One of the most hotly debated public health topics during the past few years has been the Patient Protection and Affordable Care Act (PPACA--or ACA, for short), the landmark legislation aimed at reforming our complex health care system. No matter what you think about the issue, the ACA will--or might already--affect you, even if you and your family are currently covered by an employer-sponsored health plan.
A Bird's-Eye Look at ACA's Provisions
If you're already insured, you'll find new benefits and protections. If you are not insured or if you purchase insurance on your own, a new state-based system will help you get coverage that fits your needs, perhaps at a rate more affordable than you could find before. If you choose not to get insurance, however, and aren't covered under an employer's plan, you may have to pay a penalty. The goal of the new system? Preventing situations like the one in which Cindy Crowley has found herself.
When she was laid off from her job at a start-up company in 2012, Crowley, 54, lost her health insurance. Her monthly $2,000 in unemployment needed to cover her mortgage, food, utilities, and car payment, as well as her daughter's college expenses, so she couldn't afford the $400-a-month premium to continue coverage under her employer's plan. Buying her own plan would cost hundreds, if not thousands, more--if she could even find coverage. Crowley knows she's been playing medical roulette.
She has already postponed her annual physical exam and mammogram because she can't afford the out-of-pocket costs. "It's scary," she says. "There are so many ways you can get hurt, and it would be financially catastrophic if something happened to me." (Everybody has different ways of dealing with a major life event. What's Your Coping Style?)
But Crowley can stop rolling the dice on January 1, 2014. That's when the cornerstone of the ACA kicks in: the insurance-coverage requirements. Also, the insurance you can purchase now through a state insurance marketplace takes effect that month, too.
Insurance Shopping Gets Simpler
If your employer (or your partner's employer) doesn't offer health insurance, you're self-employed, or you're unemployed, your new option is state-based health insurance exchanges. Insurance companies will offer individual plans through these marketplaces via Web sites that allow you to easily compare benefits, premiums, and costs. The law requires that plans use simple language to describe what's covered, so it'll be easier to see exactly what you're getting.
Beginning October 1, you'll be able to log on to your state's marketplace, enter the number of people in your household, their ages, whether or not they smoke, your annual family income, and the level of coverage you want, and up will pop an estimated premium for you and yours, as well as the amount of tax credit or subsidy you may be eligible for to help cover some or even most of the cost.
Those tax credits, depending on your income, could slash your monthly premium by more than half. Even a family of four with a household income up to $94,200 (based on 2013 estimates) qualifies for help.
Four health plan levels will be available through the state marketplaces. The plans should all cover the same services but will vary in the level of costs they cover: Bronze covers 60% of medical costs, silver covers 70 percent, gold covers 80 percent and platinum covers 90 percent of medical costs. The lower your out-of-pocket costs, the higher your premium.