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The Patient Protection and Affordable Care Act (PPACA), known as Obamacare, reformed the healthcare industry to make affordable insurance available to all Americans. Obamacare is designed to eliminate discrimination based on preexisting conditions and prevent insurance companies from dropping sick patients, as well as expanding Medicaid. Whether you're uninsured or you want to find out if Obamacare will provide better coverage than your current health insurance, it's a good idea to learn about how the new system works. See Step 1 and beyond to get started.
Steps
Understanding the Basics
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1Learn how Obamacare has affected healthcare. Obamacare introduced a list of new provisions to regulate insurance companies' policies and expand health coverage to tens of millions of people. Under Obamacare, insurance companies are obligated to provide coverage and benefits that they were not previously required to offer. As of January 2014, qualifying health care plans must do the following:
- Cover people with preexisting conditions and not drop people who become ill
- Stop making unjustified rate hikes
- Allow you to appeal company decisions
- Provide the Ten Essential Health Benefits, including emergency care, hospitalization, prescription drugs, maternity care, and newborn care
- Provide free preventative services such as yearly physicals, immunizations, and screenings
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2Understand how Obamacare works on the state level. Each state provides a marketplace, also known as an exchange, which showcases a list of that state's qualifying health care policies. The state marketplaces allow you to "shop" for an affordable policy with the kind of coverage you and your family need. Each policy has a monthly premium that you pay in order to receive insurance coverage.
- In the states' marketplaces, the cost of the plans depends on your income.
- If you earn less than $45,960 per year as individual or $94,200 as a family of four, you may be eligible to receive cost assistance subsidies and get low-cost or free insurance. You may also be eligible for Medicaid, which will required a separate application.
- Even if you're already insured, you may still want to consider opting for plan listed in your state marketplace. Plans that existed several years before the PPACA was passed have been "grandfathered in," and aren't obligated to provide all of the same benefits that qualifying health care plans provide. It's worth comparing your plan to those in your marketplace to decide which is best for you.
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3Figure out how Obamacare will affect you and your family. As of 2014 the PPACA mandates that every American needs to have a health insurance plan in place, get an exemption, or pay a penalty tax. This is a way to make sure that as many Americans as possible get insurance coverage.
- If you don't have insurance coverage, you need to sign up for a plan offered by your state marketplace or get an exemption by March 31, 2014. If you don't sign up for a plan before the deadline, you can sign up in any subsequent month. However, for each month you aren't covered, you'll be obligated to pay a penalty.
- If you already have an insurance plan that qualifies for Obamacare, whether through a private company, COBRA, Medicaid, Medicare or another qualifying plan, there's no action you have to take. Your health insurance company should provide some of the benefits stipulated by PPACA without you having to make a change.
- If you have an insurance plan that was "grandfathered in" and is not subject to the Obamacare provisions, and you're not happy with your coverage, check into your state marketplace and sign up for a new plan as soon as possible.
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4Take action to sign up for Obamacare. Follow the steps in the next method to sign up for Obamacare before March 31, 2014 to avoid penalties. Whether you're uninsured or you want to find out if your state marketplace provides plans with better coverage than the one you currently have, it's important to have your plan set up as soon as possible. If you miss the deadline and remain uninsured, you can still sign up, but you'll be subject to a penalty tax. Keep reading to find out how to get your new health coverage.
Comparing Plans and Signing Up
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1Go to the Health Insurance Marketplace. Visit https://www.healthcare.gov/marketplace/b/welcome/, where you'll be prompted to enter your state. Once you enter your state, you'll be redirected to your state healthcare marketplace site.
- If you want to speak with someone in person, call 1-800-318-2596, a help hotline staffed 24/7 by people who can guide you through the process.
- Note that each state site looks different and has slightly different options.
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2Enter your information. Once you're on your state site, you'll be prompted to supply information about where you live, how many people in your family are applying for insurance, and your annual household income. Once you enter this information, you'll be given a list of plans that you're eligible for.
- If you'd prefer not to enter this information online, or if you'd like help navigating the marketplace, you can always call your state marketplace contact number to receive live assistance.
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3Find out if you qualify for subsidies or an exemption. If you think you might qualify for a subsidy or exemption, and you want to know more information, follow the steps offered for obtaining that information. You'll need to enter your social security number and personal tax and income information to get this information.
- States determine what subsidies you qualify for based on your household income and other factors.
- If you qualify for major subsidies, you might be eligible for Medicaid, which could provide free healthcare for you and your family with all the Obamacare benefits, depending on which state you live in. To find out if you're eligible for Medicaid with Obamacare benefits in your state, see https://www.healthcare.gov/do-i-qualify-for-medicaid/.
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4Compare plans. All of the plans will offer the Ten Essential Benefits and all other Obamacare benefits. They are grouped into four different categories according to how much coverage they provide. The plans with the most coverage also have the highest monthly premiums.
- Platinum plans have the highest premiums and cover all but 10% of your health care costs.
