Frequently Asked Questions about Obamacare


What are the penalties if I don’t sign up?

The penalties go up per year. For individuals in 2014, it is a flat fee of $95 or 1% of your income (whichever is higher) to a maximum of $285. In 2015, it goes up to $325 or 2% of your income and topping out at $975. In 2016, the flat fee goes up to $695 or 2.5% of your income with a maximum amount of $2,085. The penalty is capped at the national average cost of a Marketplace Bronze-level plan.

Small businesses with under 50 employees are exempt from penalties. They may continue to provide health care for their employees and receive tax credits for doing so. These tax credits are incentives but expire in 2016 unless extended by Congress. Their employees may seek coverage in the exchanges as well.

Will I be denied for pre-existing conditions?

No one will be denied for pre-existing conditions. This is prohibited by the Affordable Care Act. You won’t pay more for your policy, either, based on a pre-existing condition or have a delay in care.

Will I be cancelled once I become sick?

No.  Rescission, the practice of cancelling a policy once someone suffers a major illness, will no longer be permitted. However, insurance companies can cancel a policy for fraud, misrepresentation of material facts, or non-payment of premium.

How are the subsidies applied?

You can get premium tax credits applied to your monthly insurance premiums or you can get a cost-sharing subsidy which lowers your part of the cost for deductibles, copays and coinsurance.



Five Things You Should Know About Obamacare   

1.  If you are over 65, Obamacare will have little effect on your healthcare choices. Most changes will occur in the under 65 age Market. That being said, the one area that could be affected for the Medicare-aged population is the Advantage Plans, which are government-subsidized. Cuts in these funds (which are to offset the cost of the Affordable Care Act) may make these plans more costly with benefits being pared down.

2.  There will be four plans to choose from in the exchanges, which are from low to highest in benefits and premium: Bronze, Silver, Gold, Platinum. Those who fall into the range of 133% to 400% of the federal poverty line will receive subsidies on a sliding scale. This is figured using your Modified Adjusted Gross Income. Age and family size will also determine the amount of your subsidy.

3.  There are items called Essential Health Benefits that must be included in all health insurance policies now. They include things like ambulatory and emergency services, hospitalization, maternity, mental health care, rehabilitative services and prescription drug coverage.

4.  You cannot enroll any time you want. There will still be open enrollment periods, the first being October 1, 2013 to March 31, 2014. The second will be October 15, 2014 to December 7, 2014. Number three will occur October 15, 2015 to December 7, 2015.

5.  If you think you don’t qualify for a subsidy, you might be wrong. For 2012, 400% of the poverty level for a single person would put him or her at an income level of about $44,680. For a family of four, it would be about $92,200.  You should check with your authorized insurance broker to get help picking a plan that is right for you.