The health exchanges are now open, though some have a lot of glitches. You still have lots of questions about how the Affordable Care Act affects you and your family.
And we have answers. In our ongoing series, we're addressing questions you've asked about the sign-up process.
With people having so much trouble logging onto the websites to get coverage, some are wondering how soon they have to sign up for coverage to avoid the potential penalties.
Don't worry, there's still plenty of time. There are really just two important dates to keep in mind. The first is Dec. 15. That's the date by which you need to be signed up if you want your coverage to begin Jan. 1, 2014 â the earliest any of these plans will take effect.
The other date is Feb. 15, 2014. That's the last day you can get coverage and avoid being liable for a penalty for not having insurance. The maximum penalty if you don't have coverage for the entire year is $95 or one percent of your taxable income, whichever is bigger. It will go up in future years.
The open enrollment period actually will run until the end of Mar. 2014, but if you wait until the very end you might still have to pay a month's worth of the penalty for not having coverage. That penalty would be assessed when you pay your 2014 taxes in Apr. 2015.
So people have time to sign up. But the next question is how much insurance will cost and whether subsidies will help pay for it.
Once you get on the website for your state, whether through healthcare.gov or one of the states running their own sites, that's one of the first things you'll be able to find out. You can plug in your estimated annual income for next year and it will give you an idea of how much of a subsidy you may be eligible for. People with incomes between the poverty line and four times that amount will be eligible for help paying their premiums. That's $11,490 to about $45,960 for an individual, and $23,550 to $94,200 for a family of four.
There are also various online calculators you can use, including a subsidy calculator on NPR.org.
Those calculators should also tell you if you might be eligible for Medicaid. Medicaid coverage for those with very low incomes, and is usually free, or nearly free.
Another topic of concern is whether people can sign up for insurance after the current open enrollment period ends. Many listeners have told us that they have coverage from a former employer through COBRA that ends after next March. What happens in that situation?
This is one way that the Affordable Care Act is a lot like the insurance plans most people have at work. Every year there's an open season, and for the most part you can only buy or change plans during that open season. So if next May you haven't bought insurance and you get sick or you just decide you should have gotten insurance and you didn't â then too bad. You'll have to wait until the next open season to sign up.
But there is an exception â and that's if you have one of several life changing events. Moving to another state, getting married or divorced, losing your job-based insurance or having your COBRA coverage end are all things that would allow you to buy insurance on the exchange outside the regular open season. Those events would be handled just as they are in an employment-based health plan.
Finally, there appears to be some confusion as to whether people with health coverage through Medicare need to do anything at all.
The short answer is no, but it's a little confusing. The health insurance exchanges are for people under the age of 65. They're not for seniors who have Medicare, and the exchanges don't sell Medicare prescription drug coverage or supplemental coverage.
Here's where the confusion comes in: Oct. 15 is the start of Medicare's open season. The Medicare open season runs until Dec. 7. During this time, Medicare patients can join or change drug or other health plans. But that's not Obamacare.
So if you're a Medicare patient go to Medicare.gov, Medicare's website. If it warns that it's not completely up to date due to the government shutdown, check back later.
Next month we'll answer more questions about health coverage under the Affordable Care Act. You can send them to health@npr.org.
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Transcript
DAVID GREENE, HOST:
This is MORNING EDITION from NPR News. I'm David Greene.
STEVE INSKEEP, HOST:
And I'm Steve Inskeep.
Let's begin Your Health on this Monday morning with a look at the Affordable Care Act. We're going to Week 3 of the main part of that law being in effect. And NPR's Julie Rovner is here to update us on how it's going.
Hi, Julie.
JULIE ROVNER, BYLINE: Hey, Steve.
INSKEEP: You've been taking questions and more questions and more questions about the Affordable Care Act. We have been hearing, of course, about people having trouble navigating a website, getting through a website, crashing websites, having trouble signing up. So when do they have to sign up in order to avoid paying a penalty for not having health insurance, which is now mandated?
