Breaking Down The Affordable Care Act

Flu time

A recent survey by the Kaiser Family Foundation found that slightly more than half of all Americans (51%) say they’re still not sure what the health care reform law means for them. About 4 in 10 people aren’t sure if the law is still in effect.

Key points of The Affordable Care Act or Obamacare:

Most people will NOT pay a penalty

The penalty will be $95 per adult and $47.50 for each child, or 1% of your income, whichever is greater – The maximum penalty for a family is $285

9 out of 10 working-aged adults will not be subject to the penalty

Open enrollment runs from October 2013 through March 2014.

Most people who are UNINSURED WILL QUALIFY for financial assistance to buy a new policy.

The Affordable Care Act is to help people get good-quality and reasonably priced health coverage if they don’t already have it.

Assistance is available for those who make less than 400% of the federal poverty level, or $45,960 for an individual or $94,200 for a family of four.

About 26 million adults under age 65 who are uninsured will be required to buy insurance or face a penalty. Two-thirds of that 26 million can get the coverage for free or at a reduced cost.

11 million of those will be eligible for a government subsidy (a type of financial aid)

About 8 million who can get the coverage for free or nearly free through Medicaid or the Children’s Health Insurance Program (CHIP).

According to The Kaiser Foundation – Most people – most of the uninsured, and about half of people buying individual insurance already, will be eligible for tax credits

Only policies purchased through one of the new state Marketplaces are eligible for tax credits.

Women get important new benefits and will see the biggest change. They won’t be charged more than men.

Women will see some of the biggest benefits from the law.

If you meet age requirements, health checks such as mammograms, bone scans, pap smears, pelvic exams, colonoscopies and a host of other tests are offered at no charge to patients, not even copays.

Birth control is free to women, as is the doctor’s visit to determine the best CONTRACEPTION to meet the patients needs.

Beginning in January, a woman can’t be charged more than a man for health insurance. Right now, 36 states allow insurers to charge women more — and 92% of popular plans in those states charge women between 20% and 40% more than they charged a man of the same age.

Beginning in 2014 – benefits for self-employed women. Previously, most individuals insurance policies did not cover maternity care.

With insurance, women pay, an average of $3,400 out-of-pocket to have a baby.

Without insurance, the cost averages $30,000 for a normal, healthy delivery and $50,000 for C-section. Complications in labor or delivery can easily multiply that cost considerably.

In January, all insurance plans sold to individuals will have to cover maternity care including costs of breastfeeding supplies, like breast pumps.

You can buy health insurance even if you’re already sick and pay the same price for coverage as a healthy person of the same age.

Before, insurance companies could refuse coverage. They could comb through patients’ medical records, looking for any indication of existing illness. Insurance companies were free to define pre-existing conditions, which could range from serious and ongoing problems like diabetes or cancer, to a long-forgotten ailment like an old sports injury.

Companies could deny coverage altogether or could offer limited policies or charge higher rates that were unaffordable for many.

A recent study found that 1 out of 5 adults under age 65 has a pre-existing condition that would disqualify them from health coverage prior to ACA.

Prices will be based on three things: your age, where you live, and whether or not you smoke.

If the insurance at your job costs too much or doesn’t cover enough of your health costs, you may be eligible to shop on your Marketplace and for financial assistance.

For most people, the best deals will come from health insurance policies that are part of your benefits package at work or bought through the new  Marketplaces .

The Marketplace is the only place you can use tax credits to help pay for your plan.

If you’re self-employed and make too much money to qualify for tax credits, you should look for coverage outside the Marketplace

All new plans sold on the individual market will have to meet minimum requirements

Requirements vary a bit from state to state, but all new plans will have to cover 10 essential benefits, including some that were often missing from individually purchased plans in the past, such as coverage for mental health problems, substance abuse, and maternity care.

Marketplace plans may have lower administrative costs than plans you might buy through an insurance broker.

Administrative costs of plans in the Marketplaces range from about 1.5% in states that are running their own Marketplace to 3.5% in states where the federal government is operating the Marketplace

Commissions to brokers providing individual plans and that are added to the premium usually run into the double digits.

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