The Affordable Care Act (ACA), better known as Obamacare, is a US law that changed the healthcare and health insurance industry in America. Obamacare was signed into law in March 2010, and required everyone to have at least minimum essential health coverage by 2014.
If you don’t have insurance, you must get an exemption or you will face a tax penalty for each month you are not covered. (The time to choose your health insurance is NOW, during a period known as Open Enrollment. Get quotes and compare prices here.)
How Obamacare affects each individual depends on his or her status. Let’s take this one by one.
If you work for a company that has over 50 employees, the company is required to provide insurance to full-time workers (30 hours+ a week) under The Employer Mandate.
If you work for a small company (less than 50 employees), you can arrange coverage through the Small Business Health Options Program (SHOP), a program designed to help small business offer employee health insurance.
Employees and Individuals
If you currently get health insurance through an employer, not much will change with the Obamacare reforms. You’ll still retain the healthcare benefits you enjoyed previously, plus the new rights and protections offered by the act. These include not being dropped when you are sick, free preventative care, better coverage for mental health problems and the option to include dependents until age 27.
If you are covered but can’t afford the premiums your employer requires for dependent coverage (such as your children’s healthcare), your situation is more difficult. If the full premium for employee-only coverage is more than 9.5% of your earnings, you are considered uncovered and can buy insurance through the Health Insurance Marketplaces and receive premium assistance. If your premiums are less than 9.5% of your income buy you still can afford it, you can also buy coverage through the Marketplace, buy you will not be eligible for premium assistance.
If you get insurance through your employer but your spouse and children don’t, you can purchase insurance through the Marketplace. In some situations, you will qualify for premium assistance, but not in all situations.
If you work part-time at a large employer (50+ employees), the company can decide whether it wants to offer you health insurance of not. If your employer doesn’t provide you with coverage, you can buy insurance in the Health Insurance Marketplaces.
If you are retired or disabled and receive Medicare, you will now be getting more from Medicare, including benefits protection, more preventative care, a yearly wellness visit and lower prescription drug costs. If you receive Medicare, you don’t need to purchase insurance through the Health Insurance Marketplaces.
If you receive Medicaid or other public healthcare, eligibility will be determined by your state. As of 2015, 30 states have expanded their Medicaid program to cover all Americans in families below 138% of Federal Poverty Level. To find out if your state has adopted the new program, click here. To find out if you qualify for Medicaid, you can simply apply to your state’s Health Insurance Marketplace.
If you pay for your own health insurance and have a cheaper policy with higher deductibles, it gets a little more complicated. In some cases, that policy will no longer be available, and you will have to purchase a more costly policy. In other cases, you will be given the choice of remaining with your old policy or switching to a new policy with more benefits. If you need to purchase a new plan, you can do so through the Health Insurance Marketplace or through an insurance broker.
New plans are required to cover the “10 essential health benefits,” preventative care, cannot exclude pre-existing conditions and cannot raise premiums due to health
If you were previously denied health insurance because of health problems, or offered insurance with sky-high premiums, this will no longer happen under Obamacare. You will be allowed to apply for insurance through the Health Insurance Marketplace and you will not be denied coverage or asked to pay extra.
If you recently lost your job and can’t afford to pay the health premiums yourself (which is allowed for a year under COBRA), you can apply for health insurance, even if it is outside the open enrollment period. When you apply for health insurance in the Marketplace, you will find out if you qualify for Medicaid.
If you are a student with few resources, you may be covered under your parents’ health insurance until age 27. If your income exceeds 50% of the cost of your support, you will not be allowed to be covered by your parents.
If you are self-employed, you will be able to buy a policy for yourself and your family in the Marketplace at fixed rates that are not affected by pre-existing health conditions, and you might receive tax credits that help cover the cost.
This is how Obamacare affects companies and individuals as of now, but the actual act itself may be subject to change with a new president and new congress. As always, when any changes occur, Corporate Financial will keep you updated.