the law is totally repealed.
Why is it Called Obamacare?
Technically known as the Affordable Care Act, fighting for healthcare reform Obama pushed for its passage. Republicans began using the term as an insult however Obama simply embraced the term. Interestingly, much of the bill is based on reform designed and implemented by a former Republican governor, whose innovation was widely celebrated by the GOP and in an effort to present bi-partisan reform includes many principles written by the Republican Party.
How Will the Government Help Pay for Health Insurance? What are Subsidies?
On January 1, 2014 every single American will be expected to have a current health insurance plan.
Believe it or not, the government does understand that the main reason so many people don’t currently have health insurance is because they can’t afford it, and that having to come up with a monthly insurance premium could be more than your budget can handle, especially if an unexpected expense comes up. Subsidies have been created which could ease your burden and make it possible to be properly insured.
Subsidies are tax credits, based on your income, to help cover the costs of health insurance. Subsidies are offered to:
- People who live in the U.S.
- Are U.S. citizens, U.S. nationals, or lawfully present in the U.S.
- Are not currently incarcerated.
If you meet these requirements and your total household income is between 100 -400% of the Federal Poverty Level (FPL), you will most likely be eligible to receive a tax credit/subsidy to reduce the cost of your health insurance. These subsidies are set on a sliding scale so that your contributions to the monthly premiums will be limited to a defined percentage of your income.
Do I Need to Be On the Same Plan as My Spouse?
No, there is no requirement that states that you and your spouse must be on the same plan. However, if you want to qualify for the most beneficial (i.e. highest cost savings) tax credits/subsidies, be aware that they are based off of the total household income. So even if you are on a different plan than your spouse, their income will be calculated when figuring out the subsidy for which you are eligible.
How Do Gay Couples Factor into Obamacare?
The law itself mandates that insurance companies can’t discriminate against gay couples. So, if you are already on or are signing up for a private insurance plan and you want to get coverage for your same-sex partner, you can – just as long as your plan includes some form of spousal benefits. Thanks to the Supreme Court’s decision earlier this year to strike down the Defense of Marriage Act; the government now recognizes same-sex couples for federal benefits. That means if you and your same-sex partner are in a state that recognizes your marriage, you’ll be able to apply for Obamacare as a family unit.
Can My Application Be Declined?
Beginning January 1, 2014 insurance companies cannot decline your application for health related reasons including pre-existing medical conditions. In the past, pre-existing conditions meant that it would be nearly impossible to get health insurance. It never seemed to matter how minor the condition was, or how much time had passed since the last time the individual had been effected, most insurance companies refused to cover it, or if they did provide coverage, the policy was so expensive few people could afford it.
Obamacare eliminates all of that nonsense. No matter what type of health problems you might have experienced in the past, the insurance company MUST provide coverage. Starting in 2014, American health insurance companies will no longer be able to use pre-existing conditions as an excuse for:
- Charging higher rates
- Refusal to provide coverage
- Partial exclusion from coverage
What if I Make Too Much Money to Qualify for a Tax Credit/Subsidy?
People earning more than 400% of the federal Poverty Level who have no employer-based coverage will still be required to purchase coverage on their own, though they won’t be eligible to receive subsidies. At Free Health Insurance HelpTM we offer many plans and options unique to your needs. Health insurance rates will still be filed with and regulated by the California Department of Insurance. Whether you buy from Free Health Insurance HelpTM, a large impersonal agency, or directly from the health insurance company, you’ll pay the same monthly premium for the same plan. So why not use our knowledge and services where we can personally help you with whatever you need?
Are Dental or Vision Insurance Plans Affected by the New Law?
Unfortunately, there is no dental coverage as part of Obamacare, unless you qualify for Medicaid.
Which Medical Services are FREE with Obamacare?
Even if you buy the lowest-cost plan—the one that only kicks in if you have some sort of medical catastrophe—you’ll still get these freebies (that means no co-pay either):
• Blood pressure screening
• Depression screening
• Obesity counseling and screening
• STD (sexually transmitted disease) prevention counseling for adults at increased risk
• Smoking-cessation interventions, including counseling and medication
• Some vaccines (some are included if you missed your teenage booster) including: an annual flu shot; human papillomavirus (HPV, which can protect against certain cancers); measles/mumps/Rubella (MMR); a vaccine against a type of meningitis; chicken pox; and tetanus/diphtheria/pertussis, or whooping cough, which has made a comeback in some states
• Birth control for women (under most plans; doesn’t include all brands, though)
• Breastfeeding counseling and supplies
• Domestic Violence screening and counseling
It is also now illegal for health insurance policies to put limits on how much they’ll pay for your medical bills.