September 29, 2013

Questions and answers about the Affordable Care Act's impact

HOW DO I KNOW WHETHER "OBAMACARE" APPLIES TO ME?

Pat Quinn, Kathleen Sebelius
click image to enlarge

Health and Human Services Secretary Kathleen Sebelius has played a key role in refining provisions of the Affordable Care Act, including oversight of states’ insurance marketplaces.

The Associated Press

Mitch McConnell
click image to enlarge

The clock is running out for Senate Minority Leader Mitch McConnell and other Republicans who are trying to delay the implementation of “Obamacare.”

The Associated Press

Related headlines

NEW ESSENTIAL BENEFITS

Starting Jan. 1, the following "essential benefits" must be included under all insurance plans that are considered "qualifying health plans" sold on and off the marketplace:

Emergency services

Hospitalizations

Laboratory services

Maternity care

Mental health and substance abuse treatment

Outpatient or ambulatory care

Pediatric care

Prescription drugs

Preventive care

Rehabilitative and habilitative (helping maintain daily functioning) services

Vision and dental care for children

Essential benefits are provided with no "cost sharing" on every insurance plan sold on Obamacare's Online Health Insurance Marketplace.

SOURCE: obamacarefacts.com

A: Polls show many Americans remain mystified by the Patient Protection and Affordable Care Act, or "Obamacare" as it is commonly known. But there's an obvious starting point: Do you have health care coverage?

If your employer provides health insurance for you, it's likely you don't have to do anything on Oct. 1, when enrollment begins. Enrollment continues through March 31. Coverage will start on Jan. 1.

For others -- those without insurance -- it's more complicated.

The law requires virtually all U.S. citizens and legal residents to have coverage or pay a penalty. That will happen either through an expanded government Medicaid program, which would cover costs for lower-income people, or by requiring people without coverage to buy it. Financial help will be available for those who qualify, based on income.

In Maine, expansion of Medicaid was rejected by Gov. Paul LePage. He vetoed an expansion of MaineCare -- as Medicaid is called in Maine -- earlier this year, effectively denying coverage to more than 70,000 uninsured Maine residents. The issue is likely to resurface when the Legislature reconvenes in January.

There are just a few exceptions to the requirement for coverage under the Affordable Care Act, including prison inmates, people who entered the country illegally, those facing financial hardship and religious objectors.

WHEN DO I HAVE TO DECIDE WHETHER TO BUY HEALTH INSURANCE AND WHAT HAPPENS IF I DON'T?

A: Beginning in 2014, virtually all Americans will be required to have health insurance or pay an annual penalty to the government. For an individual, the fine begins at a minimum of $95 in 2014, stepping up annually to a minimum of $695 by 2016. The fine for uninsured children in 2014 is $47.50 for each child, although the maximum a family would have to pay in penalties next year is $285. Those fees climb each year.

Federal researchers predict that about 6 million people could be hit with fines by 2016.

Those who owe penalties would see their tax refunds docked. Not everyone who fails to buy insurance will be forced to pay up -- those exempted from the requirement to have insurance, such as prison inmates, would not be penalized, for example. That also would be the case with people who earn so little that they are not required to file a tax return.

According to the government, the Internal Revenue Service plans to hold back the amount of the penalty fee from future tax refunds, but there are no liens or criminal penalties for failing to pay.

WHAT ARE THE HEALTH INSURANCE MARKETPLACES, PREVIOUSLY KNOWN AS EXCHANGES, AND HOW DO THEY WORK?

A: The marketplace is the online forum through which individuals and small businesses will buy private health insurance. Think of them as one-stop-shopping destinations similar to Amazon.com that are supposed to give consumers a quick way to compare insurance policies. Consumers are expected to be able to see all their options in the exchanges and choose their health plans based on price, deductibles and co-payments.

Maine residents who buy mid-level plans in the health insurance marketplace created under the Affordable Care Act will pay more than the national average but less than what individuals have paid in the past. Health care coverage is more costly in Maine because it is a rural state with an older population and lacks insurance competition, experts say.

(Continued on page 2)

Were you interviewed for this story? If so, please fill out our accuracy form

Send question/comment to the editors




Further Discussion

Here at PressHerald.com we value our readers and are committed to growing our community by encouraging you to add to the discussion. To ensure conscientious dialogue we have implemented a strict no-bullying policy. To participate, you must follow our Terms of Use.

Questions about the article? Add them below and we’ll try to answer them or do a follow-up post as soon as we can. Technical problems? Email them to us with an exact description of the problem. Make sure to include:
  • Type of computer or mobile device your are using
  • Exact operating system and browser you are viewing the site on (TIP: You can easily determine your operating system here.)