Obamacare is the buzzword for today. Why? Because October 1, 2013, is the day it really (sort of) goes into effect. From then until March 31st, 2014, uninsured people who can’t get insurance through employment or family can go to Healthcare.gov to get coverage, which begins January 1st, in their state’s Marketplace.
Now, I know that some of my fellow 20-somethings are confused or ambivalent about the whole situation. As a generation, we’re still pretty young and for the most part healthy. We don’t spend too much time thinking about health care, unless it’s to bemoan that our part-time jobs or internships don’t give it to us or to rejoice that we’re allowed to be on our parent’s insurance until 26 (thanks, in whole, in fact, to Obamacare).
But there are a few of us, those that are over 26, or, for whatever reasons (and there are lots of them), are not on their parent’s health insurance, that are perking their ears up at the mention of “affordable healthcare.” Especially those of us with extra bits and parts that need to be checked out once a year, those of us who need prescriptions, and those of us who are, well, sick. I myself am one of those people. Plus, there’s the fact that if you don’t have minimum essential coverage by 2014, there’s a penalty fee (although if you’re too poor, it’s waived, so #yolo). So this post is to address the whole Obamacare situation that is blowing up our newsfeeds today in terms of how it effects Young Without Money-ers.
To start, I did what all people my age do when I want to learn about something. I Googled Obamacare. I glanced at a couple trending article headlines, like, “US government shutdown: House votes to delay Obamacare law,” “House advances ObamaCare counterproposal, shutdown deadline looms,” and “What the GOP has missed on Obamacare,” but I scrolled down til I found something that hinted that it was more factual than opinion. The government hosted site about the Affordable Care Act (the real name of the bill), where you’ll be able to get coverage starting tomorrow, is where I figured I could find the most facts. Here’s what it lays down:
As part of this new law, most insurance companies that used to deny coverage or charge high rates for people with pre-existing conditions, such as asthma, any kind of condition that you had from birth, or from an injury, etc, are not NOT allowed to do that anymore. Other cool parts of the law: no more lifetime caps. If you get sick, like cancer-sick, insurance companies are no longer allowed to call you up and say, “You’ve reached your max. No more money is coming from us to pay for stuff. Sorry, not sorry.” Companies are also not allowed to spend over 20% of the money you pay them for administrative costs without paying it back to customers; so you might be getting a reimbursement check if you’re already covered. Insurance companies are also not allowed to discriminate against same-sex couples anymore. If your coverage offers spousal benefits, it doesn’t matter what the gender of the spouse is– they can be covered.
One of your first options on the Healthcare.gov homepage is to take a little questionnaire about your health care situation; whether or not and how you’re covered. No matter where you go from there, the next page will ask if there are any specific issues that pertain to you that you want info on, such as pregnancy, being under 18, being self-employed (aka freelance), or having a disability, etc. It also tells you that pre-existing conditions will start to be covered in 2014 and asks if you want info on that.
After answering those questions, you’re asked how many people will be on your tax return (it’s either 1-just you, or you plus a spouse plus any children. Then it asks if you think your annual income will be below $65,167.(If your answer is no, I’m not sure why you’re reading this blog. I’m not gonna check the over $65,167 box right now. Out of spite.)
(*From here, I say, if you HAVE insurance through your parents or through your job, you can pretty much stop reading, UNLESS this fact is about to change or you’re unhappy with the insurance you already have. Because if you already have coverage, Obamacare doesn’t effect you any more than maybe [grandfathered plans don’t have to] having your coverage upgrade to provide the preventatives without copays if it doesn’t already. You also get the benefit of no longer being discriminated against because of a pre-existing condition. Also, you don’t have to worry about lifetime caps anymore, so insurance will never cut you off if you get sick. The only thing that might change is that your company may change to a Marketplace plan, which could be good/no change/bad for you depending on the plan. If you want to shop around however, of if you’re uninsured, read on.)
Now, if you’re uninsured, and you make under $65,167 the two options that are going to be relevant to you are the Marketplace and Medicaid. What are these?
