- Just about everyone in the U.S.—except for foreign tourists, undocumented residents, prisoners, and a few other exceptions—will be required to have some kind of health insurance.
- If they don’t, most will have to pay a penalty at tax time of $95 per adult and up to $285 per family for the 2014 tax year, and that escalates to $695 for adults and $2,085 for families in 2016.
- The long-standing insurance-company practice of turning people down or charging them extra because of pre-existing conditions will be outlawed.
- Low- and moderate-income households will get financial help in the form of a new kind of tax credit that they can use right away to help pay for premiums.
A new health marketplace
The centerpiece of the transformed health care system wrought by the Affordable Care Act is an entirely new way of choosing and purchasing individual health insurance known generically as marketplaces. They open for business Oct. 1, 2013, in every state, whether the state is willing or not.
This year only, marketplace open enrollment will run from Oct. 1, 2013, through March 31, 2014. In subsequent years, it will take place on the same schedule as Medicare open enrollment: Oct. 15 through Dec. 7.
In the marketplace, a kind of virtual insurance store, millions of Americans will be able to sign up for the plan of their choice, just like that, no questions asked about their medical history. Well more than half will get the welcome news that they have income-based tax credits coming to them to help pay the premiums.
In addition, about 4 million of the poorest Americans will become newly entitled to free or ultra-low-cost Medicaid coverage, which they can apply for on the spot in their state’s marketplace. It’s one of the most significant expansions of this government-paid health program since its creation in 1965. But at least 5 million more will live in states that have decided not to expand Medicaid in that way, leaving them uninsured and too poor to get tax credits.
Judging from the decibel level of the public argument, you’d think that the new health law will upend the health insurance of practically everybody. But that’s not the case. At least 80 percent of Americans will notice almost no change because they already have insurance that meets the law’s requirements.
That includes the 49 percent of Americans who get health insurance through their or someone else’s job, as well as people who get insurance through the government. That includes Medicare, most Medicaid coverage, CHIP (health insurance for children in low-income families), some Veterans Affairs coverage, and Tricare (health insurance for active-duty military, retirees, and their families).
Although the law applies across the land, how you experience it will depend on your state. Some states have embraced the law. They’ve been working on their marketplaces for some time and have leaned on insurance companies to give consumers a good deal. In those states, you’re likely to see lots of ads and public-service announcements and find it easy to get information about the new law.
But other states have been less gung-ho. As of now, 22 are not expanding Medicaid, and three more are still debating it. Thirty-four have forced the federal government to run their marketplaces in whole or in part, a development that is putting federal officials under deadline pressure.
This report explains what you need to do to get ready for the new law, depending on
whether you now get insurance:
- Through work.
- On your own or not al all.
- Through Medicare.
For more detailed advice and calculators that can help you determine your eligibility for subsidies and links to state-run marketplaces, go to our comprehensive online guide at HealthLawHelper.org.
Regardless of how you get your insurance, also check out the rankings of health insurance plans, which can help you choose a plan.