ROVNER: Well, not that soon. There are really two important dates people need to keep in mind. The first is December 15, that's the date by which you need to be signed up if you want your coverage to begin January 1. That's the earliest that any of these plans actually take effect. The other date you have to remember is February 15. That's the last day you can get coverage and avoid being liable for that penalty for not having insurance.
Now, the open enrollment actually goes until the end of March. But if you wait until the very end, you might still have to pay a month's worth of the penalty for not having coverage. The maximum penalty next year, by the way, if you don't have coverage for the entire year, is still pretty small, $95 or one percent of your taxable income, whichever is bigger. It does go up in future years.
INSKEEP: Although one percent of your taxable income, for some people that might count as a hit. So people have a chance until February to avoid that penalty if they sign up for insurance.
The next question is, how much is it going to cost, of course, for those people who haven't signed up yet. And are they going to get any help paying for it?
ROVNER: That's right. And you can find that out pretty quickly once you get on the website for your state, whether through healthcare.gov or one of the 14 states running their own sites. It's one of the first things that you can see. You plug in your annual income and you get an idea of how much of a subsidy you may be eligible for. People with incomes between the poverty line - that's about 11,500 for an individual - and four times that amount, or about $46,000, will be eligible for help paying their premiums.
For a family of four, help is available for those with incomes up to $94,000. There's also a subsidy calculator on our website at NPR.org/shots.
INSKEEP: So that I understand, you're saying that the lower your income, the greater help you're supposed to get. And the higher your income, you get a little bit less help until the point where you're paying for it all yourself. Is that right?
ROVNER: That's exactly right. And if you have a really low income, those calculators will also tell you if you might be eligible for Medicaid. And Medicaid coverage is, of course, usually free or nearly free for its patients.
INSKEEP: OK, another question people have been asking here, Julie Rovner. You gave us some dates. You said by February, sign up if you want to avoid a penalty. You can still continue signing up until March. Then this open enrollment period ends. Suppose you just totally missed that window but you want health insurance later, what happens to you then?
ROVNER: Well, you know, in a sense this law, the Affordable Care Act, is a lot like the insurance plans that most people have at work. Every year there's an open season and for the most part you can only buy or change plans during that open season. So if next May you haven't bought insurance and you get sick, or you just decide you should have gotten insurance and you didn't, well, sorry, you're going to have to wait until the next open season.
But there is an exception and that's if you have one of several life changing events. Moving to another state, getting married or divorced, losing your job-based insurance or having your COBRA coverage from your former job run out, those are all things that would allow you to buy insurance on the exchange outside of the regular open season, just as they would with an employer health plan. So if any of those things happen, it's not during an open season, you get your own open season where you can go to the exchange and go ahead and buy new insurance.
INSKEEP: So there's also the question of people with Medicare. Many, many millions of people with Medicare in this country, and some confusion as to whether they need to do anything here.
ROVNER: That's right. And the short answer is no, but it is a little bit confusing. These health exchanges are for people under the age of 65. They're not for seniors who have Medicare and they don't sell Medicare prescription drug coverage or supplemental coverage.
Now, tomorrow is the start of Medicare's open enrollment season. That's different from what's going on with the exchanges. The Medicare open season runs until December 7. During this time Medicare patients can join or change their drug plans or other health plans.
INSKEEP: And that's the way it's always been?
ROVNER: That's right. But these are different programs at different websites. So make sure if you're a Medicare patient you go to the Medicare website, not to healthcare.gov or to state health exchanges.
INSKEEP: Julie, thanks very much.
ROVNER: Thank you.
INSKEEP: And we know people have many, many questions about the health care law, so Julie will be back to answer more of your questions. If you have one now, send it in an email to morningedition@npr.org. You can also find the answers to some frequently asked questions @shots, the NPR health blog which is at our website, NPR.org. Transcript provided by NPR, Copyright NPR.
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