As of March 31, 2014 all American citizens are required to have health insurance under the Affordable Care Act (ACA). Like so many people, I was confused as to what exactly the ACA was and how it worked, and like many I also found it hard to acquire information due to the faulty government run website. If you are struggling to get informed, here is some basic information and a few tips that may help you in your search for health coverage.
What is the Affordable Care Act?
The Affordable Care Act, also known as “Obamacare” is actually called The Patient Protection and Affordable Care Act (PPACA), which President Obama signed into law on March 23, 2010.
The PPACA aims to:
- Increase the quality and affordability of health insurance
- Lower the uninsured rate by expanding public and private insurance coverage
- Reduce the costs of healthcare for individuals and the government
The perks of the PPACA:
- Insurance companies are required to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex
- If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old. (Effective September 23, 2010).
Before the PPACA , young adults would be kicked off their parents’ health insurance as soon as they turned 18, leaving many individuals between the ages of 19 and 29 without coverage. As a result of the PPACA, young adults up to age 26 can be covered under their parent’s insurance regardless of financial dependency, residency with parent, student status, and/or employment and marital status.
Carolyn Evans of Whitehouse Station, New Jersey explains that her 26 year old daughter Nikki Evans is on the extended young adult option since she doesn’t have healthcare through an employer. “She doesn’t really make enough to pay it herself, so the option is only good because my husband and I are able to pay for it.”
If I am over 26, where can I find health insurance?
On October 1, 2013 the Health Insurance Marketplace opened to the public. The Marketplace is set up to help uninsured people find the right health coverage for themselves. After filling out the Marketplace application, you will be told what you qualify for, including if you qualify for lower costs based on your household size and income.
Set for a 6-month enrollment period, the marketplace is scheduled to close on March 31, 2014. If you select a plan by December 15, that plan will begin January 1, 2014 however, if you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income, depending on which is higher. The fee will increase every year.
In theory the Marketplace is a great way for uninsured individuals and those looking to switch to a more affordable plan to find new health insurance however, the website has been under a massive amount of scrutiny due to system failures.
27 year old, Joan Schubin of Matawan, New Jersey currently pay $305 a month for her health insurance and looks forward to switching to a more affordable ObamaCare package if available. The process however, has proven to be extremely difficult and frustrating. “Between the website being vague and unaccessible, I don’t know what I’m going to be paying for when I have to start making monthly payments. Right now, I can’t even view the plans that ObamaCare offers, so I’m really unable to make any kind of informed decision.”
38 year old, Edison, New Jersey resident Ron Sammond Jr. agrees, stating that his experience looking for insurance on the Marketplace website has been “horrible.” “I have tried three separate times to apply and each time I’ve gotten stuck at some part of the process. Being that I’m diabetic, it’s incredibly important to me to have coverage. I’m hoping at some point in the near future to finish the application process and finally be insured.”
I have been paying over $300 for my own health insurance for three years now. Being that I am 28, healthy, and barely use my insurance, I was intrigued when I heard that I could possibly be elegible to receive financial assistance under the PPACA. I checked out the website recently to aquire information and like many others I immediately received this message…
Learn what plans are available to you:
According the healthcare.gov, all plans must offer the same essential health benefits including doctor visits, prescription drugs, hospitalization, maternity and newborn care, and preventive care. Plans can offer other benefits, like vision, dental, or medical management programs for a specific disease or condition.
These plans are put into 5 categories, based on how you and the plan expect to share the costs for health care:
- Catastrophic (less than 60% of the total average costs of care)
- Bronze (60% of the total average costs of care)
- Silver (70% of the total average costs of care
- Gold (80% of the total average costs of care)
- Platinum (90% of the total average costs of care)
The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription drugs. It also affects your total out-of-pocket costs.
To find a plan that works best for you, follow these steps:
- Visit www.healthcare.gov
- Click “see plans now” on the bottom of the home page
- Answer the questions and click “next” to advance (questions include whether you are looking for insurance for yourself or small business, type of insurance, age, and state)
- Check off the category that suits your needs best (catastrophic, bronze, silver, gold, platinum)
- Begin thumbing through plans
What if I’m still having trouble connecting to the Marketplace?
Schubin offers advice to those who may also be frustrated, “I’ve used the E-Health insurance website to look for other plans, and it’s very comprehensive and easy to navigate. I also used Horizon Blue Cross Blue Shield’s Income Calculator to help me figure out if I could get a cheaper plan based on my income. It was also very easy to use, and quoted me with a much more affordable plan.”
Montclair State | New Jersey