What You Need to Know About Obamacare

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This post first appeared in ThinkProgress.

If you’re confused about Obamacare, you’re not alone. Over the past several years, every survey on the subject has revealed that Americans consistently fail to correctly identify the provisions that are actually in the Affordable Care Act. In April, a poll found that 40 percent of Americans weren’t sure about whether Obamacare was still law at all.

Administration officials are racing against the clock to reverse those incorrect public perceptions, ramping up their outreach efforts before the health law’s new state-level marketplaces open for enrollment this upcoming week. As the open enrollment period draws near, you may be wondering how it affects you or what you need to do. Or you may simply want to understand more about the law that’s dominating the news. Here are simple answers to 20 questions about Obamacare that may have you mystified.

1. Will Obamacare end up costing me money?

It depends, but probably not as much as you’ve heard on the news. If you already have insurance through your job, Obamacare probably won’t directly affect your monthly premiums — and could actually end up saving you money in the long run by eliminating your co-pays for preventative care, like regular check-ups and STD screenings. If you don’t have insurance, on the other hand, you’ll be eligible for a plan on Obamacare’s new marketplaces and you’ll have to pay a premium for it. That’s more expensive than paying no monthly premium, but arguably cheaper than going uninsured and having to pay out-of-pocket for all of your health services. Depending on your income (and whether or not your employer offers an insurance plan), you could receive federal subsidies to help cover part of that premium.

There’s been a lot of talk about “rate shock” in reference to the marketplaces, but multiple studies actually project that the new Obamacare plans will be cheaper than expected. To calculate your premium, you can use this helpful tool from the Kaiser Foundation:


2. What if I already have health insurance?

The big changes under Obamacare mostly affect the Americans who don’t already have insurance. If you already have health insurance through your job, Medicare or Medicaid nothing about that will change. You’ll continue to have the same plan and it will continue to be administered in the same way. (You should receive a notice from your insurance company explaining whether or not your plan is compliant under Obamacare and notifying you about the new exchanges opening next month.) If you’re self-employed and you buy your insurance on the individual market, you might want to compare your current plan to the new plans that will be offered on Obamacare’s marketplaces — you could be able to choose a cheaper option.

3. If I’m keeping my current health insurance, does Obamacare benefit me?

Yes. Even if you’re not enrolling for one of Obamacare’s new programs, the health law has some benefits for you. There are two major things that fall into this category:

1. Before you get sick. All of the stuff that qualifies as “preventative care” will now be available to you at no out-of-pocket cost. That means no copay on a whole battery of tests including blood pressure screenings, vaccinations and STD/HIV screenings.

If you’re a woman, there’s a lot in this part of the law for you. Birth control — of all types — is now available to women without a copay. Not only does that mean you don’t need to shell out cash to get the pill, it also means you can get an intrauterine device (IUD), the most effective form of birth control, without paying anything out of pocket. If you want to have a baby, you’ll also feel the benefits of the law. More maternity care will be covered by the new law and, when your baby is born, your insurance company will now cover the cost of a breast pump.

The preventative care aspect of the law also provides women with HPV vaccines, mammograms, STD screening and domestic violence counseling. An estimated 27 million women are benefiting from these new provisions.

Note: Some individual plans, called ‘grandfathered’ plans, will be exempt from this provision.

2. If you’re ill or hurt. People who already have suffered a major illness or accident know that insurance companies can be terribly unforgiving. But Obamacare mandates insurance companies aren’t allowed to deny you insurance if you have any pre-existing condition. That means, no matter what your medical history looks like, you’ll be able to sign up for it. The law also eliminates lifetime caps on healthcare spending. So, you’ll be able to get all the essential care you need if you get sick, without worrying that your insurance company will cut off the money you need to get better.

Note: ‘Grandfathered’ plans will be exempt from the pre-existing condition aspect of this part but not the lifetime limits.

4. Health insurance is so hard to figure out. How can I even tell what’s in my plan?

Under Obamacare, health insurers will be required to provide you with a “summary of benefits and coverage” that explains — in plain English! — what’s included in your plan. Insurers will also need to offer a standard glossary that defines some commonly-misunderstood health insurance terms, like “co-pay” and “deductible.” The hope is that Americans will be better equipped to compare different plans and decide which insurance option is best for them, when they understand the insurance jargon better.

