After a long battle by the Federal Government, the Supreme Court and following the Presidential elections, the Obamacare was introduced in March 23rd, 2010. A term colloquially used for Affordable Care Act (ACA), also known as Patient Protection Affordable Care Act (PPACA), Obamacare tries to provide healthcare coverage to all its citizen in America.
One big change as a result of the ACA is called the Individual Mandate. This requires everyone to have health coverage. Beginning in 2014, if you don't have health coverage that qualifies as minimum essential coverage, you may have to pay a fee. The fee is based on your reported income and increases every year: from 1% of income (or $95 per adult, whichever is higher) in 2014 to 2.5% of income (or $695 per adult) in 2016. The fee for children is half the adult amount. The fee is paid on the 2014 federal income tax form, which is completed in 2015. People with very low incomes and others may be eligible for waivers.
If you're covered by any of the following, you're considered covered and don't have to pay a penalty:
- Individual qualified insurance plan you already have
- Any employer plan (including COBRA) including retiree plans
- The Children's Health Insurance Program (CHIP)
- TRICARE (for current service members and military retirees, their families, and survivors)
- Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
- Peace Corps Volunteer plans
- Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014
Other plans may also qualify. Ask your health coverage provider.
Health plans that don't qualify as coverage include those that don't meet minimum essential coverage. If you have only these types of coverage, you may have to pay the fee. Examples of non-qualified plans include:
- Coverage only for vision care or dental care
- Workers compensation
- Coverage only for a specific disease or condition
- Plans that offer only discounts on medical services
Some people with limited incomes and other situations, including religious objections, incarceration and financial hardship, can get exemptions from the fee. Learn more about exemptions from paying the fee.
Under Obamacare, the 4 main ways to experience better medical assistance are:
- Buy Your Own
Employer- More the half of the American population is covered through their jobs. However, employers will find it easier to afford health insurance for their employees as:
- Caps on out-of-pocket expense will be lowered
- Preventative care will be free of cost
The bigger enterprises are already providing good coverage to their staffs. It is the smaller enterprises with less than 50 employees who find it rather difficult to pay for the employee’s health insurance. Obamacare has brought huge relief to these smaller enterprises. They can go to a special center called Health Insurance Marketplace, which will provide health coverage at much lower costs. Hence, the smaller employers now will pay lesser premiums.
Government- There are mainly two types of coverage provided by the Federal Government.
- Medicare, where all the senior citizens of America are provided free health coverage.
- Medicaid, where the elderly are covered and due to its expansion after the Obamacare, more number of people can be provided low-cost health insurance and subsidies (especially for those below 133% of Federal Poverty Level).
In case of Medicaid, it is for the states to decide if they wish to implement the new legislation or not. In case the state agrees to follow the Medicaid expansion criteria, people within 133% to 400% of the Federal Poverty Level (FPL) will be eligible for various subsidies, along with the health premium costs reduced to a great extent.
While those states that leave themselves out of the new Medicaid rules, people may still look for reduced health insurance cost through Health Insurance Marketplace.
Buy Your Own- About one-tenth of the American population buys health insurance from private health insurance marketplace. There are basically five plans offered by the private health service providers.
- Bronze- 60% coverage 40% out-of-pocket costs- Least monthly premium compared to all plans
- Silver- 70% coverage 30% out-of-pocket expense- lesser monthly premium than Gold
- Gold- 80% coverage 20% out-of-pocket expense- Lesser monthly premium than Platinum
- Platinum- 90% coverage 10% out-of-pocket expense- High monthly premiums
- Catastrophe- People who are above 26 years, out of their parents’ plan and under 30 years are eligible for this plan.
All of the plans will cover most of the medical care like prescription drugs, hospitalization, preventative coverage, screenings and lab tests, and emergency services.
Uninsured- Almost 30 million of the U.S. Population isn’t covered under any health coverage. The Federal Goverenment has provided various schemes under which more and more American citizen can now opt for health insurance coverage. However, in case someone feels he/she will take insurance only after falling ill, the Federal Govt. has unfortunately closed that option. The time of Open Enrollment for every year is pre-fixed. Only, in case of certain special changes in social status can one opt for health insurance plans outside the Open Enrollment. Moreover, people not insured will have to pay certain tax penalties to cover up for not buying their medical health coverage.
