With just over a week until the March 31 deadline to sign up for health insurance, supporters of the health care bill, from President Barack Obama on down, are engaged in a full force campaign to enroll eligible Americans, especially younger ones who tend to be healthier and less expensive to insure. But the landmark law still faces opposition from Republicans and a public that remains skeptical that the law can improve health coverage and lower its cost.
The law has already modified the health care industry and established a series of benefits for the consumer. it also has broad ramifications for state officials, employers, hospitals, and physicians.
after the failed Oct. 1 of online marketplaces, or exchanges, federal officials now say that healthcare.gov works for the “vast majority of users.” On March 17, the Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner announced that exchange enrollment had reached 5 million.
but some problems persist. for example, many of the site’s “back-end” features, which give insurers more information about enrollment and tell the government whether members have paid their premiums, are still under development.
Here’s an introduction to how the law might affect you.
I don’t have health insurance. By law, will I have to buy it and what happens if I don’t?
You have until March 31 to sign up for health insurance before you are subject to the law’s tax penalty for not having coverage. administration officials have said they will not extend this deadline.
For individuals, this year’s penalty is the greater of $95 or up to 1 percent of the portion of the individual’s modified adjusted gross income that exceeds $10,150, which is the level that requires you to file a tax return. taxes. That increases to $695, or 2.5 percent of income, for 2016. For families this year, the penalty is $285, or 1 percent of the portion of modified adjusted gross income above $20,300. that will grow in 2016 to $2,085 or 2.5 percent of household income, whichever is greater.
The requirement to have coverage can be waived for a variety of reasons, including financial hardship or religious belief. Also on the list are people in the individual insurance market whose plans were cancelled. Under the law’s “hardship exemption,” these consumers are also eligible to purchase “catastrophic” coverage policies, which have lower premiums and higher deductibles than other plans that comply with the law.
Federal officials also announced that people with plans in the individual market that haven’t yet met the requirements of the health law could keep those policies for another two years if their states allow it and insurers continue to offer the plans.
If you have an income that would make you eligible for Medicaid under the provisions of the health law, but your state has chosen not to expand its Medicaid program, you generally cannot qualify for a subsidy to purchase coverage. however, you are also exempt from the penalties for not having insurance.
What if computer problems with the federal or state exchange prevent me from purchasing health insurance? Do I still have to buy coverage before March 31?
yes. If computer crashes prevented you from enrolling, you may receive coverage retroactive to January. 1 or the 2014 date you originally applied, as well as retroactive premium tax credits and cost-sharing subsidies, in accordance with previously published administrative guidance.
Also, if you stopped trying to buy a plan due to technical issues and bought one off the exchange instead, you may be able to switch to a plan on the Marketplace and qualify for retroactive subsidies.
If you’re still having trouble, consumer advocates suggest you try meeting with one of the law enforcement navigators or assistants for practical help. You can also contact an insurance agent or broker who can help you with the application process, or call healthcare.gov at 800-318-2596 for assistance.
I get my health coverage at work and want to keep my current plan. will i be able to do that? How will my plan be affected by the health law?
if you get insurance through your job, chances are you still will. But, just like before the law was passed, your employer is not required to keep your current plan and can change premiums, deductibles, copays, and in-network coverage.
The law has already made several changes to employer-sponsored insurance. for example, plans now generally prohibit lifetime coverage limits and include a guarantee that an adult child up to age 26 can stay on her parent’s health plan. More than 3 million young adults have been able to stay on their parents’ plan thanks to this provision, according to administration figures.
What other parts of the law are in effect now?
Insurers can no longer deny you coverage or charge you more based on a pre-existing medical condition. they also cannot impose annual limits on medical coverage for essential health benefits, which include prescription drugs and hospitalization.
You may be eligible for some preventive services, like breast cancer screenings and cholesterol tests, with no out-of-pocket costs.
Health plans cannot cancel your coverage if you get sick, a practice known as “rescission,” unless you committed fraud when you applied for coverage.
Insurers are required to provide refunds to consumers if companies spend less than 80 to 85 percent of premiums on health care. According to the White House, in 2013 about 8.5 million affiliates would receive refunds with an average of $100 per family. Earlier this month, the administration said it will temporarily allow a higher proportion of premiums to be spent on administrative costs in an effort to compensate insurers for the extra work they faced when failures in federal and state health exchanges caused registration problems.
Some plans that were in effect when the law was passed and have not changed significantly do not have to comply with certain parts of the law. for example, these “exempt” plans can still charge beneficiaries part of the cost of preventive services.
Most plans are expected to change over time and lose grandfathered status.
I want health insurance but I can’t afford it. What am I going to do?
Depending on your income, you may be eligible for Medicaid. Before the health law, in most states, non-elderly adults with no minor children did not qualify for Medicaid. But now, the federal government is offering to pay the cost of an expansion in programs so that anyone with income at or below 138 percent of the federal poverty level (about $16,105 for an individual or $32,913 for a family of four ). under current guidelines) will be eligible for Medicaid.
However, the Supreme Court ruled in June 2012 that states cannot be forced to make that change. So far, 25 states and the District of Columbia have chosen to expand Medicaid.
What if I make too much money for Medicaid but still can’t buy insurance?
You may be eligible for government subsidies to help pay for private insurance sold in state insurance marketplaces.
These premium subsidies will be available to individuals and families with incomes between 100% and 400% of the poverty level, or about $11,490 to $45,960 for individuals and $23,550 to $94,200 for a family of four (according to current guidelines).
Subsidies are tied to the federal poverty level and are most generous to those who earn the least amount of money. they also require people to spend a certain amount of their income before the subsidies kick in.
For example, those earning between the poverty level and twice as much, or up to about $23,000 for an individual and $39,000 for a family of three, have to pay between 2 and 6 percent of their income for the premium before the subsidy begins. People earning two or three times the poverty rate (up to about $34,500 for an individual or $56,000 for a family of three) must pay up to 8% of the premium cost before the subsidy begins.
Will it be easier for me to get coverage even if I have health problems?
Insurers are now prohibited from rejecting applicants based on health status.
I have a small business. Will I have to buy health insurance for my workers?
No employer is required to provide insurance. but starting in 2016 – two years behind the previous date in 2014 – companies with 50 to 99 employees that do not provide health coverage and have at least one full-time worker who receives subsidized coverage in the insurance exchange health has to pay a rate of $2,000 per full-time employee. the first 30 workers of the company would be excluded from the rate. Also, starting next year, employers with 100 or more employees will be required to offer insurance to 70 percent of workers instead of 95 percent as previously required by law. they will have to cover 95 percent of workers starting in 2016.
However, companies with fewer than 50 people will not face any penalties.
Also, if you own a small business and buy insurance through the health marketplace, the health law offers a tax credit to help cover the cost. Employers with fewer than 25 full-time workers earning an average annual salary of $50,000 or less may qualify. Employers must pay at least 50 percent of their full-time employee’s premium costs to get the credit.