Health care reform: What it means for youOur two-part feature drills down to the Affordable Care Act's must-know-now details and reveals how to reap its benefits
One of the most hotly debated public health topics during the past few years has been the Patient Protection and Affordable Care Act (PPACA -- or ACA, for short), the landmark legislation aimed at reforming our complex health care system. No matter what you think about the issue, the ACA will -- or might already -- affect you, even if you and your family are currently covered by an employer-sponsored health plan.
A Bird's-Eye Look at ACA's Provisions
If you're already insured, you'll find new benefits and protections. If you are not insured or if you purchase insurance on your own, a new state-based system will help you get coverage that fits your needs, perhaps at a rate more affordable than you could find before. If you choose not to get insurance, however, and aren't covered under an employer's plan, you may have to pay a penalty. The goal of the new system? Preventing situations like the one in which Cindy Crowley has found herself.
When she was laid off from her job at a start-up company in 2012, Crowley, 54, lost her health insurance. Her monthly $2,000 in unemployment needed to cover her mortgage, food, utilities, and car payment, as well as her daughter's college expenses, so she couldn't afford the $400-a-month premium to continue coverage under her employer's plan. Buying her own plan would cost hundreds, if not thousands, more -- if she could even find coverage. Crowley knows she's been playing medical roulette. She has already postponed her annual physical exam and mammogram because she can't afford the out-of-pocket costs. "It's scary," she says. "There are so many ways you can get hurt, and it would be financially catastrophic if something happened to me." (Everybody has different ways of dealing with a major life event. What's Your Coping Style?)
But Crowley can stop rolling the dice on January 1, 2014. That's when the cornerstone of the ACA kicks in: the insurance-coverage requirements. Also, the insurance you can purchase now through a state insurance marketplace takes effect that month, too.
Insurance Shopping Gets Simpler
If your employer (or your partner's employer) doesn't offer health insurance, you're self-employed, or you're unemployed, your new option is state-based health insurance exchanges. Insurance companies will offer individual plans through these marketplaces via Web sites that allow you to easily compare benefits, premiums, and costs. The law requires that plans use simple language to describe what's covered, so it'll be easier to see exactly what you're getting.
Beginning October 1, you'll be able to log on to your state's marketplace, enter the number of people in your household, their ages, whether or not they smoke, your annual family income, and the level of coverage you want, and up will pop an estimated premium for you and yours, as well as the amount of tax credit or subsidy you may be eligible for to help cover some or even most of the cost.
Those tax credits, depending on your income, could slash your monthly premium by more than half. Even a family of four with a household income up to $94,200 (based on 2013 estimates) qualifies for help.
Four health plan levels will be available through the state marketplaces. The plans should all cover the same services but will vary in the level of costs they cover: Bronze covers 60% of medical costs, silver covers 70%, gold covers 80% an platinum covers 90% of medical costs. The lower your out-of-pocket costs, the higher your premium.
So What's Your Level?
That depends on the number of people in your family, your health, and theirs. If it's just you and you're relatively healthy, then a bronze plan may be fine. If you're married and have a couple of kids but you're all healthy, consider silver. If anyone in your family has a chronic health condition or a past medical problem that may recur, you might be better off with gold or platinum. (Wondering whether that nagging pain is a chronic condition? Here are 6 Health Problems To Never Ignore.)
How the Costs Shake Out
Take a family of four with a 45-year-old husband, a 42-year-old wife, two kids under 21, and an annual income of $70,000. They opt for the silver plan, which covers 70% of their health care bills and costs $1,015 a month before subsidies. Subtract the estimated $466 monthly tax credit the government will provide and their monthly cost drops to $549.
Experts called navigators will be available at no charge via phone and online through live chat to help you identify the best plan for you. The navigators are specially trained to walk you through the process. That's important, because what seems like the cheapest plan may actually cost you more, depending on your health care needs.
Another option may be available, depending on your income: Medic-aid. Some states are expanding Medicaid programs to more uninsured people with very low incomes -- childless adults and others whose household incomes are up to 138% of the federal poverty level (which comes out to $15,856 for a single person; $21,404 for a couple).
If you're not eligible for Medicaid, you can use the marketplaces to get insurance. But there's a glitch in the system: Tax credits to help pay for insurance are available only to those whose household incomes are between 100 and 400% of the federal poverty level -- so there's currently no financial help for people with incomes of less than $11,490 for a single person or $15,510 for a couple. This may one day be resolved through future legislation.
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