Insurance 101

What IS Health Care Reform?

Health Care Reform, otherwise known as The Patient Protection and Affordable Care Act, otherwise known as The Affordable Care Act, otherwise known as Obamacare…what is it all about? What does it mean for me? Read on, learn the basics, and email more questions…

If I have health insurance through work, does anything change for me? 

Not unless you decide to opt out of your company’s health plan.

Why would I do that?

Some employers pass a portion of the cost of health benefits onto their employees. Depending on what percentage of your health insurance premiums you pay for your employer’s plan, it might save you money to buy your own health insurance, especially if you qualify for the new subsidies provided by health care reform.

Right now my employer does not offer health insurance benefits, does he have to with health care reform?

Not necessarily.  Employers with more than 50 full time employees are required to offer health insurance benefits or pay a penalty on their corporate tax return.  Employers with less than 50 full time employees will not be subject to penalty.  So, it depends on the size of the company your work for, and whether your employer prefers to just pay any penalties associated with not offering health insurance benefits.

I am not 26 yet, should I stay on my parents plan as long as possible, or should I get my own plan?

It might be most economical for you to get your own health insurance, if you qualify for the new subsidies provided by health care reform.  The new insurance plans will still be age banded, with the most favorable rates going to younger insureds.

How does the subsidy work?

You shop for a health plan that meets your needs, apply, receive a quote and at that time determination of any applicable subsidy will be calculated and paid directly to the insurance carrier once you are enrolled.  The carrier will adjust your cost accordingly.  For examples of how to calculate the subsidy, click here.

Are the health insurance plans that are subsidized different than those that are not?

No.  All available health insurance plans must offer a certain minimum level of coverage, known as a qualified health plan (QHP).  This concept did not exist before reform, but post reform, health plans all must provide certain essential health benefits, limit cost sharing for essential health benefits, and provide bronze, silver, gold or platinum level of coverage. 

I never go to the doctor or get sick, why do I have to buy health insurance?

Being healthy is great, but does nothing to lower your odds of suffering injury from life:  accidents, falls, spills and slips.  Anyone that has ever had to pay for an x-ray and an emergency room exam knows how quickly the costs add up and exceed insurance premiums you pay.

Before Reform, if I go to the hospital uninsured, they cannot turn me away, does that change after reform?

No, but hospitals are allowed to discuss your payment options, and may enroll you in an insurance plan during your stay.

If I refuse to purchase insurance, what are my consequences?

        1) Pay a penalty

        2) Remain uninsured and have no access to affordable health
            insurance if you find yourself ill or involved in an accident.


Health Care Reform and Small Businesses


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