GTJ Health Series: What Obamacare Means for You

stethoscopeWith the Supreme Court decision in June 2012 upholding the Affordable Care Act’s (ACA or Obamacare) constitutionality, 2013 and 2014 will see the implementation of the remaining key portions of this landmark bill.  Already the act has provided additional protections for patients and increased access to health insurance and care.  In this column, I will highlights some of the upcoming changes to the ACA and provide a simple guide for young professionals and students to find health insurance coverage in the coming year.

An Insurance Policy You Can Understand

Trying to understand your health insurance policy can lead anyone to pull their hair out in frustration.  This year marks the start of a provision of the act which requires insurance providers to send you a standardized, four-page summary of benefits and coverage.  This summary will explain your health plan in plain English and will allow you to easily compare the plan you have to other available plans.

New Costs to You

While Medicare is the health insurance program for those over 65 years of age, as an American worker you pay into the program throughout your life. Two changes to these taxes will take effect this year.  Employers take out 7.65 percent of your salary of which 1.45 percent goes toward the portion of Medicare which covers hospital bills.  This year, the hospital portion will increase 0.9 percent for anyone who earns more than $200,000.  The second change is a new 3.8 percent tax on investment income that will go towards funding Medicare.

A Mandate to be Insured

Starting on January 1st 2014, you will be required to buy insurance or pay a penalty.  To help with this transition, several new avenues of coverage have been established, many with significant subsidies provided to consumers (see below).

Patient Rights and Protections

With the passage of the ACA, we are seeing several initiatives that will protect patient rights and improve care.  Beginning in 2014, health insurers will no longer be able to refuse coverage to the sick.  Patient out of pocket expenses for preventative services like pap smears and flu shots has been eliminated, and patients can no longer have their coverage dropped when they get sick or pregnant.  Women and people with pre-existing conditions cannot be charged higher premiums.  Minimum standards for health insurance policies are being established and caps to annual and lifetime insurance payouts are being eliminated.

Your Options for Health Insurance Coverage

You are . . . Where you can get health insurance The details
Employed Your employer Many employers provide health insurance coverage to their employees.  This includes federal employees as well as employees of businesses both large and small.
Under 26 years old Your parents Under the ACA you are eligible for coverage under your parents insurance until you are 26 years old. 
A student Your university Most universities offer their undergraduate, graduate, and professional student health insurance at a reduced rate.
Earn less than ~ $15,415 Medicaid The ACA will increase Medicaid coverage to those earning up to 138% of the federal poverty level ($15,415 in 2012) in 2014.  The federal government will pay 100% of the cost of coverage for new enrollees until 2016, where after the states will begin covering a small portion. Under the Supreme Court ruling last year, states can chose to implement this or not.  Maryland and DC are participating, while Virginia is leaning against participating.
Everyone Else Exchanges In 2014, the health insurance exchanges will open for business. A health insurance exchange is a regulated marketplace where the uninsured and small businesses can shop for coverage amongst several competing providers. If you earn 100-400% (~$43,000) of the federal poverty level you will be eligible for tax credits to help pay for insurance.  States can agree to provide a state based or partnership exchange.  If they decline to create an exchange the federal government will step in with a federal exchange.  Maryland and DC will have a state based exchange while Virginia will not.

 

Alex Berger, a new GTJ contributing columnist, is a native of the Washington DC Metropolitan Area.  He graduated in 2008 from the University of North Carolina and is currently in his last year of a combined MD/MPH program. He is excited to be back in the DC area and to share tips on nutrition, health, and fitness. He can be reached at Alexander_Berger@med.unc.edu.