Do I have to have coverage?
Yes. As of 1/1/15
You may qualify for an exemption if:
- You are uninsured for less than 3 months during the year;
- The lowest price coverage would cost more than 8% of your household income;
- You don't have to file a tax return;
- You are a member of a federally recognized tribe or Alaska Native Claims Settlement Act (ANCSA) shareholder or eligible for services through an Indian health care center;
- You are a member of a recognized health care sharing ministry;
- You are a member of a recognized religious sect with religious objections to health insurance;
- You are incarcerated;
- You are not lawfully in the United States.
You may also qualify for exemption if you have circumstances that affect your ability to purchase health coverage:
- You were homeless;
- You were evicted in the past 6 months or were facing evicition or foreclosure;
- You received a shut-off notice from a utility company;
- You recently experienced domestic violence;
- You recently experienced the death of a close family member;
- You experienced a fire, flood, or other natural or human-caused disaster which caused substantial damage to your property;
- You filed for bankruptcy in the past 6 months.
Failure to comply means in 2015 you will need to pay $325 per adult and $162.50 per child or 2% of income which ever is GREATER.
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.
Special Enrollment - Life changes
Did you know that life changes like moving, having a child, turning 26, losing your coverage, or getting married may qualify you for a Special Enrollment Period?
Even though the open enrollment period is over, you may still be able to get 2015 coverage if you’ve experienced a life change recently.
Important: If you qualify for a Special Enrollment Period, you’ll have 60 days from the time the life event occurs to enroll.
Special Enrollment Period - 2015
The Health Insurance Marketplace is providing individuals and families who owe the fee when they file their 2014 taxes with one last chance to get covered for 2015.
The Special Enrollment Period begins today, March 15 and ends on April 30. During this time, you'll have the opportunity to enroll in health coverage for 2015 if you owe the fee.
Important: The fee for people who don’t have coverage increases in 2015. If you don’t have health coverage for 2015, the fee is $325 per person or 2% of your household income – whichever is higher.
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 began coverage starting January 2014.
You can view the full text of the law on the GPO FDsys (Federal Depository Library System) site.
If you purchased a plan through Healthcare.gov in 2014, your insurance company should have sent you information on renewing that plan.
For 2015 plans, there is an Open Enrollment period.
The open enrollment period begins November 15, 2014, and ends February 15, 2015.
Policies purchased between November 15, 2014 and December 15, 2014 will become effective January 1, 2015.
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.
Each year there is 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.)
There are organizations approved to help individuals and businesses apply for health care coverage. Healthcare.gov provides a list of those agencies. Click here:
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: