Despite opposition from Republicans and a public that remains skeptical, the Affordable Care Act is still the law and the deadline to sign up for insurance without paying a penalty is just days away. The law has already altered the health care industry, established many consumer benefits and has sweeping ramifications for state officials, employers, hospitals and doctors.
Here's a primer on how the law might affect you.
I am uninsured. Under the law, do I have to buy it and what happens if I don’t?
You have until March 31 to enroll in health insurance before you are subject to the law’s tax penalty for not having coverage. You would pay this penalty on your 2014 taxes, filed in 2015. Administration officials have said they will not extend this deadline.
For individuals, the penalty this year is the greater of either $95 or up to 1 percent of the portion of the person’s modified adjusted gross income that exceeds $10,150, which is the level that requires you to file a tax return. For families this year the penalty is $285 or 1 percent of the portion of modified adjusted gross income over $20,300. That fee rises over time.
The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs. Also on the list are people in the individual insurance market whose plans were canceled. Under the law’s "hardship exemption," these consumers are also eligible to buy "catastrophic" coverage policies, which have lower premiums and higher deductibles than other plans that comply with the law.
What if computer problems with the federal or a state-based exchange prevented me from getting insurance? Is my deadline still March 31?
Yes. If computer glitches prevented you from enrolling, you can receive retroactive coverage toJan. 1 or the date in 2014 when you originally applied, as well as retroactive premium tax credits and cost-sharing subsidies.
In addition, if you gave up trying to buy a plan because of technical issues, and instead you bought one outside the exchange, you may be able to switch to a marketplace plan and qualify for retroactive subsidies.
If you are still encountering difficulties, you can meet with one of law’s navigators, contact an insurance agent or callhealthcare.gov: 800-318-2596.
I get my health coverage at work and want to keep my current plan. Will I be able to do that? How does Obamacare affect me?
If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep your current plan and may change premiums, deductibles, co-pays and network coverage.
Employer plans generally now ban lifetime coverage limits and include a guarantee that an adult child up to age 26 can stay on her parents' health plan.
What other parts of the law should I know about?
Insurers are no longer allowed to deny you coverage or charge you more based on a pre-existing medical condition. They also can’t limit coverage of essential health benefits, including prescription drugs and hospitalization.
You are likely to be eligible for some free preventive services such as breast cancer screenings and cholesterol tests.
Health plans can’t cancel your coverage if you get sick – a practice known as "rescission" – unless you committed fraud when you applied.
Some plans that were in place when the law was passed, and have not changed significantly, do not have to abide by certain parts of the law. For example, these "grandfathered" plans can still charge for part of the cost of preventive services.
What can I do if I can't afford insurance?
Depending on your income, you might be eligible for Medicaid. Before the health law, in most states nonelderly adults without minor children didn’t qualify for Medicaid. But now, 25 states and the District of Columbia have chosen to expand Medicaid to anyone with an income at or lower than 138 percent of the federal poverty level, (about $16,105 for an individual or $32,913 for a family of four based on current guidelines).
Other states have opted out of the expansion.
If you have an income that would make you eligible for Medicaid under the provisions of the law, but your state is not expanding its Medicaid program, you are exempted from the penalty.
What if I make too much money for Medicaid but still can't afford to buy insurance?
You might be eligible for government subsidies to help you pay for private insurance sold in the insurance marketplaces.
These premium subsidies will be available on a sliding scale for individuals and families with incomes between 100 percent and 400 percent of the poverty level, or about $11,490 to $45,960 for individuals and $23,550 to $94,200 for a family of four.
The subsidies require some people spend a certain amount of their income before the subsidies kick in.
I own a small business. Will I have to buy health insurance for my workers?
No employer is required to provide insurance. But starting in 2016 – a two-year delay from the previous date of 2014 – businesses with 50 to 99 employees that don't provide health care coverage could be fined.
However, firms with fewer than 50 people won't face any penalties.
If you own a small business and buy insurance through the health marketplace, the health law offers a tax credit to help cover the cost.
