Obama Care - Affordable Care Act
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Cover Oregon and the Affordable Care Act "ACA", also known as Obama Care
Obamacare Insurance Exchange is here starting October 2013. T.W. Morgan Insurance Services is your source for Cover Oregon and the Affordable Care Act Marketplace!
T.W. Morgan Insurance Services will guide you through the process and selection of your ACA approved health plan. We do not charge any extra fees to be your agent. You pay the same premium using our agency as if you were on your own. The benefit of using TW Morgan Insurance Services as your agent, is that you receive guidance and support without any additional charge. It's like making a purchase at Home Depot and having someone come with you to assemble your new kitchen. Our team of experienced health insurance agents will find the right plan for you and your family. With over 23 years in business selling health plans in the Northwest, we have the experience to make the transition as smooth as possible. Our agency will also guide you through the process to see if your are eligible for a premium subsidy to lower your out of pocket cost.
How much will Marketplace health insurance cost?
Prices of Marketplace plans have not been set yet. Prices will be available October 1, 2013, when open enrollment starts and you can begin shopping.
How Marketplace health plans will be priced
All insurance plans available through the Marketplace will be offered by private insurance companies. They will decide which plans to offer and how much each will cost.
All Marketplace plans must be approved by state insurance departments and certified by the Marketplace. Prices are approved by state insurance departments as required by state law.
Starting in October, when you use the Marketplace to compare plans you'll see prices for all plans available to you. Prices will show any cost savings you may be eligible for based on your income. These lower costs are available only in the Marketplace.
Will a range of prices and plans will be available
Some Marketplace health plans will have lower monthly premiums and may charge you more out-of-pocket when you need care. Some will be higher-premium plans that cover more of your costs when you need care. Others will fall in between. All plans will cover the same list of essential health benefits.
Learn more about the categories of health insurance plans that will be offered in the Marketplace.
Lower costs based on income are available only from the Marketplace
It's important to remember that the only way to get lower costs for health insurance based on your income is through the Health Insurance Marketplace. Depending on your income, you may qualify for lower costs on your monthly premiums or out-of-pocket costs.
You'll learn whether you are eligible for lower costs when you complete your application after October 1.
In the meantime, you can answer a few quick questions and find out if you may be eligible for lower costs based on your income.
The result we provide tells you only whether you might qualify for lower costs based on your estimate of your income. It does not tell you how much a plan would cost you or how much you would save.
What if I don't get health coverage?
If you don't have health coverage at all, you have to pay the full cost of all of your medical expenses. You also have no protection from very high bills. This can mean costs of $50 for a flu shot, or $10,000 or more for a 3-day hospitalization, or hundreds of thousands of dollars for comprehensive cancer care.
In addition, if you don't have health coverage in 2014 and beyond, you may have to pay a penalty fee.
Starting January 1, 2014, if someone doesn't have a health plan that qualifies as minimum essential coverage, he or she may have to pay a fee that 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 federal income tax form, which is completed the following year. People with very low incomes and others may be eligible for waivers.
What if someone doesn't have health coverage?
If someone can afford it but doesn't have health insurance coverage, they may have to pay a fee. They must also pay for all of their care.
When the uninsured need care
When an uninsured person requires urgent-often expensive-medical care but doesn't pay the bill, everyone else ends up paying the price.
That's why the health care law requires all people who can afford it to take responsibility for their own health insurance by getting coverage or paying a penalty.
People without health coverage will also have to pay the entire cost of all their medical care. They won't be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.
The fee in 2014 and beyond
The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher.
In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.
It's important to remember that someone who pays the fee won't get any health insurance coverage. They still will be responsible for 100% of the cost of their medical care.
After open enrollment ends on March 31, they won't be able to get health coverage through the Marketplace until the next annual enrollment period, unless they have a qualifying life event.
Minimum essential coverage
To avoid the fee you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following in the current year, you're considered covered and don't have to pay a penalty:
- Any Marketplace plan, or any individual insurance plan you already have
- Any employer plan (including COBRA ), with or without “grandfathered” status. This includes retiree plans
- Medicare
- Medicaid
- The Children's Health Insurance Program (CHIP)
- TRICARE (for veterans and veteran families)
- Veterans health care programs
- Peace Corps Volunteer plans
Other plans may also qualify. Ask your health certified Cover Oregon agent at TW Morgan Insurance Services.
Who doesn't have to pay the fee
Uninsured people won't have to pay a fee if they:
- are uninsured for less than 3 months of the year
- are determined to have very low income and coverage is considered unaffordable
- are not required to file a tax return because their income is too low
- would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
- are a member of a federally recognized Indian tribe
- participate in a health care sharing ministry
- are a member of a recognized religious sect with religious objections to health insurance
If you don't qualify for these situations, you can apply for an exemption asking not to pay a fee. You do this in the Marketplace.
What kinds of health insurance don't qualify as coverage?
Health plans that don't meet minimum essential coverage don't qualify as coverage. If you have only these types of coverage, you may have to pay the fee. Examples 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
Other plans may also qualify. Ask your health certified Cover Oregon agent at TW Morgan Insurance Services
If I am unemployed, do I have to pay the fee?
It depends on your household income. If insurance is unaffordable to you based on your income, you may qualify for an exemption from the fee. Complete an application in the Health Insurance Marketplace to determine whether your income qualifies you for an exemption.
How do I get an exemption?
For religious conscience and hardship exemptions, you complete an application in the Health Insurance Marketplace and indicate that you want an exemption. Most other exemptions are claimed on your federal income tax form. Information about these procedures will be available after open enrollment begins.
What if someone doesn't have health coverage?
If someone can afford it but doesn't have health insurance coverage, they may have to pay a fee. They must also pay for all of their care.
When the uninsured need care
When an uninsured person requires urgent-often expensive-medical care but doesn't pay the bill, everyone else ends up paying the price.
That's why the health care law requires all people who can afford it to take responsibility for their own health insurance by getting coverage or paying a penalty.
People without health coverage will also have to pay the entire cost of all their medical care. They won't be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.
Information source for the Affordable Care Act aka Obama care, has been obtained from the U.S. Department of Health & Human Services website and is believed to be accurate as of the publishing date of July 24, 2013. Changes in the law after July 24, 2013 may need to be updated. The "ACA" is a working document that has frequent changes monthly as the United State Government interprets the law and makes changes to the care act. For further information, contact US Dept of Health and Human Services at their websites www.hhs.gov for further updates to the law.