It’s been all over the news, heavily debated, highly controversial, beset by setbacks, opposed and applauded by many.  Yet many Americans are still confused about Obamacare and how it applies to them—and not without good reason. Health insurance coverage options, laws, and regulations can be perplexing. Still, the Affordable Care Act affects all of us, so it’s important to understand some key components. In this blog, HealthMarkets reviews the top 5 things you need to know about Obamacare so you can solve the health insurance puzzle.

We’ve got a lot of labels for it: “The Healthcare Law,” “Obamacare,” “The Patient Protection and Affordable Care Act,” the “ACA,” and simply “The Affordable Care Act” to name a few. The sheer amount of names we have for it alone is enough to confuse some people (to quite hilarious effect).

It was created to give more Americans access to quality health care through the regulation of health insurance. It was signed into law by President Obama in 2010, and some of its provisions may continue to come into effect through 2022. The law includes:

  • An Individual Mandate that requires most of us to have minimum essential health coverage or face a tax penalty
  • Subsidies to assist low-income Americans with purchasing coverage
  • Limits on when you can and cannot purchase health insurance
  • A guaranteed-issue provision, meaning you cannot be denied health insurance for pre-existing conditions.

So what are the top 5 things you need to know about the Affordable Care Act?

1. HealthMarkets Reviews: The Individual Mandate

The requirement to have minimum essential coverage began in 2014 under The Affordable Care Act. Unless exempt, those who do not buy health insurance, and are not covered by Medicaid, CHIP, or Medicare, must either:

  • Buy private health insurance on or off the Exchange
  • Obtain workplace health insurance
  • Pay a penalty tax for not having minimum essential coverage, and pay for all the costs of your medical care on your own.

2. HealthMarkets Reviews: The Tax Penalty

CostofNoInsurance_infographic_Aug2014-011.jpgUnless you’re exempt, if you don’t have minimum essential health coverage compliant with the ACA, you’ll be subject to a tax penalty at the end of the year.

3. HealthMarkets Reviews: Subsidies

If you’re worried about the cost of health insurance, you may be in luck. If you’re eligible, based on your income, you could receive financial assistance to pay for some of your insurance premium in the form of a premium tax credit health insurance subsidy. Those making between 100% and 400% of the federal poverty level will receive a tax credit. Use the Subsidy Calculator here to see if you qualify.

Your Income Level Expected Contribution
100% – 133% of the federal poverty level 2% of your income
133% – 150% of the federal poverty level 3% – 4% of your income
150% – 200% of the federal poverty level 4% – 6.3% of your income
200% – 250% of the federal poverty level 6.3% – 8.05% of your income
250% – 300% of the federal poverty level 8.05% – 9.5% of your income
300% – 400% of the federal poverty level 9.5% of your income

4. HealthMarkets Reviews: Open Enrollment vs. Special Enrollment

You’ve most likely heard the terms “Open Enrollment Period” and “Special Enrollment Period.” If you’re still not sure what it means, here’s an explanation.

Because you can no longer be denied health coverage for having a pre-existing condition, and in order to prevent people from just purchasing health insurance when they get sick, there are only two primary times when you can obtain individual health insurance, during Open Enrollment and during a Special Enrollment

Every fall, Open Enrollment begins. Individuals can obtain insurance through a variety of options, including their local health insurance agent.

The open enrollment period to obtain coverage for 2018 is November 15, 2017 to December 15, 2017, for most states. Be sure to check your state’s open enrollment period. Coverage could take effect as soon as January 1, 2018. In most cases, those who don’t obtain coverage will have to pay the fine.

So, what happens if you miss Open Enrollment?

Enrollment in a health insurance plan outside of the Open Enrollment period may be allowed during a Special Enrollment period only if you have a qualifying life event.  Without having a qualifying event, you will not be eligible for a Special Enrollment period and will have to wait until the next Open Enrollment period to buy a new health insurance plan.

Here are a few Qualifying Life Event examples:

QualifyingEvent_infographic_Aug2014-01.jpgNon-Renewal of your Insurance Coverage: In this case you may apply for new coverage up to 60 days in advance of your insurance non-renewal effective date.

Change in family size: Marriage, divorce, child birth, adoption, death, etc.

Job change: Loss of health coverage due to loss of job or a new job. In this case you may apply for new coverage up to 60 days in advance of the date your insurance is terminated.

Change in Citizenship: You become an American citizen, or obtain national or legal status.

Government error: Your coverage is changed by an error caused by the Health Insurance Exchange or the Department of Health and Human Services.

New Address: You move to a new state or county, thus qualifying you for a new health plan.

Keep in mind, the special enrollment period only lasts for 60 days from the date of the qualifying event. In any case when you can anticipate the loss of coverage in advance, you have a 60 day window of opportunity. That’s your chance to call a HealthMarkets licensed agent and review your options to prevent a gap in your coverage.

Here’s an example:  Joe Smith received a cancellation notice in June with an effective cancellation date of March 31 the next year. He began shopping on February 16 and selected a plan on March 5. His new coverage would start on April 1, so there was no gap. Now, if he had waited for his policy to cancel, he would still have 60 days after April 1 to get new health insurance. Unfortunately, there would be a gap in his coverage.

Mind the gap please – With a gap in your health coverage, if you get sick or something unexpected happens to your health, you will not be covered for any costs. To prevent the gap, you can speak with a licensed health insurance agent 60 days before your loss of coverage so that the minute your coverage expires you’re immediately covered with a replacement plan.

5. HealthMarkets Reviews: How to Sign Up

MedalRains_infographic_Aug2014-011.jpgFirst, you want to make sure you know what your budget is and what you can afford to pay in monthly premiums. Then you’ll want to calculate what your health care needs are so you can find the best plan for your needs and budget. This is where a licensed health insurance agent comes in handy. HealthMarkets reviews your information and whether or not you qualify for financial assistance in the form of a subsidy to pay part of your premium.

You should also be aware that though there are four metal levels of coverage that must offer the 10 essential health benefits and preventive care – Bronze, Silver, Gold, and Platinum – they still vary uniquely with regards to prescription drugs, specialty care, treatments, and other medical expenses covered.

New for 2018 is the “Expanded Bronze” plan. Like the standard Bronze plan, it pays 60% of the average overall cost of healthcare. However, the Expanded Bronze plan allows the percentage covered to range from 56% up to 65%. Standard Bronze plans can only vary from 58% to 62%. In addition, there’s a new Bronze high-deductible health plan (HDHP) that “will allow an enrollee to qualify for a tax-subsidized health savings account (HSA) under the Internal Revenue Code.”

There is also another level: Catastrophic health insurance plans are available for people under 30 and people with hardship exemptions. They are designed to protect you only in worst-case scenarios where medical costs are very high.

The main four metal levels help to clarify cost expectations across the board.

Beyond premium rates and cost sharing, there are many other variables to consider such as plan benefits, provider networks, the insurance company, and subsidy availability to name a few.

HealthMarkets reviews several plans and options for you so you know you’re getting the best price available.

Don’t face health care alone! Call HealthMarkets at (800) 304-3414, and we’ll help you solve the health insurance puzzle.


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