Federal Poverty Guidelines
Poverty, poverty levels, or the poverty rate is calculated several ways by the federal government. The Census Bureau caluclates poverty levels for determining the number of people living in poverty. That information is here.
The Department of Health and Human Services calculates US Federal Poverty Guidelines. The full explanation and charts for 2014 are here. The US Federal Poverty Guidelines for each year are published in the Federal Register, usually in January of the year covered.
Who is in charge?
There are three levels involved:
- US Department of Health and Human Services
The HHS does two main things: It provides a minimum threshold those policies must meet in terms of what they cover, and a maximum threshold those policies will cost anyone out of pocket who enrolls in them. (They have annual caps of a sort, but they're to protect the consumer, not the insurance company bottom line.)
- State-run Insurance Exchanges
Individual states only have to do one main thing: create and maintain a mega-website where residents of that state can find details on various insurance policies listed. This portion of the ACA is typically handled by the state's insurance regulation department. The exchange is where you will actually shop and compare policy features and choose the one best for you.
Louisiana does not have plans for a state exchange. Louisiana residents will participate in a federally-facilitated exchange. The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to establish and operate a federally-facilitated exchange in any state that is not able or willing to establish a state-based exchange. In a federally-facilitated exchange, HHS will perform all exchange functions.
- Insurance providers
The policies from private insurance companies come in various shapes and sizes, but all must meet the HHS-state mandated requirements. The out pocket premium cost for lower income people is not affected by age or preexisting conditions, it's a function of income and tobacco use. As you earn more, your age does become a factor, but the rates are still a big improvement and are calibrated to remain affordable for all tax brackets. Anyone earning less than federal poverty wages will be covered under the Medicaid expansion side of the Act.
What is the Affordable Care Act?
The Affordable Care Act (ACA) was passed by Congress and signed into law on March 23, 2010. The Affordable Care Act (ACA) has ten sections or Titles.
A brief outline of each Title, as well as the full text of the ACA can be found at The Affordable Care Act, Section by Section. The provisions of the ACA are being phased in over four years. On October 1, 2013, open enrollment in the Health Insurance Marketplace through HealthCare.gov begins for coverage starting as early as January 2014.
You can view the full text of the law on the GPO FDsys (Federal Depository Library System) site.
October 1, 2013 is the first date that you can begin purchasing new health care insurance. Policies purchased between October 1, 2013 and December 15, 2013 will become effective January 1, 2014
The open enrollment period begins October 1, 2013, and ends March 31, 2014.
After the initial open enrollment period, new policies purchased before the 15th of the month will be effective the first of the next month. Policies purchased after the 15th of the month will be effective on the first of the 2nd following month. For example, if you purchase your policy on February 20, your policy will be effective April 1, but if you purchase your policy on February 14, the policy will be effective March 1.
After the first year, there will be an annual open enrollment, just like there is for Medicare Part D or for an employer's health plan.
The official web site is Healthcare.gov.
What is Included
There are four levels of coverage — Bronze, Silver, Gold, or Platinum — based on the percentage the plan pays of the average overall cost of providing essential health benefits to members. The plan category you choose affects the total amount you'll likely spend for essential health benefits during the year. The percentages the plans will spend, on average, are:
- 60% (Bronze),
- 70% (Silver),
- 80% (Gold), and
- 90% (Platinum).
This isn't the same as coinsurance, in which you pay a specific percentage of the cost of a specific service.
Dental and Vision insursuance is automatically included for anyone under the age of 18. (If you are over 18, you will need to pay for dental and vision coverage.)
Do I have to have coverage?
Yes. As of 1/1/14
- Low-income individuals who cannot afford coverage;
- Undocumented immigrants;
- Indian tribal members and their dependents;
- Individuals with a coverage gap of three or fewer months;
- Members of certain religious sects;
- Individuals who are in prison;
- Low-income individuals in states that have opted out of the Medicaid expansion
- Employees whose employer has transitional relief, during the relief period.
Failure to comply means confiscation of tax refund starting at $95 or 1% for first year and rising to $695 or 2.5% of income by 2017.
Certified Application Counselors
To help individuals apply for health care insurance, indivduals will be able to become Certified Application Counselors. As of July 15, 2013, the requirements for becoming a counselor have not been issued, so there is no comprehensive list of counselors. The requirements are expected to be issued later in the summer.
If you have employer provided insurance
I you have job-based health insurance you like, you can keep it. You may be able to change to Marketplace coverage if you wish.
You can ask your employer if it plans to offer health insurance. If not, you may need to get insurance through the Marketplace or from other sources for coverage starting in 2014. If you do not have health insurance coverage, you may be subject to the fee (which will reduce any tax refund you are owed).
Apply through Healthcare.gov.
The Louisiana Healthcare Education Coalition (LHEC) was founded to help Louisianians better understand the Patient Protection and Affordable Care Act (PPACA). As a civic organization committed to providing unbiased healthcare and wellness information, LHEC will educate on the major drivers of healthcare costs, the critical importance of personal wellness and the need for access to quality healthcare by working with healthcare providers, small businesses, faith-based institutions, employers, community leaders, patient advocacy groups and the public. LHEC exists solely as an educational resource. It neither endorses nor seeks to create public policy.
The Kaiser Family Foundation is a non-profit, non-partisan private organization focused on health care issues. Here is their page on health care reform: