If, for some strange reason, you decided to read the news lately I’m sure you’ve heard the term “Obamacare” or, technically, the “Affordable Healthcare Act” (AHA) at least 500 times. This new law mandating health insurance is honestly beyond complicated, but to make it easy to understand let’s just sum it up with “You better have mother fucking health insurance or the federal government will pimp slap the shit out of you and then take your money.” While I’m sure that’s not the official slogan, I think it should be! š
Just to be fair, there are some really positive aspects to Obamacare such as: All new health insurance policies are now required to cover additional benefits including maternity, mental health, etc. Also, People with pre-existing conditions cannot be denied insurance coverage.
Obviously, there are negative aspects to Obamacare, as well. The biggest one being that the government will impose fines on you for not having health insurance. (This is really one of the most insane governmental policies I’ve ever heard of, but whatever…)
Needless to say, there is no possible way I could even get into specific details regarding this subject without writing something comparable to the size of an encyclopedia. So, I’m REALLY simplifying here. But it should give you a general idea or a reasonable starting point to research your own particular situation.
So, let’s get into some of basics regarding the new Obamacare/AHA – FOR INDIVIDUALS:
***OBAMACARE ENROLLMENT BEGINS ON OCTOBER 1, 2013 AND WILL LAST UNTIL MARCH 31, 2014.***
***OBAMACARE COVERAGE WILL BEGIN NO SOONER THAN JANUARY 1, 2014.****
***YOU MUST HAVE AN INSURANCE POLICY BY JANUARY 1, 2014 OR YOU WILL BE SUBJECT TO A PENALTY FEE. (See amounts below).***
There are currently 4 options for obtaining health insurance:
1. Keep your current health insurance plan through your workplace. (No changes)
2. Keep your current private health insurance plan. (No changes)
3. Determine if you are exempt from having a health plan. (rare)
4. Purchase a new policy through the Health Insurance Marketplace (with subsidies available for certain income brackets.)
The “Health Insurance Marketplace” is a new concept to purchase health insurance. It’s basically set-up like a travel site which lists the different insurance carriers with different plans and rates for you to choose from.
Each state decided whether they wanted to set-up their own State Marketplace or use the Basic Federal Marketplace.
For example:
-Most states are using the federal marketplace found at www.Healthcare.gov
-Some states have set-up their own specific websites. California has set up it’s own state marketplace called California State Insurance Exchange Program and can be found at www.Coveredca.com
*ANYONE CAN USE “THE MARKETPLACES”TO PURCHASE OR RESEARCH INSURANCE POLICIES.*
Certain policies will get a subsidy/credit/portion of premium paid for by the government. But, your income must be at least 400% or under below the national poverty level amount based on the number of family members.
For example:
-For an individual – Your income would need to be between $15,302 and $46,021 to qualify for a lower premium.
-For a family of 4 – Your combined income would need to be between $31,155 and $93,700 to qualify for a lower premium.
Here’s an example of how a subsidized premium would work, if your income is at least 400% or under below the poverty line.
Family of 4:
TOTAL premium – $8,000/yr.
LESS: Obamacare discount – $2,000 (Paid by goverment directly to your Insurance Co. upon issuance of policy. Meaning you don’t need to pay the subsidy and then get reimbursed at a later date.)
Your OUT OF POCKET premium due – $6,000/yr. (or $500/mth.)
If you decide to not buy health insurance, then the government will actually penalize/tax you for failure to obtain proper health insurance. This penalty will be reported on your tax return. The penalty structure is calculated as:
-1% of annual income OR $95 (whichever is higher.)
(Also, the penalty will be pro-rated if you had no insurance for only select months out of the year.)
-Child fee of $47.50 for each child without the required insurance. (Max. of $285).
The best suggestion I could give is if your income is at the poverty line or up to at least 400% above the poverty line, then DEFINITELY visit your state’s marketplace to at least see how much of a discount/subsidy/credit you MAY qualify for? (It only takes about a minute.)
Everyone else, I would still look at the information contained in the links above. I think both of them have helpful calculators to estimate figures on your personal circumstances regarding health insurance.
***Please Note: If anyone finds an inaccuracy or wants to add any other specifics regarding ObamaCare, please feel free!!***
xoxo, Lacey.
Hope this helps even if just a little??? š
36 Responses
Ken La Kier liked this on Facebook.
Oh well- since my income is currently below $15k/year, guess i’ll be among those paying 1% or $95….
Matuszewski Lucian liked this on Facebook.
Lacey thank you Thank you you actually answered a question that I have had and couldnt get answered (how the subsidy works) This is great info and all performers should be paying attention to it, and not just performers but everyone. Great job Thank you Im gonna pin this to the top all day
One thing I would add, if your income is such that you qualify for medicaid in your state, There is no government subsidy
Mike Kulich liked this on Facebook.
As the last major industrialized country to offer universal health care, let me welcome you to the 20th century!
