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Obamacare's Exchanges: A How-To Guide

Melissah Yang |
September 30, 2013 | 9:13 a.m. PDT

Senior News Editor

(Creative Commons)
(Creative Commons)
The Affordable Care Act kicks into effect Oct. 1, but if you're not sure what that means for you, don't worry.

We've got you covered.

The ACA, or Obamacare, prevents insurance companies from rejecting people with pre-existing conditions. By 2014, every American — with a few exceptions — must have health insurance or be fined. 

Starting Oct, 1, people without insurance can shop in private health insurance marketplaces, called exchanges, to buy plans. Many can receive government aid to help pay.

Here's what you need to know.

Timeframe and Deadline

Open enrollment runs from Oct. 1 to March 31. Plans bought through these exchanges won't start until Jan. 1 so take your time to shop around and find the best plan for you. No need to pay a premium before your insurance kicks in.

Dec. 14 is the cut-off date for plans starting Jan. 1. For those who sign up in January or February, coverage will begin the following month.

SEE ALSO: Obamacare's Online Marketplaces Open Oct. 1

How to Sign Up

All information will be available on the website www.healthcare.gov. Click "Get Insurance" to start the sign-up process. On the website, you can also compare plans in the area, see if you're eligible for Medicaid and get other general information.

You can enroll by mail.

You can enroll by calling government call centers at 1-800-318-2596. Information is available in more than 150 languages.

You can talk to someone in person. "Navigators" will give free advice and guide you through the different healthcare plans. These federally authorized organizations and advisers will be set up in health centers, malls, drug stores and churches. Navigators can't tell you which plan to pick. And they can't charge money for their services. If they ask you to pay, it's a scam.

Plans

There are different levels, ranging from bronze (basic), silver, gold and platinum (high-end). All plans bought through the exchanges must offer the same coverage benefits including free preventive care. 

There is also a catastrophic option that covers three doctor visits per year at no cost and includes preventive care such as screenings and vaccines. This plan will carry a higher deductible.

SEE ALSO: South L.A. Residents Come Out For Music, Food And Obamacare

Cost

You will have to pay a monthly premium, but different plans will have different costs. Some carry higher deductibles or ask for higher co-pays. Costs can vary depending on where you live. Smokers and the elderly might have to pay more. You might still have to pay a deductible when you go to a doctor or hospital. 

But again, no one can be turned away. 

Most of the plans will keep out-of-pocket costs to $6,350 for individuals and $12,700 per family.

You can use the Kaiser Family Foundation's calculator to help compare health insurance costs based on your location and coverage preferences.

The Obama administration says most uninsured people can find a policy for $100 or less per month.

If you buy a plan through the exchanges rather than from an insurance company, you're likely to be eligible for tax breaks and subsidies to help cover the costs. If your income is less than four times the federal poverty level — $45,960 for an individual or $94,200 for a family of four — then you can receive government aid. These subsidies can be returned to you as a tax credit or sent directly to the insurance company.

Exemptions

If you really can't afford it, meaning you don't make enough to file a tax return, then you are exempt. You do not have to buy health insurance. 

Also exempt are people who are in the U.S. without authorization; members of a federally recognized American Indian tribe; people with religious beliefs that go against accepting insurance; people in states that don't expand Medicaid; or those with particular hardships.

SEE ALSO: Healthcare: Extending Coverage To The Uninsured

Fines and Penalties

If you're not exempt and you don't sign up for insurance, you will be fined. You'll have to say on your 2014 tax return that you do not have health insurance.

Your fine is whatever's higher: a set fee or a percent of your income.

For 2014, the fee is $95 per adult and $47.50 per child, up to $285 per family. Or 1 percent of your income.

In 2015, the penalty increases to $325 per adult and $162.50 per child. Or 2 percent of your income.

In 2016, it becomes 2.5 percent of your income.

 

Read more of Neon Tommy's Obamacare coverage here.

Reach senior news editor Melissah Yang here. Follow her @MelissahYang.




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