The Marketplace, or Exchanges in some states, is a way to buy insurance if you can’t get it through your job or through your parents, and there are government subsidies to help you buy insurance. (If you can get it through your job/parent, the subsidies aren’t there.) Think of them like Amazon. You go to a site and every company selling healthcare is there. You put in some filters (age, income, conditions, etc) and appropriate plans pop up from various companies. Then you pick the one that best fits your needs, your preferred amount of coverage, and budget. All plans are going to have the minimum coverage as mandated by the law, which includes preventative services, ER visits, hospitalization, maternity, prescription drugs, mental health services, laboratories, and more, but it’s up to you to choose how much of these costs your insurance will cover and how much you want to pay a month for it. Since you’re young and making less than $65,167 but over $15,282, you’ve got some cost-reducing options, depending on your personal conditions. You will probably be able to get lower monthly premiums or lower out-of-pocket costs through the Marketplace, including Catastrophic Plans. The Marketplace is about insurances competing for your business. Be aware that your coverage won’t start until January 1st, 2014, however.
Medicaid. Unfortunately, if you live in a state that has voted not to extend its Medicaid (Texas), this won’t be helpful to most twentysomethings. Unless you’re actually poor (you as a single person make less than $15,282 in Texas), poor and pregnant, unemployed and poor, or poor and disabled/have a very serious condition you can’t pay for, you won’t be eligible for Medicaid in Texas until/unless Texas extends its Medicaid coverage to healthy, young, making $25,000 a year people.
Within the Marketplace, you’ll notice Catastrophic plans. You’re 23, you make about #32,000 a year, you go for a run once a week, you’re drinking a little less, sleeping a little more, eating a tiny bit better. Your worse sickness scare is the flu. Or getting hit while riding your bike to work. But you wear a helmet. You do however want your annual check-up, some shots, a prescription for birth control, maybe. Those things you’d like covered. You’re not that worried about bigger stuff. Catastrophic plans also cover preventative stuff up to a certain amount (think 3 visits a year covered) but beyond that, you’re required to pay for all the out-of-pocket non-preventative stuff, until the costs rack up to a certain point, then it’ll be paid for by your insurance. This is supposed to protect you from debilitating costs. What I worry about is: what if you break your leg skiing and your insurance only kicks in if your costs go over $8000, but your bills for your leg total $7500. It sucks because you’re stuck with that bill, which is still large, even though the Catastrophe plan is supposed to protect you from high costs. You also can’t get lower premiums or out-of-pocket costs based on your income, which is lame. I’m guessing (since the Marketplace isn’t open yet, so there might be another post about this) that you choose the cap limit and the more you want covered (I want my insurance to kick in when my costs get up to $3000, for example) the higher your premium. This isn’t really different from most health insurance plans already out there, except now, because of Obamacare, these plans have to cover the mandated preventative list for up to three visits.
To put it in perspective: I bought my own health insurance last year. The premium was $65 a month. The cap I could pay out of pocket was $1000 (co-insurance), my annual deductible was $200 and my co-pay was $100. It covered 80% of some services. Lifetime max was $2,000,000. Prescription drugs were not covered unless I paid an extra $200 deductible. Limits included maternity care, preexisting conditions, routine physical examines and more. All in all, a not-great plan, but I didn’t want to be uninsured riding around on a motorcycle. My woman’s wellness exam cost me over $400 out of pocket. Not to mention $30 a month in birth control because I could get $200 at one time to pay for the deductible. With Obamacare, I wouldn’t have paid anything for my exam or birth control. And my coverage would have been better, because it would have included so much more preventative services and basic services.
You may have noticed I’ve mentioned “basic care and preventative,” and thought, I want that. This is the list of stuff the government has deemed necessary to preventing illness and disease and the stuff that we use most often that everyone should have access to. Let me just say, I think these lists are awesome. It includes stuff like: cholesterol screening, HIV screening, women’s wellness (and all that goes with it) exams, contraceptives, most vaccines, various cancer screenings, depression screening, diet/obesity screening, ambulances, prescription drugs, mental health services, hospitalization, ER services, lab fees, pediatrics and so much more. And the best part? “All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover. All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.” (Network provider meaning a doctor or facility on the huge list your insurance company gives you. You can find the right network doctor/facility for you, don’t worry.) The heavens opened up and angels sing.
Now that the basics are covered (pun intended), here are some answers to some questions:
1.) Won’t companies just cut hours and make it so that they have less full-time employees, or cut my hours to make me a part-time employee so they don’t have to give me benefits?
