Here’s the story, morning glory:
- If you don’t have insurance and you want it, you can search for plans through an online database called the Health Insurance Marketplace. The Marketplace allows you to compare insurance options based on premium price, co-payments, benefits, etc. The application process also includes steps that will let you know if you’re eligible for tax credits, Medicaid, or other refunds and subsidies. Some states have their own intermediary Marketplaces (Massachusetts has Health Connector; Oregon has Cover Oregon, etc.) and others work through the HealthCare.gov website. You can only buy insurance or change your provider during a certain time span — this year, “open season” is from October 1st through March 31st to allow everyone to get used to the system. In the future it will be October 15th through December 7th. New plans go into effect on January 1st (if you sign up after December 15th, your plan will go into effect February 1st; after January 15th means March 1st, etc.) You can also buy a plan that isn’t on the exchange, but you will probably not get a subsidy.
- If you already have individual or small-group health insurance, your plan will probably be upgraded in order to include new protections that were recently made mandatory by the ACA and the Secretary for Health and Human Services. This is pretty good, because all insurance now includes these super basic protections — a provider can no longer drop you if you get sick, deny you because of a pre-existing condition, or charge you more for being a woman (they can still charge you more for smoking, though). The downside is that some providers had cancelled their services rather than upgrade them; in response, the Obama administration decided to allow these providers to keep their existing protections and hold off on upgrading at least until next year. If you’re someone whose insurance was cancelled and then reinstated, you might want to check out your Marketplace options anyway — you may be able to save money, plus be ensured these basic protections.
- If you already have insurance through your job, Medicare, or the Veteran’s Association, you don’t have to do anything, although if you’re covered through your job, it’s possible that your company will change your benefits or costs. If you decide you want to shop for an individual plan on the exchange instead, you’re free to do so, but will probably not be eligible for any subsidies. If you are a federal worker, you will continue to be eligible for health care through the Federal Employees Health Benefits Program, unless you are a Congressperson or Congressional aide, in which case you will need to buy a new plan.
- If you’re under 26, you can stay on your parents’ plan, even if you pay all your own bills and have your own cat and are several UHauls into your independent life. You can also choose coverage from your employer, if they offer it, or shop for your own plan — although if your parents claim you as a dependent, you may not be eligible for as many subsidies. If you’re a student, insurance provided by your college or university counts.
- If you’re under 30, you can choose to buy a “catastrophic plan.” These plans have very low premiums and only cover basics (three annual primary care visits and preventative services). Once you meet a $6400 deductible, the plan expands to provide “safety net” coverage in case of accident or serious illness.
- If you are eligible for Medicaid, you still will be. And if you weren’t, you might be now, because Medicaid coverage will expand in some states. Currently, certain low-income people, families, pregnant women, elderly people, and disabled people qualify for Medicaid. Starting in 2014, twenty-five states (including New York, New Mexico, and Oregon) will change their rules so that more people qualify. They will expand their programs to cover families with incomes up to 133% of the federal poverty level (~$15,800 for one person or $32,500 for a family of four). The other half of the states (including Maine, Pennsylvania, and Texas) have opted out of the Medicaid expansion, after a Supreme Court decision ruled such expansion voluntary. You can check how things work in your state — and whether you are or will be eligible for Medicaid — at this website.
- If you don’t have insurance and you don’t want to or cannot buy a plan, you’ll be required to pay a penalty. In 2014, this penalty is equivalent to either 1% of your taxable income, or a flat rate of $95 per adult plus $47.50 per dependent child, whichever is greater. You’ll be required to pay it when you pay your 2014 taxes. This penalty will increase substantially in future years, more than doubling in 2015, and then nearly doubling again in 2016.
- You will not be penalized for being uninsured if:
- You are uninsured for less than three consecutive months (with some exceptions).
- Your income is small enough that you don’t have to file a tax return (the limit is slightly under $10,000 per year).
- The cost of a premium would be greater than 8% of your household income.
- You are eligible for Medicaid under the new, expanded rules, but your state has chosen not to adopt those rules.
- You get health coverage through the Indian Health Service.
- You live abroad for over 330 days out of the year.
- You are undocumented. Undocumented immigrants cannot buy plans on the exchanges.
- You are incarcerated.
- You are a member of a “health care sharing ministry” (basically a group of people with common religious or ethical beliefs who have agreed on which procedures to cover and then share health care bills, co-op style).
- Even though it went into effect in 2010, it’s worth mentioning that The Affordable Care Act also permanently reauthorizes the Indian Health Care Improvement Act, which gives over federal resources to provide and improve health care for American Indians and Alaskan Natives.
If you have further questions, NPR’s “The Affordable Care Act, Explained” series is very helpful, and has individual articles for everyone from young adults to retirees. The official site — or at least the FAQ section — isn’t as bad as advertised, either.