You’re welcome. š
Also, by using the eligibility calculators on the new “Marketplace” websites they will let you know if you may qualify for Medicaid health benefits on a sliding payment scale or for free depending on your income.
thats not how it works…thats the penalty you pay if you DONT buy insurance, and no it doesnt get you coverage thats a fine.
at 15K a year your insurance if you are single would cost you around 200 bucks a year under Obamacare
Edited this actually depends on the state yer in…in GA its 12000 per year other states will be different depending on the states medicaid program in short if you qualify for medicaid you dont get any breaks on insurance because you can get it for free. if you cant get it for free thats where Obamacare kicks in with subsidies
Depending on your exact circumstances, you may qualify for FREE health insurance.
I would at least look into it….. š
I do have a question for lacey:
This was asked on GFY:
Can you just Buy One Month say at the Platinum Level, and then get like some surgeries done, then cancel the insurance? ha Or even down grade to the lowest after you get major work done? I think the Highest level you only have to pay 10% of the medical bill up to a Max out of pocket??
Does this also apply to Americans living abroad? I haven’t been keeping up with the Obamacare shenanigans.
DWB I thought of that too…how it would effect you…Looks like Lacey is going to be becoming an expert LOL
Hahaha… Nice try. I would do the same exact thing if possible!!
(Actually, a very large number of people do this exact same thing on the Gulf Coast during hurricane season. Therefore the property/flood insurance markets pretty much shut down once there is a “named storm” in the Gulf of Mexico essentially stopping people from buying insurance right before a hurricane.)
But, with health insurance there are “open enrollment periods” that have been set-up to combat this very issue. Meaning, other than a few exceptions like having a baby or getting married, you are only allowed to purchase or change plans during these short “windows” of time.
Currently, the open enrollment ends March 31st, 2014. This means after this date you are not allowed to switch between plans or drop your plan and then buy a new one at a different level. You would need to wait for the next “enrollment period” to buy insurance.)
Please don’t laugh too hard, but wtf if GFY?
gofuckyourself.com its a webmaster resource board mostly its a lot of people acting retarded but theres some good info for webmasters there if ya take the time to weed through the would you hit it threads
I got this one Lacey!
U.S. citizens living in a foreign country are not required to get health insurance coverage under the Affordable Care Act. If youāre uninsured and living abroad, you donāt have to pay the fee that other uninsured U.S. citizens may have to pay.
Generally, health insurance coverage in the Marketplace covers health care provided by doctors, hospitals, and medical services within the United States. If youāre living abroad, itās important to know this before you consider buying Marketplace insurance.
Expanding this:
You must be outside of the the USA for 330 days in a calendar year to qualify.
or
You must qualify under IRS requirements to be a ābona fide residentā of a foreign country. http://www.irs.gov/pub/irs-pdf/f2555.pdf
Omg, that’s what I thought… but, then I thought no way it refers to go fuck yourself.
Awesome.
@Mike: oh, I know the $95 or 1% is a fine, not coverage- that’s why i said “oh well”….at this point, Texas, where i happen to reside, is still trying to find ways out of implementing the AHA, still trying to keep people OFF medicare, etc…if it actually does turn out to be $200/year for a single person making less than $15k annually i suppose i could swing that but my more immediate concern is my property taxes. No subsidies for that.
Texas is not a state known for giving a shit about the health of its residents- currently near the very bottom of the list of states with insured residents, very close to Mississippi (which is saying a lot)… I still don’t see how a family of four, which just means up to two adults working, many at crap jobs, will possibly be able to afford a “subsidized” $500/month plan.
Texas is not a state known for giving a shit about the health of its residents- currently near the very bottom of the list of states with insured residents, very close to Mississippi (which is saying a lot)… I still don’t see how a family of four, which just means up to two adults working, many at crap jobs, will possibly be able to afford a “subsidized” $500/month plan.
Damn double posting- oh, i meant “medicaid,” not “medicare”….
@Art: i wouldn’t exactly call it “universal”-it’s still a compromise that placates the incredibly powerful insurance lobby. Very far from being a single-payer system that those in Canada, most of Europe, etc. have had for ages.
True. Regardless, the U.S.A. pays more per capita for health care except for Norway and Denmark.
@art: and it’s more per capita in the US despite a vastly inferior system controlled by Big Pharma, the insurance companies, and their lobbyists. The system is broken and the AHA is really not much more than a ten-dollar bandaid (commonly found on hospital
bills).
Now realize the “fine” is actually a tax collected by the IRS for not having insurance…and a little over 50% of the population pays $0 (that’s correct, NOTHING) in IRS taxes.
Maybe I don’t know WTF I’m talking about, but looks like fines will be few and far between considering the above.
As for Obamacare overall? There is no free lunch. The expense will come in poor coverage, plain and simple. Narrowing of available physicians within your network, etc. Not to mention the other stuff that’s coming along with it – like my employer reducing FTEs to part time status.