5. Why did I get a check in the mail from my insurance company?

If your insurance company sent you a reimbursement check, it’s probably to make up for the fact that you’ve been paying for its administrative costs instead of your health care. Obamacare requires insurance companies to strike a balance in this area, devoting 80 to 85 percent of the money you spend on your insurance premiums to providing health care and just 20 to 15 percent of it to their own overhead and profits. If they spend more on that second category, they’re required to pay that money back to their customers. It’s called the “medical loss ratio” and since its implementation in 2011, this Obamacare provision has saved Americans more than $1 billion.

6. Are dental or vision insurance plans affected by the new law?

Unfortunately, there is no dental coverage as part of Obamacare, unless you qualify for Medicaid. Some are pushing for the inclusion of vision in the new health exchanges but it is not currently part of the plan.

7. What are the “exchanges,” and should people like me join them?

The state-level exchanges, one of the essential tenets of the health reform law, are marketplaces where multiple insurers will compete to provide health plans. Each state and Washington, DC, will have its own insurance exchange and all of the plans offered within them will be required to offer a set of “essential benefits” to ensure they’re not too skimpy. Along with Obamacare’s optional Medicaid expansion, the exchanges are the vehicle that will extend insurance to the millions of Americans who are currently uninsured.

The important thing to understand about the exchanges is that they intend to provide coverage only to the people who can’t get it elsewhere — such as through their job, or through another federal program like Medicaid — and they’ll extend federal subsidies to help those people afford the cost of buying that coverage. Americans earning annual incomes up to 400 percent of the federal poverty level (in other words, up to $94,000 for a family of four) will qualify for federal assistance to help them buy plans on the marketplace. You can use this site to figure out whether you’ll get a subsidy based on your income.

The most recent projections say the premiums for these plans will be even cheaper than originally predicted. Among the Americans who are currently uninsured and will be able to purchase plans on one of Obamacare’s exchanges, an estimated 6 in 10 of them won’t need to pay more than $100 per month to get coverage.

Undocumented immigrants will be barred from purchasing plans on the new health exchanges, even if they have benefited from deferred action. Some immigration reform advocates are pushing to change that on the state level.

8. If I want to sign up for a new government-organized health plan, how can I?

The enrollment period for the new insurance exchanges begins on October 1 and goes until March 31. During that time period, Americans will be able to sign up for new Obamacare plans by either logging onto healthcare.gov, mailing in a paper copy of an application (to find out where to mail it, click here), or meeting with a “navigator” in person at one of the many enrollment fairs that are kicking off around the country. The navigators, who are specifically tasked with assisting Americans with signing up for health care plans, are available to answer questions for the people who are confused about what they should do. You can reach them by calling the hotline at 800-318-2596, and they’ll help you fill out an application if you’re having trouble with it.

There’s been a lot of confusion swirling around Obamacare and the federal government doesn’t expect a rush of people to sign up for the exchanges right away. Enrollment will likely be a slow and steady process. After the initial enrollment period ends, another one will open up in October 2014. But if you want health coverage by January 1, you need to sign up before then.

9. Why am I hearing so much about October 1? What does that date mean for me?

October 1 has been all over the news because that’s the date when Obamacare’s state-level exchanges officially open for business. Starting on that date, Americans will be able to purchase one of the plans offered in the new insurance marketplaces. But in reality, the date itself probably doesn’t mean that much for you. It’s a big symbolic day for the Obama administration, but Americans aren’t required to take any action on October 1. If you want to sign up for a plan in the exchanges, you have until March to do so. If you already have insurance through your job or through another government program, you don’t need to do anything at all because the exchanges don’t affect you right now.

10. What if I can’t afford any health coverage?

If you can’t afford health coverage right now, Obamacare hopes to change that for you. There are two main ways the health reform law could accomplish that.

First, if your income falls below 138 percent of the federal poverty line (for reference, that’s about $15,415 for an individual and $26,344 for a family of three), you could be eligible for expanded Medicaid coverage under the law. But it depends. Although Obamacare initially intended for the Medicaid expansion to be universal, the Supreme Court ruled that it should be optional — so now, not every state is participating. Check this map to see if your state is going to expand Medicaid.

Second, you could be eligible for federal assistance to afford an insurance plan in the new insurance marketplace in your state. Thanks to the federal subsidies available to help Americans buy plans on the newly-created marketplaces, most of the options will be relatively inexpensive. About 6 in 10 people will be able to buy one of those plans for less than $100 per month. You can find out whether you’ll qualify for a federal subsidy by using this calculator.

