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How do I get healthcare under the Affordable Care Act?


By Judy Reed


Rhetoric. Sound bites. Pages upon pages of rules and exemptions. A website not quite up to par. And not much useful information printed for those who need healthcare under the Affordable Care Act. So many people just want to know, how do I get healthcare? Where do I go, what do I do, and how much is it going to cost?

The Basics

Starting in 2014, every individual in the United States of America is required to have some minimum essential health insurance coverage or pay a tax penalty when you do your taxes for that year.

The deadline to acquire coverage is March 31, 2014.

There are six ways to meet the minimum essential coverage:

1. Being insured through your employer or your spouse’s employer. 

2. Being insured on your parent’s policy. Children can remain on their parent’s policy until age 26 regardless of whether they are working, in school, single or married. However, if that child has a baby of his own, that baby is not covered on the grandparent’s policy.

3. Enrollment in another government health program such as Medicare, Tricare, or a Children’s Health Insurance Program (CHIP) or Michigan’s MiChild.

4. Being eligible for coverage under Medicaid due to expansion of coverage to people with income up to 133 percent of the Federal Poverty Level.

5. Purchasing healthcare through the Exchange or Marketplace at healthcare.gov

6. Purchasing healthcare insurance from a company in the individual market.

How to find out what you are eligible for

If numbers one through three do not apply to you, you will want to see if you are eligible for subsidies to help pay for insurance. The only way to do that is by applying at healthcare.gov. You can do that one of two ways: either try to navigate it yourself, or contact a registered agent who will do the work for you at no charge.

“You will pay the same amount either way. You are paying for an agent, even if you don’t use one,” explained Gabrielle Warner, of Innovative Solutions Agency, Inc. Warner is a Chartered Benefits Consultant, and Marketplace and SHOP registered agent.

An agent will be your advocate and guide throughout the process, and can track where your application is at all times.

An agent will take you through the healthcare.gov application process to see if you are eligible for subsidies to offset health insurance premiums. You will see one of three possible results: your income is low enough that you will best benefit by expanded Medicaid, which starts in April 2014; you are eligible for subsidies; or you make too much money.

If you are eligible for subsidies, then the agent will help you choose a plan through the three insurance companies in Michigan’s exchange or marketplace. If you are not eligible for subsidies, the agent will help you to purchase insurance from a company on the individual market.

To find a registered agent to take you through the process, go to www.wmahu.org. On the left side, scroll down to “find an agent.” Put in your zip code and choose “50 mile radius” in the drop down box. Go further down the page and mark Michigan in the section titles “Certified to sell health insurance exchange marketplace coverage.” Twenty or so random agents will come up.

What if I don’t buy insurance?

In 2014, the penalty for not having insurance is $95 per person, or 1 percent of your income, whichever is greater. The penalty for children is $47.50 per child. The maximum penalty is $285 per family. Next year it increases to 2 percent or $325 per person, and in 2016 it is 2.5 percent of income or $695 per person. In 2017 and beyond it will be adjusted by the cost of living. The penalty will be due when you pay your taxes. Paying the penalty does not give you insurance; you will still need to fully fund your own healthcare, at a non-discounted rate.

There are some circumstances that may help you qualify for a hardship exemption. To see those and to get a form to apply, go to www.healthcare.gov/exemptions/

What is the transitional reinsurance program?

One thing that caught some people by surprise this month is a new fee called the transitional reinsurance program. People covered under their own employer’s insurance plan began paying the fee this month, in addition to the fee deducted for their own insurance plan. The program takes the fees and then pays it to insurers in the individual market that cover high-risk individuals. The fee will be in place from 2014 to 2016, and supposedly “levels the playing field” across the health insurance markets, and protects the high-risk insurers from huge losses.

NEXT WEEK: What businesses need to know

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One Response to “How do I get healthcare under the Affordable Care Act?”

  1. Be careful! Security experts say healthcare.gov is not secure, and those using the site are vulnerable to identify theft. Read the report at http://freebeacon.com/hearing-healthcare-gov-still-not-secure/




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