by Cara and Rachel

There’s been so much discussion about the battle to get the Affordable Care Act passed you may have let your focus slip from what the ACA is actually for — trying to make it easier for people (like you!) to access healthcare. The ACA, aka “Obamacare,” isn’t a health care plan in itself — it’s a set of laws that requires almost every citizen to have a health plan (or pay a penalty), and standardizes the process for getting one. It also sets minimum standards for those health plans, offers subsidies that will help a lot of people better afford insurance, and changes some eligibility requirements for federally funded programs like Medicaid. As the deadline for January coverage approaches (it’s December 23rd!), here’s a guide to what the ACA actually means for you, and what you have to do to get in on it. First, let’s quickly run through some of the questions you might have.

I don’t have health insurance. Can I just keep not having  health insurance?

Probably not. There are a few situations in which you aren’t required to have insurance, but part of the ACA is that everyone is supposed to have to have insurance for real now. Or, more accurately, you don’t have to have it, but you’ll have to pay a penalty if you don’t, so.

I do have health insurance. Do I have to change anything about it or switch to Obamacare?

If you already have insurance, you’re probably good to go! It’s worth checking out whether anything about your situation has changed — if the plan you already have has been updated, whether Obamacare might be cheaper for you, whether you might be newly eligible for Medicaid — but there’s no requirement to have Obamacare specifically, just health insurance, any health insurance.

I’m still on my parent’s insurance because I’m young enough to qualify. Can I stay on it?

Sure! You’re golden.

I’m turning 26 and won’t be able to stay on my parents’ plan soon. Should I opt for workplace/school insurance or Obamacare? Which will be cheaper/provide better coverage?

Good question! The answer is gonna vary. You’ll need to go to the Health Insurance Marketplace to figure out what options are available to you through the ACA and how those stack up against your other choices. The good news is that the ACA has set new standards for what ALL health plans are required to provide, so it’s possible that if your options for coverage were underwhelming before, they may now be beefed up a little in terms of what they’ll cover. Obamacare does have built into its infrastructure that it tries to provide subsidized plans for people, whereas your employer probably doesn’t, so there’s that.

How much does Obamacare cost?

This is complicated because “Obamacare” isn’t one singular plan; it’s more of a way to encourage and assist people in accessing a variety of different insurance plans.  So there’s not one simple answer to this. For many people, Obamacare will be cheaper than other options; for some people, that won’t be the case.

I live in one of the states that opted out of the exchange. Does that mean I can’t get Obamacare?

Nope! You can still sign up for it! Things in your state are gonna be different, though, especially as relates to Medicaid. We’re gonna talk about this more later on, so keep reading.

I keep hearing about Obamacare and abortions and birth control. I don’t really know why. Does Obamacare cover abortions?

Again, this is gonna vary, because Obamacare isn’t one thing but a gateway to many things. You could say it’s one ring to rule them all.  (One NuvaRing? I’m sorry.) Obamacare does require all plans to cover preventative care, so birth control, implantable birth control devices, Plan B and more are definitely covered. But Obamacare doesn’t require plans to cover abortion.

I’m trans*. Does Obamacare change anything about healthcare for me?

Possibly! One thing the ACA has done is codify Title VII federal nondiscrimination protections into healthcare, which should ban discrimination based on gender identity and require that your physician treat you with the same respect, dignity and quality of care as a cis patient. (This should also apply to places like rape crisis centers, drug rehab programs, and veterans health centers!) The ACA has also secured funding for cultural competency trainings for healthcare professionals, which means there’s a greater chance your doctor will have a clue about your specific health concerns and experiences.  However, the ACA doesn’t require that plans meet any level of coverage for transition-related healthcare, and so it’s still possible for insurance plans to refuse to cover transition-related expenses. For more information, check this out.

Does the Obamacare website even work? Can I use it now?

Yeah, more or less. I mean, it’s not like we have the option to sign up for Obamacare via carrier pigeon or trained capuchin monkey, so you might as well try it. Good luck.

Ok, but how do I actually do all of this stuff? How do I find out if I’m one of the people exempt from the insurance requirement? Do I qualify for Medicaid now? I’m confused. Hold my hand.

YOU ARE IN LUCK. We will now explain all of these things in even greater detail. Check out the next page!

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.

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