What is Obamacare?

How Does the Affordable Care Act Affect You?

You may know it as Obamacare or call it health care reform. Perhaps you want to investigate your health benefits or you’re looking to enroll in health insurance. All of these are a part of The Patient Protection and Affordable Care Act, or the ACA, which has changed the way we use – and talk about – our health care.

No matter what you call it, the ACA means that all Americans have access to insurance, and all of us are required by law to be covered. In the year since the ACA was enacted, we’ve learned a lot about the kind of coverage people need, how much it really costs, and how to make enrolling simpler, swifter and more supported.

How We Got the Affordable Care Act

A Quick History of the ACA

Health care reform was a top priority for President Barack Obama from the first days he took office. Developing and passing a plan to bring health insurance to more Americans took time. But after a year of debate and multiple drafts, health care reform passed on March 23, 2010.

The reform legislation was first passed in a vote by the US Senate with a procedural rule called “budget reconciliation.” From there, it was sent to the US House of Representatives, where the ACA was approved in a close vote. Voting was sharply split along party lines. Although 34 Democrats voted against it, not one Republican voted for the bill. Passed with a lead of only seven votes, it was put in the hands of President Obama, who then signed it into law.

Today, all provisions of the ACA are in place. Health insurance is available for purchase by all Americans through marketplaces called “exchanges”, in accordance with the ACA.

In 2013, GoHealth signed an agreement with the US Federal Government that enabled us to enroll consumers in subsidized health insurance plans under the ACA. GoHealth was the first private exchange to do this. Today, we can estimate if you are eligible for tax credits, verify if you can participate in a Special Enrollment Period, and directly enroll you in the health insurance plan of your choice.

For more insurance news, wellness updates and information on health care reform, visit the GoHealth Blog.

Here’s a rundown of facts about the ACA and what that means for you.

Affordable Care Act Fast Facts

What We All Need to Know

  1. Most Americans are required to have health insurance.
    Know more: The ACA’s individual insurance mandate requires individuals who are not covered by workplace insurance benefits to enroll in coverage or face a fine.

  2. Health insurance is now more affordable.
    Know more: The government provides tax subsidies to help eligible Americans afford health insurance. Medicaid benefits have also been expanded to cover more people. Limited-income adults without children may qualify. And children may also be eligible for low-cost or free health insurance through the Children’s Health Insurance Program (CHIP).

  3. Insurers must now provide coverage for preventive care.
    Know more: The ACA requires health insurance companies to offer consumers free preventive services, like routine check-ups and physicals, to help detect diseases early and address conditions regularly. Seniors have access to no-cost preventive care.

  4. Health plans must cover essential health benefits.
    Know more: All health plans must offer the same set of essential health benefits. We will all be covered for services like hospitalization, pregnancy care, mental health treatment, prescription drugs, pediatric visits, dental care for kids, and more. See a full list of essential benefits here.

  5. There are new benefits just for women.
    Know more: Your insurance plan must cover contraception that is prescribed by a doctor and approved by the Food and Drug Administration. Some of these forms of covered contraception include birth control pills, IUDs, PlanB, diaphragms, sterilization procedures and other forms of birth control. Breastfeeding support, equipment and counseling are also available to all women, including the cost of renting or purchasing a breast pump.

  6. Pre-existing condition? Covered.
    Know more: You can no longer be denied coverage if you have a pre-existing condition, including pregnancy. Insurers cannot charge you more or reject claims for any essential health benefits for a medical condition you had before purchasing your plan.

  7. Dental coverage is also available for purchase.
    Know more: Some health insurance plans include dental coverage, or you may choose to purchase a separate, stand-alone dental plan for one monthly premium.

  8. Benefits for Medicare haven’t changed.
    Know more: The original Medicare program that was administered by the federal government hasn’t changed because of health care reform. However, seniors with Medicare Advantage may notice changes in benefits and a possible rise in premiums due to health care reform.

  9. Undocumented immigrants cannot buy insurance through exchanges or apply for Medicaid.
    Know more: Undocumented immigrants are not eligible to purchase health insurance through the exchanges, including full-cost, out-of-pocket coverage, and will not qualify for Medicaid.

  10. Most Americans must apply for insurance or change their coverage during Open Enrollment.
    Know more: The next Open Enrollment Period runs from November 15, 2014 to February 15, 2015. If you experience a Qualifying Life Event outside of those dates, you’ll be entitled to a Special Enrollment.

One More Very Important Fact

The Final Word on Why You Need Health Insurance

Most of us are required by law to carry health insurance. And if we don’t, we will face a fine.

Know more: Most Americans must have health insurance or face a fine, known as a tax penalty. For 2015, the tax penalty will be equal to 2 percent of income or $325 for each adult and $162.50 for each child, whichever is higher. The penalty will more than double in 2016 and will continue to increase years after that. You avoid this tax penalty if you have individual coverage, health insurance through your job, Medicaid, Medicare or CHIP, or qualify for an exemption. There is a one-time allowance for a lapse in coverage. If that lapse in coverage is less than three months, you will not be fined.