11. If I don’t want to get insurance, am I going to have to pay?

You will have to pay a penalty if you don’t sign up for health insurance. Why? Because taxpayers will be fronting the cost of your care if you wind up getting sick or hurt and need to go to the hospital, and that will be a lot more expensive than the penalty you’re paying. In 2014, the tax penalty for an adult will be $95 or 1 percent of your family income. For a child, the cost will be $47.50, with a total family cap at a $285 fine. By 2016 and beyond, it will cost you 2.5 percent of your family income, or $695, whichever is higher. Again, there is a cap on how much you’ll have to pay: $2,085 for a family.

Realistically, though, the law creates enough options that you shouldn’t forgo care because of cost. If you don’t think you can afford to get health care, look into the Medicaid expansion. If you don’t qualify there either and you really can’t afford it, you should know that there are financial hardship exceptions from the penalties. There are also penalty exemptions for the undocumented, the incarcerated and people with religious objections.

12. What happens to my insurance if I change jobs?

Should you quit or get fired and don’t have a new job you’re going to right away, you can go into the exchanges. COBRA, the Consolidated Omnibus Reconciliation Act, will also still exist, but for most people it will be the less advisable option. That government program is meant explicitly to provide health insurance for people who have reduced hours, are transitioning between jobs, have lost their jobs for any reason, or are coping with death or divorce. But it requires you to cover the entire cost of your monthly premiums, which is much more than most people are used to paying for employer-based insurance. The exchanges will probably be cheaper.

If your income level is low enough, you could also qualify for Medicaid under its new, expanded definition.

The process of changing insurance with a new job will look a lot like it does now. If you want to go into the health exchanges instead of take insurance from your new employer, you’ll be able to do that. People who have the option of getting qualified health coverage elsewhere, like through an employer, won’t qualify for any federal subsidies to help them buy a plan on the exchange. But if you do want to try a new employment opportunity that doesn’t come with stable insurance benefits, or start your own business, the exchanges could give you better options for your coverage than you had before.

13. Is Obamacare still at risk of getting repealed or defunded?

Republicans would like to think so but it’s nearly impossible at this point. The US House of Representatives has voted 42 times to dismantle the law, but hasn’t succeeded once. The Democratic-controlled Senate won’t agree to get rid of the law in its entirety. Most recently, Sen. Ted Cruz (R-TX) performed a sham 21-hour “filibuster” in an effort to force the Senate to agree to defund the health law. But that ultimately won’t work either— the money designated to fund Obamacare’s most important provisions has already been appropriated, and can’t be removed unless the law is totally repealed.

Sen. John McCain (R-AZ), a strong opponent of Obama on most things, recently said on the Senate floor that it’s time for Republicans to move on. “I don’t like it, it’s not something that I wanted the outcome to be,” he said in reference to to health reform law. “But I think all of us should respect the outcome of elections, which reflects the will of the people.”

Even though Republicans haven’t been able to completely repeal Obamacare, they are successfully slowing the law’s implementation on the state level. Anti-Obamacare lawmakers have rejected the law’s optional Medicaid expansion, slashed the budgets for outreach efforts to teach Americans about the law, enacted a whole lot of red tape to impede Americans from easily signing up for new plan and ultimately confused the public about the nature of the law. That type of sabotage is impeding health reform in some ways but it’s not doing away with it completely.

14. Is it true that Obamacare keeps getting delayed?

There has been a lot of news about individual Obamacare provisions getting delayed. Some people may assume that means the health law is being slowly dismantled or put off for an additional several years. Republicans typically seize on this type of news to make the case that Obamacare isn’t working and call for additional delays. Don’t be fooled, though. The Affordable Care Act is an extremely complicated law with a lot of moving parts, but ultimately, the biggest provisions are still moving forward. So far, the administrative issues along the way have been relatively minor in terms of the scope of the entire law.

There will likely be more hiccups along the way. As the enrollment period opens for Obamacare’s new exchanges, industry experts predict there will probably be other issues that need to be ironed out — but that doesn’t mean the whole law is collapsing.

15. Who will wind up benefiting most from the new law?

There’s no clear-cut answer to that question. People who can’t afford insurance right now will obviously benefit a lot, because they’ll gain more options for getting coverage. A lot of people who have been locked out of the insurance market because they have a pre-existing condition, or because their medical care has become too expensive and insurers won’t keep paying for it, will also gain affordable coverage that wasn’t available to them before. And people who already had insurance through their employers will gain an expanded pool of benefits, like preventive check-ups and cancer screenings, at no additional cost to them. Women definitely stand to benefit, since insurance companies will no longer be allowed to charge them more for the same care that’s offered to men. Young adults no longer have to worry about going uninsured right after graduating from college because they can stay on their parents’ plans until the age of 26. Seniors on Medicare are getting cheaper prescription drugs.

