Some American consumers are still unfamiliar with the Affordable Care Act and what it means for them. They’re uncertain about their responsibilities under the law, where and how to shop for coverage, and the role of government exchanges, among other things.
At eHealth, we believe that consumers deserve straight answers and simple explanations to help them understand how Obamacare affects them now. The Obamacare facts and myths identified below reflect points of confusion that are sometimes expressed by health insurance consumers contacting eHealth’s Customer Care team.
MYTH: The penalty for being uninsured is only $95. It costs way more than that to buy health insurance. I might as well go uninsured this year.
You may face a tax penalty much higher than $95 for going uninsured this year. The penalty is $95 or 1% of your income – whichever is greater
. Therefore, if you earn $50,000 per year, you could face a tax penalty of $500 if you do not have insurance for more than three consecutive months in one year.
MYTH: I can go uninsured next year and just enroll in a health plan when I get sick.
The Affordable Care Act established specific open enrollment periods
when consumers can enroll in health insurance coverage. The next open enrollment period runs from November 15, 2014, through February 15, 2015. Unless you experience a qualifying event, such as a marriage, the birth of a child, or the loss of employer-based health insurance, you cannot get a health insurance plan on your own outside of the open enrollment period.
MYTH: “Government insurance” plans purchased through the state exchanges will be accepted by all doctors and hospitals.
Whether your health insurance plan was purchased through a government exchange or elsewhere, you will typically be limited to visiting doctors and hospitals in your plan’s provider network if you want to get the best coverage for your medical care
. Individual and family plans purchased through the government exchanges are not “government insurance” products in the way that Medicaid and Medicare are. Instead, these plans are offered through private health insurance companies that may also sell coverage off of government exchanges.
MYTH: Subsidies are for people who need Medicaid, they don’t pertain to me.
While the Affordable Care Act does allow states to expand access to Medicaid
programs, subsidies are designed for people who don’t qualify for Medicaid or Medicare or who are without another form of minimum essential coverage (such as some employer-sponsored plans) to help them pay for coverage on their own. If your household income is up to 400% of the federal poverty level (about $46,000 per year for a single person or $94,000 per year for a family of four) you may qualify for a subsidy. The amount of subsidy you may receive can also vary depending on the relative affordability of coverage in your area.
MYTH: I have to buy an Obamacare plan even if I’m on Medicare.
If you’re already enrolled in Medicare or Medicaid you do not have to do anything as a result of the health reform law. The Affordable Care Act (Obamacare) is primarily designed for people who are not eligible for Medicare.
MYTH: I have to buy an Obamacare plan even if I’m offered insurance through my job or through a family member’s employer.
If you are enrolled in a health insurance plan through an employer and that health plan is compliant with the coverage requirements of the Affordable Care Act, you do not need to buy health insurance on your own. If you lose your employer-based coverage in the middle of next year, this is considered a “qualifying event” and you will be able to purchase a plan on your own at that time – even outside of the nationwide open enrollment period.
MYTH: If I don’t have health insurance right now, I will have to pay a tax penalty.
Under the Affordable Care Act, you are only subject to a tax penalty
if you are uninsured for more than three consecutive months in one year or if your current coverage is not compliant with ACA requirements (with certain exceptions) for more than three consecutive months in that year.
MYTH: Obamacare is being delayed. I don’t have to worry about it until they get the website completely fixed.
Though government health insurance exchange websites did experience some difficulties, the provision of the law requiring most Americans to have health insurance still took effect on January 1, 2014.
MYTH: I already have a health insurance plan of my own. I don’t need to re-shop again.
Unless your health insurance coverage fulfills the ACA coverage requirements and qualifies as minimum essential coverage, you may need to reconsider your coverage options this year. Many existing health insurance plans will not meet the coverage requirements of the Affordable Care Act and are being phased out. In some states, insurers may allow you to retain coverage under your current health plan, but you’ll need to ask your insurer to find out if this applies to you.