The Patient Protection and Affordable Care Act, commonly referred to as Obamacare, has officially opened for enrollment. Coverage will begin in January 2014, and open enrollment will continue until March 31st.
Even though Obamacare has been a buzzword for most of the Obama administration, there are still many people in the dark about what exactly Obamacare is — and what it means to their personal insurance needs.
While I’m by no means an expert in the policy, here are a few facts that may help you decide whether you need to enroll in this historic government-provided insurance makeover.
Reasons You May Not Need Obamacare:
- You’re already sufficiently insured by your employer
- You’re already enrolled in Medicaid, Medicare, or another government-funded insurance program
- You’re a member of a religious organization that rejects health insurance as a part of their core beliefs
The main objective of Obamacare, whether you agree with it or not, is to provide health insurance for the 57 million Americans who are currently uninsured. If you’re employed, chances are you’re already enrolled in your employer’s insurance program. If you’re happy with your coverage, there’s no need to do anything, and you won’t be penalized for not enrolling.
Medicaid, Medicare, and other government programs that require specific qualifications are already designed to provide affordable healthcare to lower income individuals, elderly, veterans, etc.
And, as some are exempt from certain taxes due to their religious beliefs, those who reject Obamacare as part of their rejection of all insurance won’t be penalized.
Reasons You Should Enroll in Obamacare:
- Your current insurance is too expensive
- You’re uninsured and want affordable healthcare
- You have a pre-existing condition that makes it difficult to find coverage
- You don’t want to be penalized
While you may currently have insurance coverage through your employer, it’s recommended that you switch to Obamacare if the cost to cover one individual through your employer’s plan is more than 9.5% of your income. This is because comparable coverage through most state exchanges would most likely be less than that, and you could also qualify for subsidies.
If you’re uninsured either because your employer doesn’t offer insurance, or because you’ve opted out due to high cost, Obamacare is a good option. There are four levels of coverage: bronze, silver, gold, and platinum. Each level has a higher premium and corresponding higher coverage percentage.
While the rates are based on where you live, your age, your health, and what subsidies (government tax credits) you qualify for, coverage is significantly more affordable than many traditional healthcare plans.
The subsidies offered are one of the main reasons Obamacare is cheaper than other plans. Although they’re essentially tax credits on income you’re spending on healthcare, participants have the option to apply the subsidies to their monthly premiums instead of receiving it in one lump sum.
In the past, many insurance companies haven’t provided coverage for what are deemed “pre-existing conditions.” While there are legitimate reasons that insurers have these policies, it makes getting affordable coverage nearly impossible for people in these categories. Under Obamacare, insurance providers that are in the state exchanges will be required to provide equal coverage and standard premiums for those with pre-existing conditions.
The last point is perhaps one of the most important. If you’re not insured and choose not to enroll in Obamacare, you’ll be penalized when you file your taxes. While the per-person penalty for 2014 is relatively low (1% of your income, plus a fee per uninsured child), fees are slated to rise to 2.5% of your income by 2016. Ouch! This is one of the main points protested by those who oppose Obamacare.
But whether or not you support it, it’s the law starting in January 2014. Even if you’re not crazy about Obamacare, you’ll be paying for it either way. Why not be paying for insurance instead of throwing money away?
Are you going to enroll in Obamacare?
{ read the comments below or add one }
I been trying to enroll in the Federal Employee Health Benefits. But it did not go through.
I found out the hard way, the truth of the 9.5% rule. If any person eligible for insurance coverage under an employer’s plan has a premium that falls under 9.5%, then you DO NOT qualify for subsidies. This means, if the premium for my husband on the employer’s plan is $1 but it’s $1000 to put me and my daughter on the plan, then we are out of luck. THIS IS HUGE! How many people can afford that kind of monthly premium? And all insurance premiums have gone up to compensate for the new coverage requirements! So, the average family cannot qualify for subsidies but is stuck with outrageous health insurance premiums!
Although it is true that the kinds of illnesses described in the comments are diseases that strike untimely and unexpected, it is not generally true that “one does not choose to get sick” in the United States. For what sets the US apart from virtually the rest of the world is precisely that: the high incidence of preventable diseases arising as a consequence of lifestyle and dietary habits.
Those of you who get struck down by the diseases that may be truly called “acts of God” are caught in the cross-fire of all this. You were the ones the concept of “insurance” was meant for. Insurance is meant to be a small premium we all pay to protect against the risk we all have in being struck down.
But what “insurance” means in the United States is something quite different: “the bankrolling of the costs of ill consequences of the lifestyle of a population that is amongst the most sedentary and obese in the world.” I cannot in good conscience be part of any system that would ask me to bankroll the medical consequences peoples’ choice to remain sedentary and engage in habits that make them obese — not even if that means being caught in the cross-fire too.
If they get out of their cars and learn how to talk (like the rest of the world), stop smoking, stop overeating, then we can talk about sharing the responsibility for risks. But until then, the bets are off. Those who engage in these behaviors and expect the rest of us to share in the costs of their strokes, heart attacks, etc., are the true “free riders” and “freeloaders” here.
