Obamacare and You 

The deadline for securing health insurance as required under the Affordable Care Act – often called Obamacare -- is this Sunday, February 15.

Are you and your family covered yet?

Most likely, the answer is yes. But if you haven’t figured out your health insurance for this year, it’s definitely time to take action. Check out the good information you’ll find at getcoveredillinois.gov, the official website for our state’s insurance exchange. The site has frequently-asked questions and resources to guide you through the process.

Act quickly, though: if you miss Sunday’s deadline, you will be required to pay a fine of $325 or 1% of your income over the tax filing threshold, whichever is greater.

Even if you’re already covered, there are things you should know about the new law. Below is a quick summary to read and share with anyone you know who may have questions.

 

What all of us need to know about Obamacare

• Signed into law by President Obama in March 2010, the ACA’s intent is to give all Americans access to health care. 

• Until now, an estimated 47 million of us did not have health coverage – including many who were uninsurable due to preexisting conditions and other issues. 

• The law is designed to end insurance abuse, reduce health care spending and make health care more affordable for all. 

• ACA achieves its aim by requiring all of us to carry coverage, penalizing those who don’t comply and imposing new taxes to raise revenues to support the program.

The health care reform timeline

From 2010 to 2014, the following regulations became law:

• Small employers can get a tax credit for providing medical insurance.

• Employer health plans are allowed to extend coverage for children up to age 27.

• Indoor tanning services now pay a 10% excise tax on services performed.

• A tax of 2.3% is imposed on the seller, manufacturer or importer of any medical device.

• Health insurance providers must now pay an excise tax. 

• Over-the-counter medicines are no longer reimbursed via flexible health care (FSA) spending plans.

• Annual FSA contributions are now capped at $2,500.

• Distributions from health care spending accounts (HSAs) or medical spending accounts (MSAs) that do not comply with ACA requirements carry a 20% penalty.

• High-earning taxpayers must pay an additional Medicare tax of .9%.

• High-income taxpayers also pay a surtax of 3.8% on unearned income.

• The threshold for deducting medical expenses increased to 10% for those under 65.

In 2015, large employers who do not offer health insurance will pay penalties. Americans who do not have health insurance will pay either $325 or 2% of their income over the tax filing threshold, whichever is greater. Penalties will increase to $675 or 2.5% of income in 2016.

The minimum coverage you must carry

All U.S. citizens and residents must have health insurance that covers at least these 10 essential benefits:

1. Ambulatory (outpatient) patient services

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

5. Mental health and substance use disorder services

6. Prescription drugs

7. Rehabilitative services and devices

8. Lab services

9. Preventive and wellness services and chronic disease management

10. Pediatric services

Workplace or marketplace?

As of January 1, employers with 50 or more full-time employees are required to provide health coverage to their full-time staff or pay a tax penalty. As a result, you may be among the millions who have access to an employer-sponsored plan. You will probably see few changes in your coverage as a result of the new law.

If you are not eligible for coverage at work, you will need to find it on your own through the Illinois marketplace exchange. Key facts to keep in mind:

• Marketplace plans cannot discriminate on the basis of pre-existing medical conditions, gender, family history or occupation.  

• Plans are priced using only two criteria: age and tobacco use. The Affordable Care Act allows health insurers to charge smokers buying individual policies up to 50% more. The law also allows the states to limit or change the smoking penalty.

There are 5 categories of plans available through the exchange:

• Platinum: Covers 90% of average health care costs

• Gold: Covers over 80% of average costs

• Silver: Covers 70% of average costs

• Bronze: Covers 60% of average costs

• Catastrophic: Low-cost coverage available only for those 30 or younger

Getting covered – and help for those who need it

To register in the marketplace, you will need the birthdates and Social Security numbers for yourself and other family members listed on your tax return. You will also need to know information about your income, so having a copy of your tax return handy would be a good idea.

Premium Assistance Credits are available for those who qualify based on income. In 2014, credits are available for single‐person families earning less than $11,670, 2‐person families earning less than $15,730, and 4‐person families with less than $23,850 in income.

When to shop the marketplace, even if you’re covered at work

• Are you young and healthy? If you’re under 30, you can buy a low-cost catastrophic policy, which may even be less than the rates offered by your employer.

• If you’re an early retiree paying COBRA premiums, you may find the marketplace will give you a lower rate.

• Do you have your own private health insurance, purchased before the law took effect? You can keep it, but you may find lower rates through the exchange.

Need more help? Here’s where to find it

Simple, easy-to-read explanations of the Affordable Care Act can be found at healthcare.gov. Online help is available 24/7 with a chat function.

Questions can also be answered at any time by calling 1-800-318- 2596.

The Kaiser Family Foundation (kff.org) has done extensive research on Obamacare. Their easy-to-use subsidy calculator tool can help you figure out how much premium assistance may be available to you.

Local health centers across the U.S. have received $150 million in grants to help with health care applications. If you need to enroll but are having difficulties, visit getcoveredillinois.gov to find the help center nearest you.