HEALTH INSURANCE, MEDICAID AND MEDICARE
This article tells you about the Affordable Care Act, also known as “Obamacare.” It tells you how to enroll, when, and the enrollment costs.
The Affordable Care Act (ACA)
The Affordable Care Act (ACA) is a federal law that helps uninsured people get low-cost health insurance. This affects how much you will pay for insurance and the quality of health insurance offered by private insurance companies in the health insurance market.
Higher standards for insurance companies.
Health insurance companies must:
- insure people who have pre-existing medical conditions,
- cover basic medical benefits,
- offer preventive health care at no cost and
- allow children under 26 years of age to remain on their parents’ health insurance plan.
Insurance costs.
Under the ACA, the cost of your health insurance premium is based on your income, not what the insurance company wants to charge. Most people who sign up under the ACA qualify for tax credits that lower the cost of their insurance premiums. Cost-sharing subsidies lower out-of-pocket costs for Silver plans purchased through the Health Insurance Marketplace. If you don’t qualify for these, you may qualify for Medicaid.
Types of plans
- Bronze – Lowest cost plan. 60% of medical costs paid by the insurance company; you pay the remaining 40%.
- Silver: 70% of medical costs paid by the insurance company; you pay the remaining 30%.
- Gold: 80% of medical costs paid by the insurance company; you pay the remaining 20%.
- Platinum: the most expensive plan. 90% of medical costs are paid by the insurance company, you pay 10%.
Do I have to sign up?
Yes, unless you already have health insurance through Medicaid, Medicare, your job, or an individual insurance plan. Some people who are uninsured are still exempt from the ACA. These include those whose income is below the threshold for filing a federal income tax return or if enrollment would cause undue financial hardship; people who qualify for religious exemptions; people who are in jail or prison and Native Americans who are members of tribes.
What happens if I don’t sign up?
You will still be responsible for paying 100% of your medical expenses AND you will be charged a penalty when you file your income tax return. The amount of the penalty depends on your income and increases each year you remain uninsured.
What happens if I don’t pay the fee?
Unpaid installments will be carried over to the next fiscal year, with interest charges. The IRS may also deduct the fee from your income tax refund. But the IRS cannot withhold your wages to collect the fee.
How do I sign up?
Enrollment is through the Health Insurance Marketplace during the open enrollment period. You can enroll online or through a paper application by going to https://www.healthcare.gov/ or by calling 800-318-2596. In Central Texas, Insure Central Texas provides one-on-one help with enrollment at various walk-in sites.
When can I sign up?
“Open enrollment” is for a specific period of time that varies from year to year. It normally starts during the fall and closes at the beginning of the following year. If you don’t enroll during the open enrollment period, you’ll have to wait until the next enrollment period. You may qualify for Special Enrollment (outside of the enrollment period) if you have experienced a “significant life event” such as marriage, the birth of a child, or the loss of your current insurance.