Are There Exceptions to the Rule?

You May Qualify for an Individual Health Insurance Exemption

Most Americans who do not have health insurance through their employer must purchase their own health plan or face a fine. You may be exempt from this ACA requirement if:

  • You live below the poverty line. If you do not have to pay taxes because your income is extremely limited, you may not have to purchase health insurance.

  • You are a member of certain faiths. Practitioners of religious sects that have been in existence since 1950 or earlier and outline conscientious opposition to accepting public or private insurance benefits may be exempt. The Amish, for example, are considered exempt.

  • You are a member of Health Care Sharing Ministries(HCSM). Nonprofit organizations with HCSM status offer members of the same faith and lifestyle a clearinghouse to share medical expenses and burdens. These HCSMs are exempt from the health insurance mandate.

Need Coverage for Your Whole Family?

What to Know for Your Children and Young Adults

Children must have health insurance coverage, too. The ACA offers several coverage options for children, and may fine parents or guardians who do not secure a plan for them. Children and young adults up to age 26 can be added to a health insurance plan purchased by a parent through an exchange, or the parent may purchase a separate plan for each child. Families with limited income may also apply for free or low-cost health care coverage through the Children’s Health Insurance Program (CHIP).

How can the Children’s Health Insurance Program(CHIP) help?
More than 7 million children and teens nationwide have free or low-cost health insurance thanks to CHIP. Each state runs its own CHIP program and is jointly funded by the federal government and that state. Children aged 19 years old and younger who have no other coverage available, and are US citizens, US nationals or Qualified Aliens are eligible to apply.

What about young adult children?
Young adults can now be covered on a parent’s health insurance plan until the age of 26. The ACA stipulates that they qualify even if they are not financially dependent on parents, are eligible for an employee insurance plan, are married, are not living at home or with family members or are attending school full-time.

Are You an Employer?

What Health Care Reform Means for Your Business

Starting in 2015, the Affordable Care Act’s employer mandate will require businesses with more than 50 full-time employees to offer health insurance coverage to workers who clock at least 30 hours per week. Employers who do not will be subject to a tax penalty.

The cost of not offering employees health insurance
Large businesses must offer affordable health insurance to employees. Employers who don’t offer health insurance may be subject to penalties of $2,000 per employee. There is also a penalty for plans not deemed affordable. For each employee who qualifies for insurance subsidies and purchases their own coverage through a public exchange, employers will be fined $3,000.

Is my business eligible for tax credits?
Some small businesses are eligible for tax credits for offering employees health insurance. Credits are determined by a sliding scale and range from 35 percent to 50 percent. Small business operators who employ no more than 25 people, and with employees who earn no more than $50,000 in average annual wages, may apply for tax credits.

Are you self-employed?
If your business generates income and you do not have other employees on the payroll, you are considered self-employed. You are eligible to purchase your own health insurance plan. If you have one or more employees – people who perform services for your business or receive a W-2 at the end of the year, for example – you have the option of offering health insurance to your staff. Your business may be eligible for tax credits if you do.

Two More Options for Your Small Business

How You Can Help Your Employees Stay Healthy

Employers contribute to employees’ health insurance
Large businesses must offer affordable health insurance to employees. Employers who don’t offer health insurance may be subject to penalties of $2,000 per employee. There is also a penalty for plans not deemed affordable. For each employee who qualifies for insurance subsidies and purchases their own coverage through a public exchange, employers will be fined $3,000.

Employees can then purchase their own health insurance plan through a private exchange, and are responsible for any costs that exceed the contribution stipend. Employers who offer defined contribution get the benefits of providing a uniform system for all workers to obtain health insurance and cover costs of care, while reducing their own paperwork and logistics of managing enrollment.

Reimbursing medical costs with HRA funds
Employers can also offer Health Reimbursement Arrangements (HRAs), funds that supplement health insurance benefits between businesses and employees. Employers create a tax-deductible fund in an account approved by the IRS to draw reimbursements for employees who have qualified medical expenses. HRAs can be in any amount – there is no minimum or maximum contribution by the business – and they roll over year after year.

Want More Information?

How Health Insurance Exchanges Work

The marketplaces where you can find information about health care coverage and purchase plans are called health insurance exchanges. While visiting the exchanges online or discussing them over the phone, you can view and compare organized, certified health plans. Exchanges also offer educational services and information to help you understand all of your options.

States have options in what kind of exchange they offer to their residents. The ACA requires each state to establish at least one exchange or merge with other state exchanges or partner with the federal government to operate an exchange. States have a final choice to opt out completely and let the federal government take control of their exchange.

As a private exchange, GoHealthInsurance.com allows you to compare thousands of health plans from top carriers in your area, and unlike other exchanges, our expert licensed insurance advisors are standing by to guide you through the enrollment process.