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- U.S. NEWS
- September 29, 2013, 7:32 p.m. ET
- By LOUISE RADNOFSKY
The rollout of the Affordable Care Act—also known as “Obamacare”—is approaching, and starting in October people will be able to sign up for new insurance policies that begin Jan. 1, when the law’s major provisions are set to go into effect.
Here’s what you need to know about whether and how the law affects you.
Q. I have coverage through my job. What happens to me?
If you’re one of the 171 million Americans with coverage through your job or your spouse’s job, the big changes in health insurance this fall might not affect you much. You may have recently received a letter from your employer telling you about your existing insurance plan, and how much the company pays toward the cost of your premium. Most likely, the company also told you that you have the opportunity to visit new health insurance exchanges to look at plans you could buy on your own, but that you wouldn’t be eligible for a federal subsidy for one of them because you’re already covered.
Q. Will anything be different about that coverage?
Some changes to employer-sponsored coverage have already kicked in. You may have noticed that you’ve been allowed to keep children on your plan up to their 26th birthdays, and that you no longer have to pay out-of-pocket costs for some preventive-care services including contraception. Some union-sponsored plans are about to undergo bigger changes, and so are skimpy benefit plans popular in the retail, restaurant and agricultural sectors, sometimes called “minimeds.” And as companies become even more conscious about their health costs, and face a tax starting in 2018, they’re expected to scale back some of their offerings. Some are excluding coverage for spouses who have access to insurance through their own employers. Some are changing the way they offer coverage by giving workers a fixed sum of money and letting them choose their own plan from a private exchange—which is different from the health law’s exchange.
Q. I have Medicare. What about me?
If you’re one of the 49 million Americans in the Medicare federal insurance program for the elderly, with or without a supplemental insurance plan, you’ll continue to enroll in coverage the same way you always have. You do not need to go to the new insurance exchanges to sign up for anything. If you’re already in Medicaid, the federal-state insurance program for low-income people, you may find you have to enroll in a slightly different way this year. Your state will tell you more about that.
Q. Are my benefits changing?
The law doesn’t directly affect Medicare benefits, but here has been a lot of discussion—especially in last year’s presidential elections—about the law’s impact on the program. That includes hundreds of billions of dollars in spending cuts, largely from reducing payments to hospitals and doctors and increasing incentives for more efficient care. Supporters of the law say this will strengthen the Medicare program in the long term. Opponents say that seniors in Medicare will find it harder to access their benefits if health-care providers are squeezed.
Q. I buy insurance on my own. What do I do?
Your insurer may be pushing you to renew your existing policy early, saying you can lock in a similar premium to the one you pay now. On Oct. 1, you’ll have the option of seeing new insurance plans available through the insurance exchanges in most parts of the country. You could also buy a plan directly from a carrier selling off of the exchanges, which would still be subject to new regulations. If you’re single making less than $46,000 a year, a couple making less than $62,000 or a family with slightly higher income levels, you may be eligible for a subsidy toward the cost of coverage, although the value of your subsidy will vary. You will only be able to use the subsidy toward coverage bought through the new insurance exchanges.
Q. What will change about my insurance?
The law includes many changes to the way the individual insurance market is regulated: Starting next year, your premium won’t be based on your medical history. That means that if you were previously denied coverage for certain conditions, or charged a higher rate because you were considered to be a bad risk, you might be getting a lower premium. If you were being offered a low rate because you were considered to be perfectly healthy, you could find yourself paying more. If you had a relatively skimpy plan that excluded certain coverage or had extremely high deductibles, you could also see bigger changes to your plan, including richer benefits, which will affect its price tag.
Q. I don’t have coverage. Now what?
If you’re one of the 46 million uninsured Americans, you’re the focus of the biggest effort in U.S. history to expand coverage. You may be subject to a penalty starting at $95 next year and rising in subsequent years if you don’t have coverage starting Jan. 1. You can go to the new insurance exchange in your state to shop for a plan, and depending on your income, possibly qualify for a federal subsidy to help pay for it. If you work more than 30 hours a week for a big company, your employer may have to offer you coverage starting in 2015. If your income is below 138% of the federal poverty level, you may qualify for Medicaid, depending on your state.
Q. How do I find these exchanges? Can you tell me more about these subsidies? What will I have to pay?
Here is our list of exchanges for all 50 states. Some 14 states are running their own exchanges. The other 36 have turned over part or all of the task to the federal government, and you can also find details about them here. Rates will still vary based on your age, whether you smoke, and where you live, with some differences within the same state, so you’ll need to go to the exchanges to get a detailed list of prices on offer. But you can see some sample rates already from the administration, for many parts of the country.
Q. Do I get to keep my doctor?
There’s nothing in the health law that directly affects whether you still see the same doctor as before. If you have coverage through your employer, little is likely to change. The same goes for Medicare, although doctors do sometimes decide to change the kinds of insurance they take. If you are seeking to buy a new policy, either for the first time or because you’re switching insurers, you may find that not every plan offered in your area has the same network of providers. If your doctor is very important to you, try to find out more about plan networks before deciding. Some of the lowest-priced policies on the exchanges are likely to have smaller networks of providers to help keep costs low.
Q. What if my situation changes?
The biggest changes in the health law directly affect only a relatively small group of people who don’t already have access to coverage through an employer or a government program. But many people who have access to insurance through an employer fear what might happen to them if they lose their job. They may benefit from changes in the individual insurance market, where insurers will no longer be allowed to deny coverage for pre-existing conditions, but the cost will depend in part on what happens to that market as the health law takes effect.
Write to Louise Radnofsky at firstname.lastname@example.org