I have MS since I am 19 years old and I always dreamed of moving to usa. So my husband (American) and I (French) did it with our 2 years old daughter. And I realized how much of a hard life you have to compare us. You are strong person and a good exemple to us all. But I think that you should have a minimum of help for healthcare cause you don’t choose to be sick. End up bankrupt with medical bills is a shame in 2013.
Obamacare in the long-term mean much to the American health. It costs a little more in taxes, but it pays off in the long run.
In which alternate universe will this pay off? For many families, they will have to pay their monthly premium, let’s $1000. Then they will pay their deductible of maybe $6300, so if one member gets sick, it is $18000+ from their budget in one year before insurance kicks in. That is cheap compared to financial ruin but it is likely considerably more than they were paying before they were required to have coverage for “maternity care (which may or may not be applicable) and “mental health coverage” again, maybe you want this, and “drug rehabilitation”, I guess a lot of people have drug problems. You will have Rx coverage but the deductible is about $200 so only those getting some serious drugs will reduce their costs.
Thank God I have health insurance through an employer and from what I understand our cost remains the same. I am hearing terrible things on costs for families.
I would not go fishing on the health exchange sites, though, because your info is being shared and you will have been netted. It feels terrible this happening here in the US.
Levi, I feel badly for those that cannot get insurance due to pre existing conditions. It’s so stupid. Any of us could be hit by a bus tomorrow and need trauma care but your condition is manageable and that’s not factored. I watched a sad CSPAN presentation about being being treated for cancer being cut off when they began to cost a lot. I personally feel the gov’t should have dealt with that problem specifically instead of remaking the entire system. Now it’s hugely expensive and fewer people will opt in for care at all. Oy.
There is another way to not participate in Obamacare.
There is a type of mutual aid society explicitly exempted in the PPACA. They happen to be faith based, and the organizations must have existed since before 2000. One is called Medi-share, and another is thehealthcoop.com (which has Samaritan Ministries and member benefits wrapped together).
We joined TheHealthCoop.com and have been very pleased with the cost and the personalized approach.
Thanks for the alert of this type of health care arrangement. We need to rethink our health care options next year since our current plan is no longer going to be offered and this is a possible route for us.
Levi, you make a good point. I think people need understand, though, is that the reason you could not get insurance on your own is because of government interference. The reason prices were so high BEFORE Obamacare were government mandates and other government intrusions into healthcare. They rocked the boat, and then later they act like they are the only one who can save you.
This is why I vote libertarian.
People seem to really hate Obamacare, and I agree it has a lot of faults. One thing I am really glad they are addressing is the pre-existing conditions problems. Because I have type 1 diabetes and have since I was a child, I can’t get health insurance on my own and so I must work with a employer who can provide it. I would like the chance to be a freelancer but can’t because I need the health insurance to survive. My medicine is way to expensive to buy on my own, and because of my condition I’m unable to get health insurance. I want to start my own business and this will give me the ability and freedom to do so.
Maybe it’s not all bad, then.
Levi, you may still be stuck unless of course you don’t intend to make any money in your solo venture. I am self-employed so have been buying my own policy, the premium will increase under the ACA. I already opted for a high deductible to keep my premium manageable, that too will now be higher. Essentially those who qualify for subsidies will do so at the expense of those whom the government perceives as having enough money to support another policy or two, they will pay little or nothing. Then there is the deductible which must be paid before insurance actually pays for anything other than a well visit (which is about $150 for a self-pay). So, as it stands I will have paid $8500 before my insurance pays anything. With the ACA I will have paid $11150 before insurance kicks in- that means every year I don’t use insurance, I give away nearly $12000k. The subsidized guy likely doesn’t pay the deductible either so he gets 100% coverage and I cannot afford to get sick or hurt and I am still out a minimum of $4800 each year. Actually more if I get any prescriptions. If I could work more to make up the gouge in my existing budget, it will be taxed – so my standard of living has essentially been diminished – it is called socialism.
Just know that each letter and number and personal piece of information you enter into the exchange is being sent simultaneously to the IRS. Want the IRS knowing TMI about you? Then, go ahead, enter away. Or perhaps you like being bribed by Obamacare by accepting the subsidies, just to get that personal information out of you.
Alternate: you can find an independent broker to sell you the same exact policy Obamacare will sell you, at the same exact price BUT without spilling out your guts and revealing every damn thing about you there is to know.
Just sayin’
Alicia: Thank you for that information. I am extremely concerned about the IRS now sticking their noses into our healthcare and am very wary of going on the Obama website to enroll. Knowing that I can use an independent agent is a great relief
But I thought the only way a person could receive a subsidy to buy the insurance was by enrolling in Obamacare in some way.
Whether you enroll on the website or thru an individual at an insurance company (and that person is going to have all of your income info, too), the info required is going to be the same, if you need a subsidy to buy the insurance. Just mho, but I feel more anonymous and private going thru the website than giving all my enrollment info to the local insurance broker.
If you don’t need the government money to buy your insurance, then of course there’s no need to enroll. But the insurance agent will enroll you and ask all the same income questions, is my understanding. And the IRS will become involved when you file your 2014 tax return in 2015, if you have mis-estimated your 2014 income whether it’s on the website or with the insurance agent.
#4 You’re a member of a free society called America and you are already overtaxed to the point that it may be better just to stay home, not work, and get “free” benefits.
#5 You love communism and oppressive governments who force people to buy stuff.