Most Daily Kos users probably are reasonably well-informed about their health insurance options. But perhaps you have questions, or perhaps you have friends or family who have questions. Here’s a basic guide.
Thanks to BrainWrap for all his tireless and informative work, including his diary today telling us the deadline to sign up for coverage effective January 1 has been extended to 11:59 PM PST this Thursday, December 17.
Do you have health insurance? If so--are you satisfied with it? If not--do you wonder if you should get coverage, or get different coverage? Do you wonder if you CAN get coverage, or different coverage? Are you going to get penalized if you don’t get coverage? Here are some basic questions and answers.
[I apologize for the lack of line breaks in the text below. I inserted them repeatedly, but the Daily Kos server keeps deleting them.]
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Q: Am I under some kind of deadline?
A: If you want coverage by January 1, and you’re going to buy a plan through your state’s exchange or healthcare.gov (see below), then you need to sign up by 11:59 PM PST this Thursday, December 17 (extended from December 15 due to high last-minute demand). If you want coverage any time in 2016, then you need to sign up by January 31, 2016. Read the stuff below and decide if you need to shop for coverage on your state’s “exchange” or on the federal “marketplace,” healthcare.gov.
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Q: Hey, you’re just a schmoe on the internet. Where can I get REAL answers?
A: From a healthcare “Navigator”--an actual professional that has a government grant to help people figure out their health insurance options. Google “healthcare navigator [your state or zip code]” and you’ll find at least one. For my home state, Georgia, try Seedco: www.seedco.org/...
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Q: I don’t want to take the time right now to deal with a pro and get detailed answers. Even though you’re just a schmoe on the internet, can you just give me the gist?
A: Yes. But first--if you’re at least age 65, this doesn’t apply to you--you get Medicare, which is a whole other deal. If you’re under 65, here’s the gist:
- If you’re age 26-64 and your employer offers coverage, that’s probably your best bet.
- If you’re age 26-64 and your employer doesn’t offer coverage, and your income is at least 100% of the poverty level, then your best option is probably to shop for a plan on your state’s “exchange” or (if your state doesn’t have its own “exchange”) the federal “marketplace,” healthcare.gov.
- If you’re not yet age 26 and your parents have coverage, then you can stay on your parents’ plan. That’s probably your best bet.
- If you’re age 18-25 and your parents don’t have coverage, and your employer offers coverage, the employer coverage is probably your best bet.
- If you’re age 18-25 and your parents don’t have coverage, and your employer doesn’t offer coverage, and your income is at least 100% of the poverty level, then your best option is probably to shop for a plan on your state’s “exchange” or the federal “marketplace,” healthcare.gov.
- If you’re at least age 18, and your income is under 100% of the poverty level, and your employer doesn’t offer coverage, and you can’t get under-26 coverage on your parents’ plan, then what happens depends on the state you live in.
- If your state has “expanded” Medicaid, then it’s simple--you get Medicaid.
- If your state has not “expanded” Medicaid, then most likely you’re just going to have to go without health coverage. You can get Medicaid if you’re disabled, or have minor children, or qualify as “medically needy,” or maybe some other special Medicaid programs--but most people don’t qualify for any of these. If none of these apply to you, then you’re probably just going to have to go without coverage.
- Which states have expanded Medicaid: kff.org/...
Q: What’s the poverty level?
A: Depends on your family size. Here you go: obamacarefacts.com/...
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Q: Will I be penalized if I don’t get health insurance?
A: Maybe. If getting coverage would cost more than 8.05% of your income, then you’re exempt. You don’t have to buy it. If you’re not exempt, and you don’t get coverage, then you have to pay the penalty (also called the “individual mandate” or the “shared responsibility fee”). There are other exemptions, too: obamacare.net/...
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Q: How much is the penalty?
A: If you’re not exempt, the penalty is the higher of (a) 2.5% of your income, or (b) $695 per adult, plus $347.50 per child under 18 in your family. www.healthcare.gov/...
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Q: Paying the penalty doesn’t sound good. How much is coverage going to cost me?
A: Most Americans will get a subsidy, limiting premiums to 9.5% of their income or less. The lower your income, the less you’ll pay. obamacarefacts.com/...
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Q: I, or somebody in my family, has a pre-existing condition. Will I be denied coverage? Will coverage for that pre-existing condition be excluded? Will my coverage cost more?
A: You can no longer be denied coverage, or charged more, because of a pre-existing condition. The pre-existing condition will be covered. You will not be charged extra. You and your loved ones will be fully covered.
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Q: Is there any other special stuff I should know?
A: (1) If your income is between 100% and 250% of the poverty level, check out the “Silver” plans. You may get “enhanced cost sharing” on Silver plans (only)--that is, help with deductibles and copays. (2) If your income is between 100% and 138% of the federal poverty level, you might have your choice of Medicaid or shopping for private coverage. Check with a Navigator. (3) If you’re under 30, check this out: www.healthcare.gov/...
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Q: You call this simple? Why is it so damn complicated?
A: Well, that’s a political question, and I said this would be mostly non-political. But most other advanced countries make it simpler and cheaper, and in most of them people have longer life expectancy. If you think the American health care system ought to be simpler, cheaper, and better, then read this: feelthebern.org/...
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Q: I still have questions.
A: Sorry, I’m just a schmoe on the internet. Call a “navigator.” Google “healthcare navigator [your state or zip code]” and you’ll find at least one. For my home state, Georgia, try Seedco: www.seedco.org/...