New Orleans Ignoring the sound and fury signifying nothing, enrollment under the Affordable Care Act for tens of millions of Americans, many of them uninsured, opens on October 1st at www.healthcare.gov on-line or using paper applications that may be downloaded or accessed through navigators or state insurance commission offices. You have to have a couple of things ready when you apply: your Social Security number, information about whether or not your job offers insurance and what it costs, and your wage and income statement or your W-2. If you have computer access, you are then good to go.
Sound simple? Well, yes, it is easy to enroll. The best news is that once you answer the first simple questions and enter your information, you will get a real-time, meaning virtually immediate, response if you are enrolling on-line at home, at a library, or with a navigator. Quickly, you will find out whether or not you are eligible for what Obamacare calls “premium tax credits” and “cost sharing.” The tax credits are either direct subsidies that the government will pay to whatever insurance company you choose or refunds that you can get when you file your taxes, if you paid the insurance premium directly. Keep in mind that in order to be fully covered for 2014, you will need to get through the enrollment process and the insurance company you choose will have to have your payments in hand by December 15th. If you are also eligible for cost sharing, the government will also assist you in making co-pays and deductibles. Assuming you do not have affordable job-based insurance, you will be eligible for some kind of assistance if you, or your family, have annual income less than 400% of the Federal Poverty Line. For one person that’s less than about $35000. For a family of four it’s less than about $92,500. There are a lot of people who will get assistance!
Remember this is mandatory. If you don’t enroll there will be penalties for you and your family. In the transition year of 2014 the penalties will be modest, less than $100 for a single individual or 1% of gross annual income whichever is higher. By 2016 it’s close to $700 and 2.5% of gross annual income for an individual and a couple of thousand for a family of four. American society is finally saying: “Hey, we’re not playing! We want you and your family to be healthy, and we’re not willing to let you be a free rider, where if you scammed us and get sick, we pay.” This is a shared and collective experience in creating a healthier America.
Knowing all of this you then have to choose what you can afford. If you want lower premiums, the Bronze plan gives you that, but it only pays 60% of the freight, where the Platinum policy pays 90%, but has a higher premium. At 70% the Silver plan pays up and opens the door to cost sharing, and then the Gold plan pays 80%. There are often only a couple of bucks between these levels, so if you can do it, it makes sense to supersize your health coverage and go towards the top. All of the plans are required to provide prevention services and have to accept all comers without any caps on the coverage. You have to decide which company in your Marketplace is best for you of course, and in some you will have narrow choices and in other states you will have a longer list. In Massachusetts when their mandatory coverage came in under Governor Romney, the average person going on line visited 18 times while figuring out their best decision. You may not have that many choices, but it means you shouldn’t wait until later, ok?
If you have job-based insurance and the premium is over 9.5% of your gross wages, it’s unaffordable and you qualify for subsidies under the exchange, but anyone can buy on the exchange if you think you can get a better deal, you just may not get any help from the government. Many companies are playing a lot of tricks as ACA comes online, so it’s worth doing some on-line shopping ASAP!
These are the rough cut basics. Need help? call 800-318-2596. On-line it’s www.healthcare.gov. Don’t let the front pages or the funny pages confuse you. Enroll now!