By Dr. Dionne Hart, MD
What is the law known as “Obamacare” or the Affordable Care Act (ACA)?
In March 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 that collectively reform healthcare access.
What is the mandatory insurance provision?
By 2014, most U.S. citizens and legal residents are required to obtain minimal essential health insurance coverage or pay a penalty or $95 per year or one percent of income, whichever is greater. The penalty will increase to $325 per year or two percent by 2015 and $695 or 2.5 percent by 2016.
After 2016, the penalty will increase annually by cost-of-living adjustments. The law provides substantial subsidies in the form of tax credits for individuals with incomes up to 400 percent of the federal poverty level to assist them in purchasing insurance.
Who is exempt from paying the penalty?
Individuals are exempt if the lowest cost plan exceeds eight percent of their household income; if they are members of an Indian tribe; if they lack coverage for less than three months; if their income is below the tax-filing threshold or their household income is below 100 percent of poverty level for family size; or for hardship with respect to obtaining coverage.
Who benefits from Medicaid expansion?
The law expands Medicaid coverage to individuals under age 65 with incomes up to 133 percent of the federal poverty level. In 2014, individuals with an income less than $14,403.90 and a family of four with an income less than $29,326.50 will be eligible.
How does this law protect an individual with a pre-existing condition or expensive treatment?
The ACA requires health insurance companies to provide coverage to individuals who have been uninsured for at least six months and without additional costs because they have a medical condition such as pregnancy, diabetes, cancer, HIV/AIDS, or hypertension diagnosed prior to their application for insurance. Health insurers are prohibited from canceling coverage if their health services become expensive or they make an unintentional mistake on their insurance forms.
Are Preventive Services covered under the ACA or Medicaid and Medicare beneficiaries?
The ACA requires health plans to cover 45 in-network preventive and immunization services recommended by the U.S. Preventive Services Task Force without charging a deductible co-pay or coinsurance.
What is the health insurance exchange?
In October 2013, a health insurance marketplace became available to individuals and small businesses to compare benefits and prices of qualified health plans and purchase health insurance.
How does the ACA affect my dependent children up to age 26?
Individuals up to 26 years old may remain on their parents’ coverage even if they are married. Furthermore, insurers can no longer impose limits on who qualifies based on financial dependency or residency.
What is MNSure?
MNSure is the Minnesota marketplace where Minnesotans can compare and purchase healthcare coverage. Open enrollment for individuals and families runs through March 31, 2014: www.MN Sure.org.
Trained specialists are available at 855-3MNSURE. Coverage purchased through MNSure begins January 1, 2014.
What are some resources for the health insurance marketplace?
Consumer websites: HealthCare.gov
Marketplace call center: 800-318-2596
You Tube: YouTube.com/HealthCareGov
Dr. Dionne Hart of Care From The Hart studied at the University of Chicago and Rush Medical College, and completed a residency in adult psychiatry at the Mayo Clinic. She is a leader in several medical organizations.