Your Affordable Care Act Questions, Answered

A doctor and patient sit smiling in front of a computer.

Image by andyde, Flickr Creative Commons

September 04, 2013

In about a month, the state health insurance exchanges (also called marketplaces) created under the Affordable Care Act (aka Obamacare) will open. Enrollment begins October 1 and will run for six months, although benefits will begin to kick in on January 1, 2014. Yet even as deadlines loom, many people still have questions about what the law will mean for them. It’s important that folks understand the insurance exchanges — and the ACA as a whole — so that they can take advantage of receiving comprehensive insurance coverage, including access to reproductive care.

To help everyone understand ACA a little better, here are my answers to a few questions my friends and co-workers have asked me recently.

Say a person is paying a ridiculous price for (not very good) health care since they are self-employed or their small-business employer doesn’t cover health care. How will the exchanges help them? Does it matter what state they live in?

Starting October 1, the self-employed can use their state’s marketplace website to find health coverage that fits their budget and needs. The websites compare important features of several plans side by side, all of them covering essential health benefits. You’ll be able to see what your premium, deductibles, and out-of-pocket costs will be before you decide to enroll. If you currently buy your own insurance, you may be able to change to a marketplace plan. Each state will have its own exchange, with different insurance companies participating, so options and prices will differ among states. (You can learn more about the marketplaces here.)

My family owns a small business (with fewer than 50 employees), and we want to be able to provide health care, but it’s been too expensive. Will the ACA do anything to help us get something more affordable?

Starting in 2014, businesses with 50 or fewer full-time equivalent employees can use the Small Business Health Options Program marketplace to offer coverage to their employees. Employers can control the coverage they offer and how much they pay toward premium costs. Depending on your employees’ average wages, you may qualify for a tax credit to help pay for health insurance costs.

My grandmother is very happy with her current health care through Medicare — how will the law change her health insurance?

The ACA is on track to actually make health coverage for older Americans even stronger. Medicare recipients aren’t required to replace their coverage with ACA insurance plans, although they will receive many benefits from ACA’s provisions. Because of ACA, Medicare now covers certain preventive services, like mammograms, colonoscopies, and a yearly wellness visit, without charging for the Part B coinsurance or deductible.

How does Obamacare affect insurance coverage for pre-existing conditions?

Beginning in 2014, insurance companies are no longer allowed to deny coverage or charge more because of a pre-existing condition. The only exception is for grandfathered individual health insurance plans — the kind you buy yourself, not through an employer. However, if you have one of these plans, you can switch to a marketplace plan during open enrollment and get coverage for a pre-existing condition.

In addition to women’s preventive care (including contraception), are there other items that will be required to be covered with no copay under ACA?

Numerous preventive care services will be covered without copay. Check out the list for adults, women, and children.

My sister is a 27-year-old graduate student, so being on my parents’ plan is not an option for her. Does she have to purchase insurance? I don’t know if she can afford it.

Under the new law, only people who can afford to pay for health insurance must do so. Many universities offer student health insurance plans, and your sister might qualify for that coverage. Additionally, unemployed and certain low-income people may qualify for Medicaid, the Children’s Health Insurance Program, or lower costs on marketplace insurance, based on income. For example, your sister may be eligible for coverage under the Medicaid expansion, which covers people who earn up to about $15,000 a year. Of course, that depends on whether she lives in a state that’s expanding its Medicaid coverage. The bottom line is that she should be aware that if she does not have health insurance or qualify for an exemption, she will pay a penalty and face the uncertainty of paying for all unexpected health care costs.

Will the health care exchanges provide abortion coverage?

It’s complicated. Under the ACA, insurance plans in the state exchanges may cover abortion unless a state passes a law prohibiting them from doing so (many states have already done so). Plans offering coverage of abortion, however, may not use federal funds to pay for it. Additionally, tax credits that help the uninsured afford coverage must be separated from premiums collected for abortion coverage, although AAUW and others have opposed this requirement.

Have other questions about the Affordable Care Act? Ask us here or check out healthcare.gov.

By:   |   September 04, 2013

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