You might have heard rumors that Obamacare is gone. That’s not true. Despite efforts to dismantle it, the Affordable Care Act (that’s the official name for Obamacare) is still very much alive and available.
Here’s what you need to know about enrolling and whether it makes sense for you.
Should I Even Bother With Obamacare?
Just like standard health insurance in St. Petersburg, anyone can sign up for Obamacare, and honestly, you might be surprised at how much it could help you depending on your situation.
The main enrollment period runs from November 1st through December 15th each year. Special enrollment periods are available for qualifying life events. You can browse plans and check subsidies anytime at Healthcare.gov, and compare local doctors, hospitals, and healthcare providers year-round.
If You Don’t Have Insurance
This affects you the most. Good news is that as of 2019, you won’t get hit with a tax penalty anymore for being uninsured.
But here’s the bad news. You could get slammed with massive medical bills.
Average annual treatment costs:
- Diabetes: $26,971 per family
- Multiple sclerosis: $34,167
- Cancer treatment: $30,000 minimum
- Single ER visit: $1,265
Medical bills are actually the number one cause of bankruptcy in America. That alone should tell you why having health coverage matters.
Who Gets Financial Help?
If your income is below $45,000, the government will help pay for your premium. That makes Obamacare way more affordable than you’d think.
For Medicaid eligibility in expansion states, individuals earning under $18,000 or families of four earning under $35,000 may qualify for free coverage. Healthcare.gov will tell you if you’re eligible and whether your state participates.
Special Options for Young People
If you’re under 30, you’ve got extra choices. You can stay on your parents’ insurance until age 26, which is usually the cheapest option. Or you can buy a catastrophic plan with lower premiums that covers emergencies, hospital stays, and three regular doctor visits per year.
Already Have Insurance?
You can keep whatever insurance you have now. Employer plans, COBRA, retiree plans, catastrophic plans all count as qualifying coverage.
Note: Discount plans, vision plans, dental discount plans, or workers’ comp don’t qualify as real health insurance.
Even with coverage, compare it with Obamacare plans. You might find better coverage for less money if your plan was grandfathered in (existed before March 23, 2010) and lacks full ACA benefits, you qualify for subsidies (under $50,000 individual or $100,000 for a family of four), or your employer drops your insurance plan.
How to Shop for Plans
Getting Started
Head to Healthcare.gov and follow these steps:
- Enter your state
- Create an account with your email
- Set up username, password, and security questions
- Verify your email address
To check subsidy eligibility, you’ll need your Social Security number and recent tax documents (W2, 1099, etc.).
Understanding the Metal Tiers
Plans come in four categories based on coverage. Bronze covers 60% of costs with the lowest premiums but highest out of pocket expenses. Silver covers 70% of costs and is the middle ground option. Gold covers 80% of costs with higher premiums but less out of pocket spending. Platinum covers 90% of costs and has the highest premiums but lowest out of pocket expenses.
What Affects Your Cost
Five factors determine your premium:
- Plan type (Bronze through Platinum)
- Your age
- Your income
- Family size
- Where you live
Remember to submit payment at least 15 days before coverage starts.
Missed Open Enrollment?
Who Can Enroll Year-Round
Native Americans, people eligible for Medicaid or CHIP, and those experiencing qualifying life events can enroll outside the regular period. CHIP income limits are generous, so check your state’s requirements even if you’re middle class.
Qualifying Life Events
Major life changes can trigger special enrollment:
- Losing job-based insurance
- Getting married
- Having or adopting a baby
- Moving to a new state
Important changes: You now need coverage before your move to qualify for special enrollment in your new location. Same with marriage, at least one spouse usually needs existing coverage.
The government requires proof of qualifying events, so have documentation ready when you apply.
The Waiting Game
Without a qualifying event, you’ll wait until the next open enrollment. Nevada is the exception with year-round off-exchange plans, though insurers can impose a 90-day waiting period.
Why All the Confusion?
Shorter Enrollment Periods
The enrollment schedule kept changing. The first period lasted 6 months. The second and third ran for 3 months but on different dates. The fourth kept the same schedule as the third. Starting with the fifth period and continuing beyond, enrollment runs from November 1 to December 15, which is significantly shortened.
Reduced Federal Support
The Trump Administration slashed funding for outreach, marketing, and enrollment assistance. This created confusion about whether Obamacare still existed.
Despite shorter enrollment and reduced funding, 2018 enrollment only dropped slightly from 2017. Grassroots groups stepped up to educate people, and larger subsidies made coverage more affordable for millions.
2019 enrollment fell more noticeably due to elimination of the individual mandate penalty and expansion of short-term health plans as alternatives.
Get Expert Guidance
Want to learn more about your options for health insurance in Jacksonville and elsewhere? Contact Star Nsurance + Tax today to understand your choices. Our licensed agents can walk you through the best plans for your specific situation and answer any questions you have.