- Gold plans have slightly lower premiums and cover all but 20% of your health care costs.
- Silver plans have even lower premiums and cover all but 30% of your health care costs.
- Bronze plans have the lowest premiums but you'll have to pay up to 60% of your own health care costs.
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5Purchase the plan you want. Your state marketplace website will direct you to instructions on how to purchase the plan you have chosen. You can purchase a plan online, through a broker, or directly from the insurance company.
- You'll need to submit your payment at least 15 days before your coverage begins. After that, you'll be billed monthly or according to the payment plan you set up.
- If you sign up for insurance before March 31, 2014, you won't have to pay the penalty tax. If you sign up after that date, you may have to pay the tax in addition to your first monthly premium.
Making the Most of Your New Healthcare
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1Hold your insurer accountable if necessary. Your insurer is required to have transparency. Your provider must tell you what they spend on administrative costs, and they will have to give you a rebate if their overhead is unusually high. This means your insurance premiums are primarily used for your health coverage, and not for office overhead.
- The insurance coverage limits do not have lifetime caps or annual caps.
- You cannot be dropped from a policy if you get a serious, long-term illness.
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2Take advantage if you're an early retiree. Early retirees get expanded coverage.[1] The law provides money so that early retirees can continue getting their health care coverage through their former employer until they are eligible for Medicare.
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3Find out if you qualify for a tax credit. Low income Americans may qualify for a health insurance premium tax credit. Qualified citizens can take the credit (even if they don’t have a tax liability) and arrange for the tax credit to be paid in advance directly to the insurance company of their choice. This credit will be applied towards the premium. Talk with a broker at your state marketplace for further details.
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4Don't hesitate to opt for preventative health procedures. Health insurers must provide coverage for preventative health procedures without imposing additional fees or co-pays. Your health insurance plan must include preventative screenings for:
- Abdominal Aortic Aneurysm
- Alcohol misuse (includes counseling)
- Aspirin (age restrictions for stroke prevention)
- Blood pressure
- Cholesterol (age restrictions/higher risk patients)
- Colorectal cancer (age restrictions)
- Depression
- Type 2 Diabetes (for adults with high risk)
- Diet (for adults with high risk of dietary-related disease)
- HIV (for adults at high risk)
- Immunization (Doses and age restrictions vary according to risk. Go to Vaccines.gov [2] for a schedule of adult vaccinations.)
- Obesity
- STI (sexually transmitted infections, including Syphilis)
- Tobacco use (includes cessation treatments)
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5Get the services you qualify for as a woman. The following prevention-related health services must be covered at no additional cost:
- Breastfeeding (support, counseling and supplies)
- Contraception (methods and sterilization procedures approved by the FDA; does not include abortifacient drugs)
- Domestic violence (includes counseling)
- Gestational diabetes (for women at high risk)
- HIV (includes counseling)
- HPV (Human Papillomavirus)
- STI (Sexually transmitted infections)
- Well-woman physician visits (to get advice on recommended preventative services)
- Anemia
- Bacteriuria (urinary tract infection) for pregnant women
- BRCA (genetic testing for women at high risk for breast cancer)
- Mammography (every two years for women over the age of 40)
- Breast cancer chemo prevention
- Cervical cancer
- Chlamydia infection
- Folic acid (supplements for women who may become pregnant)
- Gonorrhea (for women at high risk)
- Hepatitis B (first prenatal visit)
- Osteoporosis (women over age 60 and for women at high risk)
- RH incompatibility (for pregnant women)
- Tobacco use
- Syphilis (for pregnant women or women at high risk)
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6Take advantage of services for children. Parents can keep their children on their health insurance policies until they reach the age of 26. This means you will be able to provide health insurance for your child all the way through college, if necessary. These preventative screenings, tests and supplements apply to all children under the age of 18:
- Alcohol and drug use
- Autism
- Behavioral assessments and developmental screening (including depression)
- Blood pressure
- Congenital hypothyroidism and Dyslipidemia
- Fluoride chemoprevention and oral health screenings
- Newborn screenings including gonorrhea preventive medication, sickle cell, PKU and hearing screening
- Height, Weight and Body Mass Index measurements and obesity screenings
- Hemoglobin
- HIV screening and STI prevention counseling for adolescents at higher risk
- Immunization vaccines
- Iron supplements (for infants at risk for anemia)
- Lead poisoning (for children at risk of exposure)
- Medical history for all children throughout development
- Tuberculin testing for infants and children at higher risk of tuberculosis
- Vision screening for all children
Warnings
- This article touches on the main points of the new law. The bill itself comprises 2,700 pages. You can read the bill in its entirety at Healthcare.gov.[3]⧼thumbs_response⧽
References
About This Article
To get Obamacare, visit healthcare.gov to sign up. Alternatively, you can call 1-800-318-2596 to speak with someone who can walk you through the sign-up process. When you're signing up, you'll need to provide information about where you live, how many people in your family are applying, and your annual household income. To learn how Obamacare works, keep reading!