You’re hearing all kinds of things about health care reform, commonly referred to as ObamaCare (the Patient Protection and Affordable Care Act [PPACA] or Affordable Care Act [ACA]). But how much of what you’re hearing is TRUE? In addition to misinformation being passed around, scammers have been cropping up at an alarming rate. Here is a list of 6 things you need to know about ObamaCare if you’re an INDIVIDUAL:
(1) Unless you’re exempt under law, if you don’t have federally approved health insurance in place by January 1, 2014, you’ll be subject to a “shared responsibility payment.” Technically, this payment is NOT a fine or penalty–it’s a tax payable when you file your federal income tax return. [This provision of the PPACA is referred to as the Individual Mandate.]
(2) If you have insurance in place right now, the following plans meet requirements of “approved” health insurance under the PPACA beginning in 2014:
- Medicare Part A
- Medicaid, CHIP
- Federal Employees Health Benefits Program (FEHBP)
- any government plan
- any Indian tribal government plan
- any health plan offered in the individual or group marketplaces
The following plans will NOT be considered “approved” health insurance under the PPACA beginning in 2014: Medicare and TRICARE supplements, long-term care, disability, dental or vision plans (when issued without health insurance), accident-only, and workers’ compensation.
(3) The shared responsibility payment for individuals is the greater of an established amount per person (a family maximum applies) or a percentage of the family’s household income. For example, in 2014, each adult will be required to pay $95, each child will be required to pay $47.50, the family maximum is $285, and the percentage of family income is 1%. These figures increase until 2016, after which they’ll be adjusted by annual cost of living increases. In 2016, they’ll be $695 per adult, $347.50 per child, $2,085 family maximum, and 2.5% of family income.
(4) Exempt Americans (those who are not subject to the shared responsibility payment) include:
- individuals who are NOT required to file an income tax return based on income
- undocumented immigrants
- individuals serving time in jail or prison
- members of an Indian tribe
- members of a religion that is opposed to receiving health care (meaning the religion AND members are opposed)
- individuals whose employee-only cost of group health insurance is more than 9.5% of their household incomes
(5) Beginning in 2014, the manner in which health insurance is rated will change. NO health insurance rates may be based on a person’s health status or medical condition(s)–meaning pre-existing conditions exclusions and limits will no longer be permitted by law. Only four elements may be used when establishing premium rates beginning in 2014: age, the geographic location of residence, tobacco use, and whether enrollment is for an individual or a family.
(6) Premium tax-credits (i.e., federally approved reductions in the cost of health insurance) will be made available to Americans who buy health insurance from one of the Health Insurance Exchanges IF the following eligibility requirements are met:
- the individual is not eligible for Medicare, Medicaid, CHIP, TRICARE, employer-sponsored health insurance, a grandfathered plan, and a few other types of coverage (a few exceptions apply)
- household income must fall between 100% and 400% of the federal poverty level (FPL); in 2013, the FPL for a single individual is $11,490 and for a family of four it’s $23,550
Individuals purchasing insurance directly from an agent, as opposed to through an exchange, are NOT eligible for premium tax credits.
(7) Fraudsters are already capitalizing on consumers’ lack of familiarity with the provisions of the PPACA and people are being defrauded EVERY day as the deadline for compliance approaches. Here are some links for you to learn more about the Affordable Care Act and how to avoid becoming the victim of health insurance fraud as the PPACA rolls out:
- Health Insurance Basics and the PPACA
- Health Insurance Exchanges (referred to as the Health Insurance Marketplace)
- Protect Yourself against Health Insurance Fraud
- Excellent Web resource about health care reform (Kaiser Family Foundation)
- CMS’s Web page for health care reform
- U.S. Department of Labor’s Web page for health care reform
P.S. I’m qualified to talk about health insurance because I’ve worked for more than 30 years in the insurance industry as a licensed agent, consultant, instructor, and education provider. In fact, after selling the second of my two insurance agencies in 2011, I began working full-time as a course developer and writer, putting together insurance courses for continuing education and pre-licensing purposes. My clients are insurance companies, professional insurance organizations, and national and regional insurance education providers. I’ve developed and written several continuing education courses on the subject of the PPACA, including a two-hour webinar for A.D. Banker and Company that I present on a monthly basis.
P.P.S. Check in later in the week to learn about what businesses need to know about ObamaCare.
You don’t have to be an insurance agent to attend the A.D. Banker webinars I’m presenting on the Affordable Care Act … although you do have to pay for the presentations and CE filing fees. Cost: $27. Click this link for more information about A.D. Banker’s PPACA webinar. Upon arriving at the A.D. Banker website, click on Webinar and choose Health Insurance and the PPACA.
Click this link f you’d like to subscribe to my mailing list to be notified of about other webinars and presentations. I plan to begin presenting informational webinars about insurance to the general public before January. A nominal fee will be charged for these presentation (i.e., $5 – $10)