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Mo Ivory: “Obamacare” – In Plain English

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(Credit: Sonia Murray/CBS Local)

(Credit: Sonia Murray/CBS Local)

Mo Ivory
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Tomorrow the biggest piece of healthcare reform goes into effect: the Patient Protection and Affordable Care Act, a.k.a. “Obamacare.”

Here are some simple answers to questions we all have.

What does Obamacare really mean?

It means 100% of Americans will have access to affordable health care insurance. If you already have insurance from your employer, then you will see changes in the essential health benefits and other requirements laid out in the law starting in 2014, including changes to co-pays, wellness visits, etc.

When does Obamacare go into effect?

Obamacare goes into effect on October 1, 2013 at which time any American that does not have health insurance can go online to healthcare.gov and basically shop for the best plan to fit their lifestyle and look for the best rates. Think going online to get car insurance with several options at your disposal. Simply put, the law doesn’t sell health insurance, it just creates a marketplace for Americans to buy regulated, subsidized private insurance.

Do I have to get health insurance?

Yes, you have to buy health insurance, it’s the law and you must have insurance by January 1, 2014. If you don’t get health insurance, you will pay a fee. The fee will be 1% of your annual income or $95 per person – whichever is higher. The fee for uninsured children is $47.50 each, with a maximum of $285 per family.

You will pay the fee through the IRS in your tax refund and if you don’t get a refund, you will be billed for it. You won’t have to pay if you’re uninsured for fewer than three months of the year, have “very low income” and can’t afford insurance or don’t have to file a tax return, are a member of an Indian tribe or a recognized religious sect that objects to health insurance.

RELATED: Georgia & The Affordable Care Act

What are my options for health plans in the new marketplace?

Plans are divided into four categories: bronze, silver, gold and platinum. The platinum plan has the highest premiums or monthly costs and the bronze plan has the lowest premiums. Another option for people under 30 and certain low-income people is a high-deductible catastrophic plan. They typically have lower premiums, but require you to pay up to several thousand dollars out of pocket. These plans aren’t eligible for subsidies. To see the difference between the four plans, go to http://www.healthcare.gov.

What do the plans cover?

All individual and small group health plans must offer certain products and services known as “essential health benefits,” whether they’re sold on the marketplace or not. The benefits fall within 10 categories, including emergency services, maternity and newborn care, substance use disorder services, chronic disease management, pediatric care and other services. While all plans offer essential health benefits, some may include other features not advertised on the marketplace, such as an online service for finding low-cost prescriptions or the option to receive medical advice and prescriptions over the phone or online.

How much will it cost?

The cost will depend on a person’s age, family size, tobacco use, income and geographic location (some states will be more than others). It is said that the average nationwide cost of basic coverage will be about $249 per month, not including tax credits that could reduce the cost for most Americans. A great resource and calculator to figure out cost can be found at http://kff.org/interactive/subsidy-calculator/.

Will there be financial assistance or subsidies?

Americans in certain income levels can apply for tax credits or subsidies to help offset the cost of plans purchased on the health care exchange. The tax credits are sent to the insurance company so enrollees don’t have to pay that money up front. The tax credits are available to individuals and families with incomes between 100 and 400 percent of the poverty level. That amounts to up to $45,960 for an individual and up to $94,200 for a family of four in 2013. For example, a family of three with an annual income of $29,000 could get $7,078 toward an annual premium of $8,250, leaving out-of-pocket costs at $1,172, according to Families USA.

How do I apply for coverage and subsidies?
To apply, visit http://www.healthcare.gov or call 800-318-2596 starting Oct. 1.

Who can help me apply?
The law has provided for funding for people and organizations called health insurance navigators that are trained to help consumers and businesses shop for and purchase insurance on the marketplace. They are required to provide free, unbiased assistance. You can find them at https://www.healthcare.gov/glossary/navigator/.

DO YOU STILL HAVE QUESTIONS?

Here’s where to go for help:

The federal government has a hotline and website available 24 hours a day, seven days a week. Call 800-318-2596 or live chat at healthcare.gov/chat. Spanish speakers can visitCuidadoDeSalud.gov, and translators for more than 150 other languages are available at 800-318-2596. Also, the nonprofit, non-partisan Kaiser Family Foundation has a health reform website with a wealth of information, including helpful tools like a subsidy calculator and animated video that explains the key parts of the law. It can be found at http://kff.org/health-reform/.

Start learning how the Affordable Care Act affects you. Visit ACAStart.com.

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