Affordable Care Act reformed Health Insurance

Working Americans deserve affordable health care choices. Under the new health care law, there’s help for working families, including possible lower monthly premiums.

We know there are a lot of questions out there and we want to help. See the frequently asked questions below to get started.

What is the Affordable Care Act? What does it mean for me?

The Patient Protection and Affordable Care Act (PPACA), more commonly known as the Affordable Care Act (ACA), is a law enacted in 2010 to reform health insurance coverage for Americans. The goal of ACA is to make health insurance more affordable and available to all.

Numerous provisions of ACA have already taken effect in the last three years, and you may have benefited from some of them. Under ACA, you may not be denied health insurance because of a preexisting condition. Insurance companies are barred from imposing annual limits or lifetime caps on coverage. Young people can stay on their parents’ policies through age 26. And you can’t be dropped if you get sick or injured.

Many of you who remain uninsured or underinsured will be eligible to purchase health insurance on the newly created Health Insurance Marketplaces beginning October 1, 2013.

Sign up here to receive more information from Working America about the new health care law.

What is a Health Insurance Marketplace?

One of the most important parts of ACA is the creation of Health Insurance Marketplaces, also known as Health Exchanges.

There will be a Health Insurance Marketplace in each of the 50 states. The Marketplaces will open to the public on October 1, 2013, to enroll in coverage that starts as soon as January 1, 2014. There, you will be able to make side-by-side, apples-to-apples comparisons among the health plans available to you. You will also see up front what the monthly premiums, co-pays and deductibles will be before you enroll in a plan. With one application, you will be able to choose the plan that best fits the needs of you and your family, and find out if you qualify for financial help.

Note that the Health Insurance Marketplace may be known by different names, depending on the state in which you reside and from which you would apply for coverage (e.g., Cover Oregon, Connect for Health Colorado, Massachusetts Health Connector).

Sign up here to receive more information from Working America about the new health care law.

Am I eligible to obtain financial help through the Health Insurance Marketplace?

There are several factors used to determine if you can get financial help to buy insurance through the Health Insurance Marketplace. These include your current insurance status, annual income, household status and where you live.

If you currently get coverage through your job and what you’re paying for it is considered “affordable and meets minimum value,” then you don’t have to do a thing. However, if the insurance plans offered by your employer aren’t affordable (in other words, if your share of premiums exceeds 9.5 percent of your household income) or aren’t adequate (in other words, if the plan doesn’t meet minimum value standards), then you may qualify for financial help to purchase insurance through the Health Insurance Marketplace, depending on your income.

Those who aren’t fortunate enough to have comprehensive health insurance through an employer or a program like Medicare, Medicaid or CHIP may be able to obtain health insurance through the Marketplace with financial help, depending on income and household status.

You may be able to get financial help to buy insurance in the Marketplace if your income is at or above 133 percent of the federal poverty level (roughly $15,000 for a single individual, $21,000 for couples or $31,000 for a family of four). In some states, where Medicaid won’t cover as many people, this threshold may be set at or above 100 percent of the federal poverty level (roughly $11,000 for a single individual, $16,000 for couples or $24,000 for a family of four).

*Note that the income figures listed here are based upon 2013 information.

Insurance plans in the Marketplace will fall into one of four categories: Bronze, Silver, Gold and Platinum, based on the level of coverage they provide.

Depending on your age and annual income, you may qualify for other assistance programs, including Medicare, Medicaid or CHIP. The Health Insurance Marketplace can help you find out.

Starting on January 1, 2014, most people will be required to have some kind of coverage—through your job, through the Marketplace or through another program—but there’s help available to make sure you can get a plan that works for you.

Sign up here to receive more information from Working America about the new health care law.

How does the financial help work to lower my costs?

You could be eligible for a tax credit that lowers your monthly premiums—or even a $0 premium. This works in a couple of ways.

Starting on January 1, individuals and families who obtain insurance through the Marketplace may be eligible for newly available Advance Premium Tax Credits (APTCs). You will be able to immediately use these tax credits to lower the costs of your monthly premiums when you purchase coverage through the Health Insurance Marketplace. APTCs are available to individuals and families whose incomes are between 133 percent and 400 percent of the federal poverty level (in some states, income eligibility begins at 100 percent of the federal poverty level).

Furthermore, if your income is below 250 percent of the federal poverty level and you select a Silver-tiered plan, you may qualify for Cost Sharing Reduction Subsidies that will further reduce your out-of-pocket costs like deductibles and co-pays.

Sign up here to receive more information from Working America about the new health care law.

Do I make payments to the insurance company or do I pay the Health Insurance Marketplace? What about when I go see a doctor?

Once you’re enrolled in an insurance plan, you’ll receive a bill from your insurance company every month for monthly premiums. The amount on the bill will only reflect your portion of the bill—what you owe to the insurance company each month. If you qualify for tax credits and/or subsidies to help lower the costs of your monthly premium, this amount will be deducted from your premium. The insurance company will receive this payment directly from the government, so you won’t need to worry about it.

When you go see a doctor or another health care provider, you’ll need to show them your insurance card. You may owe co-pays and/or deductibles, depending on the plan you select. You’ll pay your doctor or health care provider directly for these.

Sign up here to receive more information from Working America about the new health care law.

Working America, Working America Health Care and Union Privilege are not certified as and do not claim to act in the capacity of Navigators, non-Navigator assistance personnel, nor certified application counselors as it relates to the Patient Protection and Affordable Care Act as defined by the Department of Health and Human Services in final rule, 45 CFR Part 155.

About Suzanne

Suzanne Lewis, editor and manager Wholisticbodymind.com since 2000. Suzanne is a Planetary Peacekeeper, an Agent for Conscious Evolution, a Spiritual Healer, a Mother, a multi - faceted artist (beads, gems to trade beads; guords star seed art; published author and Lover of Life for the sake of All our Relations.
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