Obamacare by the Numbers
American citizens that plan to sign up for the Affordable Care Act (Obamacare) can do so now. The U.S. Centers for Medicare & Medicaid Services has established a website for the Health Insurance Marketplace, one that opened on Oct. 1, 2013. Not every person must be part of the marketplace and there are some important dates and numbers to remember.
Launch Date: The first day for signing up for health insurance was on Oct. 1, 2013. Regardless of the state where you reside, you can use the federal website to compare your marketplace options and find a plan that is on budget and meets your needs. You can also visit your current insurer’s website to learn what plans are available through them.
When Coverage Begins: Your health insurance coverage via the marketplace can begin on Jan. 1, 2014. You must be signed up by Dec. 15, 2013, to have your coverage begin on Jan. 1.
Last Day to Enroll: Americans must sign up for coverage no later than March 31, 2014. Those that do not may be charged a fee equal to 1 percent of their yearly income or $95 per year, whichever is higher. The fee for uninsured children is $47.50; the most any family would pay is $285 per year. If you do not sign up by March 31, you won’t be able to get insurance through the marketplace until the next annual enrollment period. However, if you have a qualifying life event (a new baby, marriage or divorce) you can make changes later.
Your Cost: Your monthly premium will vary and will be based on your estimated income for 2014. You need to determine what your expected income will be and use that figure when applying for health insurance. Based on your information, several plan options will be offered. Insurers may offer plans based on “metallic” levels: platinum, gold, silver and bronze. Platinum offers the most comprehensive coverage; bronze the least.
Network Options: Health care plans vary by insurer. Your choices will likely include limited and large network with the option of using doctors within and outside of that network. Expect that your out-of-network costs to run double what you’d pay in-network.
Prescription Drugs: The cost you pay for prescription drugs will depend largely on the plan you choose. Some plans offer a percent discount, ranging from 30 to 50 percent. Other plans set a price limit based on the tier drug selected. Those tiers range from 1 for generic to 5 for specialty and higher cost drugs. Tier 2 represents non-preferred generic drugs, tier 3 is for preferred brand drugs and tier 4 is for non-preferred brand drugs. Your costs may range from $4 to $10 or more for tier 1 to a 25 to 30 percent discount off of the cost of tier 5 drugs.
Co-Pays: Every visit to your doctor will likely result in a co-pay. Your cost per visit will range from as low as $5 to as much as the full cost depending on your coverage selected. Many plans offer co-pays ranging from $15 to $25 per visit. Some plans offer 50 percent discounts off of each doctor’s office visit.
Annual Deductibles: Your annual deductible may range from $500 to $11,000 per year or more depending on your state. That is an individual amount. For families, double that figure for deductibles ranging from $1,000 to $22,000 per year. The higher your deductible, the lower your monthly premium.
Obamacare Exceptions and Exemptions
Not everyone is required to sign up for Obamacare. The first group is for people that make too little money to afford health care. Likely, they’re getting Medicaid or Medicare if over 65.
Another group of exempted folk include native Americans who get care through an American Indian healthcare provider. Also, certain people whose religious beliefs conflict with government assistance — such as the Amish and Mennonites — are exempt. Christians that belong to a medical care sharing community also may opt out.
Another group includes the president and his family, Congress and those that have secured waivers including more than 1,200 companies and at least 500,000 union members. There are others, but the chances that you are part of the exception and not the rule are quite slim.