This chart explains how the Health Care Law affects you. Use the Health Care Law and Your Tax Return chart to see how the law will affect your tax return.
|IF YOU…||THEN YOU…|
|Are U.S. citizens or are non-U.S. citizens living in the United States||Must have qualifying health care coverage, qualify for a health coverage exemption, or make a payment when you file your tax return|
|Have health coverage through an employer or under a government program such as Medicare, Medicaid and coverage for veterans for the entire year||Just have to check a box on your Form 1040 series return and do not have to read any further|
|Do not have coverage for any month of the year||Should check the instructions to Form 8965 to see if you are eligible for an exemption|
|Are eligible for an exemption from coverage for a month||Are not responsible for making an Individual Shared Responsibility payment for that month and must claim the exemption or report an exemption already obtained from the Marketplace by completing Form 8965, Health Coverage Exemptions, and submitting it with your tax return|
|Do not have coverage and are not eligible for an exemption from coverage for any month of the year||Are responsible for making an individual shared responsibility payment when you file your return|
|Are responsible for making an individual shared responsibility payment||Will report it on your tax return and make the payment with your taxes|
|Received the benefit of more advance payments of the premium tax credit than the amount of credit for which you qualify||Will repay the amount in excess of the credit you are allowed subject to a repayment cap|
|Need qualifying health care coverage for the current year||Visit Healthcare.gov to find out about the dates of open and special enrollment periods for purchasing qualified health coverage.|
|Enroll in health insurance through the Marketplace for yourself or someone else on your tax return||Might be eligible for the premium tax credit|
|Did not enroll in health insurance from the Marketplace for yourself or anyone else on your tax return||Cannot claim the premium tax credit|
|Or another person on your tax return who is enrolled in coverage through the Marketplace is not eligible for health care coverage through your employer or under a government program||Might be eligible for the premium tax credit|
|Are eligible for the premium tax credit||Can choose to get premium assistance now to lower your monthly payments or get all the benefit of the credit when you claim it on your tax return|
|Choose to get premium assistance now||Will have payments sent on your behalf to your insurance provider. These payments are called advance payments of the premium tax credit|
|Get the benefit of advance payments of the premium tax credit and experience a significant life change, such as a change in income or marital status||Report these changes in circumstances to the Marketplace when they happen|
|Get the benefit of advance payments of the premium tax credit||Will report the payments on your tax return and reconcile the amount of the payments with the amount of credit for which you are eligible|
If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services are covered at no cost to you. This applies only when these services are delivered by a network provider.
- Abdominal Aortic Aneurysm: one-time screening for men of specified ages who have ever smoked
- Alcohol Misuse: screening and counseling
- Aspirin: use for men and women of certain ages
- Blood Pressure: screening for all adults
- Cholesterol: screening for adults of certain ages or at higher risk
- Colorectal Cancer: screening for adults over 50
- Depression: screening for adults
- Type 2 Diabetes: screening for adults with high blood pressure
- Diet: counseling for adults at higher risk for chronic disease
- HIV: screening for all adults at higher risk
- Immunization: vaccines for adults--doses, recommended ages, and recommended populations vary:
Recommended Immunization Schedule for Persons Age 0 Through 18 Years
- Obesity: screening and counseling for all adults
- Sexually Transmitted Infection (STI): prevention counseling for adults at higher risk
- Tobacco Use: screening for all adults and cessation interventions for tobacco users
- Syphilis: screening for all adults at higher risk
There are also additional covered preventive services for Women, Including Pregnant Women and children
Another important aspect of Preventive care is immunization. Individuals, including children, enrolled in new group or individual health plans will have access to the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) with no co-payments or other cost-sharing requirements when those services are delivered by an in-network provider. These new health plans will be required to cover new ACIP recommendations made after September 2009 without cost-sharing in the next plan year that occurs one year after the date of the recommendation.
The latest immunization schedules can be found using the resources below:
Recommended Adult Immunization Schedule
Recommended Immunization Schedule for Infants and Young Children Ages 0 to 6 Years
Recommended Immunization Schedule for Children and Teens Ages 7 to 18 Years
Catch-up Immunization Schedule for Children and Teens Ages 4 Months through 18 Years
Immunization Information for College Students and Young Adults Immunization Information for Seniors
Immunization Information for Pregnant Women
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