Getting Covered Under the ACA: Part III in a Series

Over the last few weeks, we’ve been rolling out information on the Affordable Care Act – first telling you what has changed already then moving on to the changes that are coming next. On Tuesday, the insurance Marketplaces officially opened for business. Also, you may have heard something about a government shutdown … well, that’s tied to the ACA, too, as some hard-line lawmakers decided they hated the law so much, they were willing to bring the government to its knees. We’ll save that for a separate story, though.

As we’ve written before, this topic won’t affect everyone — mainly those who have employer-provided health insurance — but there are many part-time SEA members, including adjunct professors at CCSNH, who don’t have coverage and will benefit from the law. No doubt you have some friends or relatives who could benefit, too, so you can take what you learn here and help them navigate the system.

So today, as we move along in our ACA education series, we’ll take a closer look at buying insurance through the Marketplace, starting with a fundamental question:

Why should I get covered?

There are a lot of great reasons to get insurance, with an obvious one being in case of a catastrophe. An unexpected hospitalization could leave you tens of thousands of dollars in debt. That’s a big burden to crawl out from under.

Another big reason to get covered is that the ACA actually requires you to have coverage, under something known as the “individual mandate.” The mandate was actually upheld by the Supreme Court, so as of Jan. 1, 2014, you must purchase insurance or pay a tax penalty. Some are exempt from the penalty, mainly those who already have health coverage. Also exempt are those who would have to spend more than 8 percent of household income on coverage.

Forcing people to buy health care might not seem fair, but there’s a reason why a mandate is necessary: it will help keep insurance affordable for all. Because insurance companies can no longer refuse to cover sick people – that will cost more for insurers and, by extension, cost more for everyone who has insurance. The pools of insured people need some healthy folks among them to balance things out, and keep costs down.

How can I get covered?

Last week, we introduced you to the Marketplace, the place you can go to get coverage, but also to find out if you’re eligible for tax credits or subsidies to lower the cost of coverage. You may also be eligible for other programs, such as Medicaid or CHIP coverage for your children – the Marketplace is a one-stop shop to find out all of this. In the Marketplace, you’ll be able to choose between numerous plans, including options offered by Anthem and a federal multi-state plan.

New Hampshire was one of several states that opted to let the federal government run its Marketplace, so if you’re a Granite Stater looking for coverage, you must go to www.healthcare.gov. That site has been overwhelmed by traffic in its first few days, a victim of its own popularity. The good news is, there’s no huge rush, as you have until Dec. 15 to get coverage that will go into effect on Jan. 1. You can actually enroll in coverage through the Marketplace through the end of March, though that would delay the date your coverage goes into effect. If you’d like to get a quick look at what Anthem’s coverage from the Marketplace would cost, you can check out this snapshot of rates.

Can I get help paying to get covered?

There are a few ways to save on coverage, not including Medicaid. The first is an upfront discount, which individuals making between $11,505 and $46,021 and families making between $23,425 and $93,700 are eligible for. You can also save money on out-of-pocket costs through subsidies, if you earn less than $34,516 as an individual or $70,275 as a family. The amount you’d save will vary, and you can find the specific amount on the Marketplace website. You can also get an idea of what your subsidy might look like by using the Kaiser Foundations subsidy calculator.

Finally, another way to save on coverage for those with the lowest incomes would be to enroll in Medicaid. The Marketplace website will let you know if you’re eligible. Many states have expanded Medicaid coverage to a larger group as part of the ACA, though New Hampshire hasn’t done so yet. Lawmakers are currently studying Medicaid expansion, and will issue recommendations on Oct. 15. The Legislature is then expected to go into a special session to vote on the issue. We’ll talk a bit more about this next week – we’ve covered a lot for today – in the fourth and final part of our series.

 

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