Breaking Down Obamacare

Everywhere you turn these days, you hear something about the Affordable Care Act (ACA). October marked the official launch of open access to the Health Insurance Marketplaces of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, which has expanded access to health care for millions of Americans who either could not afford insurance, or couldn’t qualify for coverage in the past.  There are an estimated 40 million uninsured in the U.S., and LGBT Americans are over twice as likely to NOT have health insurance, so our communities are affected to an even greater degree.

And for women, the changes brought about by the ACA are especially helpful! As you may know, women have historically been charged more than men for the exact same health coverage, but companies are no longer allowed to do that. In addition, insurance policies must provide for an annual “well-woman” visit at no cost. The ACA means free screenings for breast and cervical cancer; FDA-approved contraception; breastfeeding support and equipment; screening and counseling for domestic violence; smoking cessation medications and services; and more.

Still, there’s a lot of information –and misinformation – floating around about the ACA.  So let’s start with some key facts:  for the vast majority of Americans, this law makes absolutely no changes to their insurance coverage or health care access. If you already have health insurance that covers the required “10 essential health benefits” through your employer (or your spouse’s or parents’ employer), you satisfy the mandate and don’t have to do anything further. Likewise, if you have Medicaid, Medicare, or Veterans health coverage, you’re all set.

If you are under 26, you are eligible for coverage through a parent’s plan (if that’s an option for you).  For many people, particularly those who are recently graduated and not earning much income, or still looking for work, this will be the most cost-effective option.

Do you really NEED health insurance?

Insurance is an strange product, in that you are purchasing something you hope you won’t need to use (at least, not beyond the usual check-ups and preventive care). Unlike rent or groceries, it’s the kind of thing you can often get by without, assuming you are healthy and your luck holds for a while.

But as we all know, luck can change in an instant. And a single accident or a serious illness can be incredibly costly. Something as “simple” as a broken arm might cost you $2,500 in the ER, and many thousands more if you need surgery. Three days in the hospital could cost as much as $30,000. It’s the kind of thing that can set you (and your credit rating) back for a long time.

When it comes to the new insurance marketplaces, there are many variables when it comes to pricing – such as your age, location, and whether or not you smoke. Insurance plans with lower premiums tend to have higher deductibles and co-pays (a premium is the monthly payment for your insurance coverage; a deductible is the amount of money that you have to pay out-of-pocket each year before your health benefits kick in; and a co-pay is the amount of money that you pay out-of-pocket each time you see your medical provider, have a procedure done, or fill a prescription).

If you have a chronic health condition and require frequent care, or take medications on a regular basis, it’s generally better to pay a higher monthly premium and save money in the long run with no deductible and lower co-pays.

If your annual income is between 100% and 400% of the Federal Poverty Level (between about $11,490 and $45,960 for a single person), you’ll be eligible for subsidies to help cover your monthly premium.  The exact amount of your subsidy won’t be known until you complete the application process on Healthcare.gov. (and yes, the website is finally working!)

When comparing health insurance plans, be sure your medical provider and any specialist that you see are in the plan network, since most plans won’t cover out-of-network providers, or may charge higher co-pays for these visits.

For people under 30, there’s also the option of a “catastrophic” plan, which has very low premiums and provides three primary care visits per year.  (Other plan benefits don’t kick in until you’ve met a high out-of-pocket deductible – so this plan is only recommended for those in very good health!)

The penalty for not obtaining insurance by the enrollment deadline of March 31, 2014, is $95, or one percent of your taxable income, for the first year (it will increase in future years). But if you have an accident or illness without insurance, that’s where your costs will really add up. Health insurance won’t cover 100% of all medical bills, but it does protect against financial ruin in the case of serious bad luck, and having insurance means easy access to care.

The Fine Print

For those who plan to purchase health insurance through the Marketplace, the open enrollment period runs through March 31, 2014. Uninsured Pennsylvanians can purchase affordable health insurance through the federally-run Marketplace at http://www.healthcare.gov or 800-318-2596.

Need more help?

Mazzoni Center is providing assistance with Marketplace applications for our uninsured clients and patients through our benefits counselor Stephanie Moran at smoran@mazzonicenter.org  or 215-563-0658 x332.

There’s also the Out2Enroll project, a collaborative effort from the Sellers Dorsey Foundation, the Center for American Progress, and the Federal Agencies Project aimed at educating the LGBT community about their options under the Affordable Care Act.  Look them up at www.out2enroll.org.

Additional resources for folks in Philadelphia include:

  • Resources for Human Development (healthinsurance@rhd.org or 215-951-0300)
  • Pennsylvania Association of Community Health Centers (pachc@pachc.com or 866-944-CARE)
  • Mental Health Association of Southeastern Pennsylvania (215-751-1800 or 800-688-4226).

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Elisabeth Flynn is Senior Communications Manager at Mazzoni Center.  She has worked at writing and public relations for a variety of academic, nonprofit, and arts organizations.  She lives in Havertown, PA with her partner and their daughter.

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