Obamacare is taking a problem (overpriced healthcare due to third party payers – health insurance and Medicaid/care) and making it a whole lot worse.
The only solution to providing adequate, lower cost, on-demand healthcare is free markets and catastrophic care insurance.
You’re just guessing, as are most others that are so adamantly against ObamaCare. From what I’m seeing at this point I’ll likely have better coverage than I do now, for about $150-$200/month less, without factoring in any gov’t subsidy.
Interesting they are using the IRS bona fide resident qualification for Obamacare.
Most of Obamacare is built around your tax return
Why is the goverment shutdown today? Thats what Donny might
Ask?
I thought it might be helpful to add this information on the “Obamacare” tread as well;
This is my friend with diabetes response to my inquiry asking what insurance he recently found that accepts his precondition.(.im not sure what his income level is at this time but by guessing from what he does for a living I think approximately 35,000 to 40,000 annually)ā¦..āI actually qualified for something called Healthy Way L.A Itās state funded and perfect for me. Itās FULL coverage and I love the doctors, dentists etcā¦ You have to live in L.A to get it though. Thanks for asking.āā¦.hope thatās helpfulā¦I donāt live in LA so im unaware of this programā¦.hopefully thereās something similar in your area if you donāt live there either….on a side note: Since its a State funded program its possible that his child support payments put him in a lower annual income bracket and help qualify him for this program.
The only thing I’d add to this is that there are significant subsidies available for families making up to $78,000 a year which reduces the cost of premiums. The Kaiser Family Foundation calculator is very helpful here. http://kff.org/interactive/subsidy-calculator/. If you’re not familiar with them KFF is one of the best agencies reporting on health care and health insurance issues.
@BT –
That IS a very good calculator!!! š
That’s a good add BT…thanks:)
I am much more passionate about the health insurance market than the porn market – which is the reason people run screaming from me at cocktail parties. It’s not a political stance, or driven by Obamacare. Although I have been employed since July by a small business that splits the cost of a pretty darn good (but expensive) health insurance plan with employees, I was self-employed for 30 years prior. I purchased health insurance in the private market from September 1984, when my wife left a corporate job and opened her own business, until this past July. In addition, I’ve been the treasurer of a good-size, local non-profit since 2000, where I pay the premiums for a Blue Cross/Blue Shield group plan for our director. Last, I was a consumer writer for a very well-known magazine from 2000 till 2012, and part of my job was writing about insurance – life, auto, homeowners and, yes, health. Well, last may be that our daughter had some serious health issues – fully recovered, knock on wood, but issues that resulted in several surgeries and a four-month recovery from complications following one of those surgeries.
In other words, I was living and writing about this stuff long before there was even talk of Obamacare. I’ve been a consumer of the product, I’ve studied and written about it, and had to put it in use for something more than office co-pays, annual physicals and blood work.
At one point during my daughter’s recovery, I took her into the hospital for a treatment. A hospital administrator took me aside, told me that our insurance was declining to pay for treatment for the complication, which was life threatening, and handed me a bill for $63,000. Before we were done, that bill ballooned to $250,000. I’m in my 50’s – $250,000 was half the value of my IRA at the time. In other words, half of my retirement savings from a 30 year career would have been wiped out with one illness.
Fortunately, the hospital worked with me and having followed this stuff as a consumer advocate, I was savvy enough to study the details of the health insurance policy and file an appeal. It took me nearly 4 months to resolve the issue with the insurance company. During that time, I paid the hospital $30,000 out of my pocket. Eventually, the insurance company agreed that they were responsible and paid the bill. I was reimbursed all the money that I had been required to pay in error – I had a high deductible plan, so I was responsible for about $7,500 and didn’t argue about that. But even the reimbursement took about 6 months because I had to get it back from the providers who had been over-paid. First I paid them, then the insurance company paid them, then they issued a refund.
Again, I was fortunate that I’d been a consumer reporter and was used to dealing with insurance companies. But it made me realize how vulnerable are most families if they don’t have a stellar plan form work or the government, come down with an illness that requires real insurance – not one of those crappy plans with a $3,000 cap – and are uninsured.
I would have been put in the position of having my daughter declare bankruptcy as a senior in college because she was 21 – legally, it really was her responsibility and not mine; selling or liquidating my wife’s business and probably remortgaging our home while in my 50’s; or liquidating half of my retirement savings at a time when I was about 12 years in retirement. In other words, one illness could have wreaked havoc on 30 years of doing all the right things when it came to working and saving and undone all of my carefully laid retirement plans.
What’s scarier is that my daughter didn’t have a chronic disease, like heart disease, diabetes or, like Cameron Bay, HIV. She developed a nasty, persistent staff infection following what should have been routine surgery. Something that happens in about 4% of all surgeries.
BT you have a lot of interesting insights to add to the topic of Healthcare…your personal experiences along with your work experience really helps paint the picture of how important good health insurance is….thank you for sharing your story I think it will go a long ways:)