If companies are doing this, they’re terrible. Most companies that are cutting hours or employees aren’t doing it all because of Obamacare, but because of a myriad of cost-cutting reasons. The law provides some measures to make small businesses able to provide health care for its full-time employees, and not all small business are required to. And, if you do become a part-time employee, the Marketplace is there to provide coverage.
2.) I’ve heard I’ll have to switch doctors. Is that true?
You might have to switch doctors if you change providers (go from your employer’s insurance to a Marketplace insurance, for example) or if your provider changes its network and your new provider/network doesn’t have your current doctor as part of the network. You could still go to an out-of-network doctor, just like always, but it’ll cost more. You employer might use the Marketplace to get its insurance, and they may or may not choose an inferior plan to save money. Critics of the Act cite this chance as a terrible blowback from the bill, saying millions of Americans might lose their insurance.
3.) Will Obamacare cost me money?
If you have insurance already, it won’t. In fact, because preventative care now has to be offered without co-pays/co-insurance, you might save money. If you’re uninsured right now, you’ll obviously be spending more money because you’ll now be paying for insurance. But on the upside, you’ll have insurance. And depending on your circumstances, you might get subsides or Medicaid to pay for healthcare. At the very least Marketplaces help you find rates you feel comfortable with by providing insurance plans in one place.
4.) Isn’t Obamacare going to be repealed or delayed or taken apart or something?
At this point, Obamacare is still probably not going to be repealed. The House keeps voting to repeal it, and has only just succeeded today only to be told, “NO” by the Senate. Again. The money to fund the Affordable Care Act has already been appropriated and the law supported by the Supreme Court– it’s going to happen. But there are delays because of what’s going on in Capital Hill and, as all new endeavors go, there’s bound to be some bumps along the way. And some parts of the law don’t take effect until later, such as various taxes and provisions that effect insurance companies.
5.) What about the government shutdown? What’s that all about?
Republicans seem not to like the idea of Obamacare so much, for various reasons. In order to get the Act repealed, they’re holding a law that funds lots of government activities hostage until they get Democrats to delay Obamacare for a year. It’s being called a government shutdown because many federal agencies wouldn’t have the money to open their doors for business (accept the military) and federal employees would stay at home on unpaid leave until stuff got figured out. This would be highly annoying to anyone wanting to mail letters at USPS, eat clean meat graded by the USDA, get their Social Security check, who is a federal employee, etc. The longer a shutdown goes, the more annoying it gets until it’s actually really bad.
6.) What if I lose/leave my job?
You can find new coverage in the Marketplace. COBRA still exists, but it’d probably be cheaper to get a Markeptlace plan, depending on your certain circumstance.
7.) If I don’t want or still really feel like I can’t afford insurance, what will happen?
There is a fee of $95 or 1% of your annual income as an adult in 2014 if you still don’t have minimum coverage. If after going through the whole process of trying to get coverage and still not seeing the numbers add up, and you still somehow don’t qualify for Medicaid, then there are hardship exemptions allowing the fee to be waived for you.
8.) This covers dental and vision, too, right?
Sadly no, America doesn’t give a shit about your gingivitis or near-sightedness.
9.) Are the any negative aspects to Obamacare?
As with any bill passed in Congress, it’s got some crappy stuff connected to it. Critics of the bill project that healthcare costs will increase, now that people will have free access to preventative medicine and may find out about a serious illness (as opposed to living with the unknown disease or just dying). As posted in #1, some people might have to switch provides and potentially get less coverage if their employers switch to a Marketplace plan to save money. Some people don’t like being told to buy health coverage. Small business with 50 employees or more have to provide health insurance by 2015 or pay a high fee, which could be challenging. Pharmaceutical companies may make up the loss in profit they may have due to taxes by raising prices. Medical companies may not hire new employees because of taxes. People that make over $200,000 a year will have a tax increase to help pay for the Act.
So there you have it Twentysomethings. Hopefully now you’re a bit more schooled on Obamacare and know how to approach it come October 1. If you have more questions, check out Healthcare.gov, leave a comment or hit me up on Twitter @kgraves23.
TL;DR: This video does an okay job of summing up. Except the hick-who-doesn’t-want-to-pay stereotyped character towards the end is kind of insulting…