Find out more about how the health law specifically impacts you here.

16. How do gay couples factor into Obamacare?

The law itself mandates that insurance companies can’t discriminate against gay couples. So, if you are already on or are signing up for a private insurance plan and you want to get coverage for your same-sex partner, you can — just as long as your plan includes some form of spousal benefits.

Thanks to the Supreme Court’s decision earlier this year to strike down the Defense of Marriage Act, the government now recognizes same-sex couples for federal benefits. That means that if you and your same-sex partner are in a state that recognizes your marriage, you’ll be able to join the exchanges as a family unit. If you are eligible for Medicaid, the government is also working on creating a system that recognizes your legal marriage and treats you as a family unit.

17. Is it true that Obamacare will force me to switch doctors / force my company to cut my hours / end employer-run health insurance as we know it?

Many of these “downsides” to the law are being pushed by people who don’t like it for political reasons, but that doesn’t make them true. No, your doctor is not now going to be forced to ask you about your sex life. The new government-run plans aren’t going to put all your personal information at risk. And all the buzz you’re hearing about having to switch doctors because of the law is overblown. It is possible you might have to switch doctors in the coming years, but that has more to do with the state of the health insurance industry than with the specifics of Obamacare. As the LA times explains, forcing patients to switch doctors “has been happening anyway because insurers are under enormous pressure from big customers to cut costs.”

Obamacare is also becoming a scapegoat when it comes to the prospect of your employer potentially cutting your hours or moving people from full- to part-time. Any employer you hear about that is cutting people’s hours is just pretending Obamacare is the reason so they don’t look like the bad guy. Very few employers have cut hours citing Obamacare and many actually say they’re planning to hire more workers just in time for the full Obamacare rollout.

And, in terms of Obamacare ending employer-based insurance, there’s no need to panic there, either. Yes, the law will provide more options than we used to have. It will probably gradually shift people away from employer-run plans, too. But even generous predictions estimate that the vast majority of people will still get insurance through their jobs over the next decade. One potential impact of the law is that more people will have the flexibility to look for a new job now that they know they won’t be tied to their employer-provided insurance for coverage.

18. What happens to my spouse’s coverage under Obamacare?

Spouses will not lose coverage when Obamacare rolls out. A few big companies have captured headlines by announcing they want to move spouses off of insurance plans and into the newly-created exchanges. In those very few cases, spouses may have to switch plans, but they aren’t losing coverage, they are just changing providers. Either way, in the vast majority of cases, employer based insurance will continue as it always has.

19. What’s the timeline for rolling out all of these features? What’s already happened and what are we still waiting for?

Believe it or not, a lot of Obamacare has already gone into effect. The first provisions took place way back in 2010. In June of that year, Obamacare closed the so-called “doughnut hole” and seniors who fell into that gap in Medicare coverage received a $250 check in the mail. That was the very first provision to be rolled out, but it’s far from the last. The majority of the law will go into effect by 2014, when the exchanges are set up. The very last aspect won’t roll out until 2018, when certain “Cadillac” insurance plans — top-of-the-line health plans that cost tens of thousands of dollars — will get an added tax. The White House has a fairly comprehensive timeline of dates for Obamacare’s rollout here.

20. Where do I go to ask more questions?

There are a ton of options for where to get information on Obamacare, but a great place to start is at healthcare.gov  —cuidadodesalud.gov for Spanish-speakers — or at whitehouse.gov/healthreform. The Kaiser Foundation, too, can give you more specific guidance if you still have any questions. And, on top of all that, another neat aspect of the new law is that your state is now required to employ people called “navigators,” whose sole job is to help you navigate the massive new law.

Annie-Rose Strasser is deputy managing editor for ThinkProgress. Before joining American Progress, she worked for the community organizing non-profit Center for Community Change as a new media specialist.
Tara Culp-Ressler is the health editor for ThinkProgress. Before joining the ThinkProgress team, Tara deepened her interest in progressive politics from a faith-based perspective at several religious nonprofits, including Faith in Public Life, the National Religious Campaign Against Torture, and Interfaith Voices.
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