Thanks to Obamacare, there are many ways to get health coverage

03/11/2014 5:12 PM

03/11/2014 5:31 PM

As of April 1, Americans are required by law to be covered by a health plan — from an employer or government program such as Medicare or Medicaid, or individually purchased on a government-run exchange or through an agent or broker.

But many people remain uninsured — some for philosophical reasons; others because they have not been able to afford the premium on any plan, or have had changes in circumstance since Jan. 1 and are now uninsured.

People may choose to go uninsured and pay a relatively small fine imposed by the IRS, and accept that remaining uninsured is risky. There are some exemptions to paying that fine, but there are no exemptions for what is owed for medical bills. If you or an immediate family member becomes ill or is injured, you are responsible for paying for all the necessary medical care. Non-payment of medical bills is the most common reason for declaration of bankruptcy.

You may decide that Obamacare is socialized medicine, and that a requirement to be insured violates your freedom of choice. But in fact, Obamacare uses private insurance companies, free markets, and freedom of choice to provide coverage. These plans are regulated but not managed by the state and federal governments.

In 1965, when Medicare was introduced, many considered it to be socialized medicine. But in the past 49 years, the American public has overwhelmingly rated its satisfaction with Medicare much higher than its satisfaction with private insurance.

Because so many Americans believe that the emergency room can be a clinic for the uninsured, the medical community has been forced to cut back on services previously available. Emergency care is expensive, and emergency rooms are required only to stabilize a patient before releasing that person.

If you think that you cannot afford any insurance plan premium, be sure that you have investigated the subsidies the government offers. That can substantially reduce a premium’s cost, your out-of-pocket responsibility, or both. More than half of the Americans who have enrolled for health care coverage on the government exchange have qualified for a subsidy.

Another area to explore is whether you may qualify for catastrophic coverage. That is offered at an extremely low premium cost. If your application for one of these programs was denied, there is an appeals process available.

Medicaid has long been a government subsidized option for low-income individuals, but there have been changes in this safety net. The Supreme Court made the decision in 2012 that states could decide whether they wanted to participate in an expansion of Medicaid. The ACA expands Medicaid to a national eligibility floor of 138 percent of the federal poverty level and provides 100 percent federal financing for those newly eligible for Medicaid from 2014 through 2016. The federal contribution phases down to 90 percent by 2020. After 2020, the federal funding will remain at 90 percent.

But some states, including Missouri and Kansas, declined this opportunity.

As of January 2014, in Kansas, Medicaid eligibility for non-disabled adults is limited to parents with incomes below 38 percent of poverty, or about $9,000 a year for a family of four, and adults without dependent children remain ineligible regardless of their income. In Missouri, Medicaid eligibility for non-disabled adults is limited to parents with incomes below 23 percent of poverty, or about $5,500 a year for a family of four. Adults without dependent children remain ineligible regardless of their income.

If your desire to enroll in a medical insurance plan occurs on April 1, 2014 or later, you must have what is known as a “qualifying life event.” That applies to coverage purchased both on- and off-the exchange. These events include the birth or adoption of a child, change in marital status, a permanent move to a new area that offers different health plan options, losing other health coverage due to job loss, loss of eligibility for Medicaid or CHIP, expiration of COBRA benefits, or having your health plan decertified. Note that losing coverage because of non-payment of premiums or voluntarily choosing to quit your current health plan are not qualifying life events.

If you enrolled in a health plan on the exchange, any change in income can affect your eligibility for tax credits. Be sure to report this change within 60 days of when it occurs so that you have the opportunity to change your plan.

With these exceptions, as of March 31, the uninsured will have to remain without coverage. The next open enrollment period is scheduled to run from Nov. 15 to Jan. 15.

The Affordable Care Act has caused confusion. It is a significant departure from what has been the American health care payment system, and it depends on nearly all of us to participate so that we can begin to see how it benefits us all. There is still time. Enroll today.


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