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ACA (Affordable Care Act) - Health Insurance

Resources for library users about the Affordable Care Act and insurance choices

Official Information

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 https://www.govinfo.gov/.

If you previously purchased a plan through Healthcare.gov, your insurance company should have sent you information on renewing that plan.

The open enrollment period begins November 1, 2018, and ends December  15, 2018.

Policies purchased between November 1, 2018 and December 15, 2018 will become effective January 1, 2019.

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.

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 eviction 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.

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 the most recently available year are here. The US Federal Poverty Guidelines for each year are published in the Federal Register, usually in January of the year covered.

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.)

Special Enrollment Period - Moving

Moving can be stressful, but enrolling in a health plan that suits your new life doesn’t have to be. If you’re moving, whether out of state or within your current state, you may be able to get Marketplace health insurance coverage with a Special Enrollment Period (SEP). This means you can enroll in or change your plan outside the annual Open Enrollment Period. In most cases, you’ll have 60 days from your move date to enroll in new coverage or change your plan.

Depending on where you move, you may have new options, prices, and savings available to you.

Not sure if you qualify? Answer a few quick questions and Healthcare.gov can tell you if you qualify and explain how to apply and enroll.

Special Enrollment Period - 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.

 

Check here to see if you qualify.

     

Louisiana Navigators

Navigators for a Healthy Louisiana is the Official Louisiana federally-facilitated marketplace.

They provide services, including in-person consultations, for individuals and for businesses in Louisiana. Their web site is here: http://lahealthcarenav.com/

or you can connect with them on Facebook: https://www.facebook.com/louisiana.navigators/

Here is one map from their web site/Facebook:

Louisiana state map with navigator contact information

Contact them directly for more information.

Local Help

There are organizations approved to help individuals and businesses apply for health care coverage. Healthcare.gov provides a list of those agencies. Click here:

https://localhelp.healthcare.gov/

If you have employer provided insurance

If 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. 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.

Additional Information

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:

https://www.kff.org/health-reform/