The Affordable Care Act
The primary purpose of the Affordable Care Act (ACA) is to increase the number of Americans who have access to affordable health insurance. The ACA connects you to insurance options in your area through the health care “marketplace.” You can sign up for insurance at HealthCare.gov or a state health insurance marketplace to see which plans you qualify for.
As part of the ACA:
- Medicaid was expanded in many (but not all) states to provide eligibility to the nation’s poorest citizens.
- Small-business owners have been given tax credits to encourage them to offer health care to their employees.
- State-based insurance exchanges (marketplaces) have been set up for individuals to purchase their own insurance.
- Tax credits have been provided to certain individuals who need help paying for health care in the ACA marketplace.
- Pre-existing conditions no longer can be used to deny or charge additional amounts for health coverage.
- Children up to age 26 can be covered as dependents on parents’ plans.
How to Get ACA Insurance
- Get your finances in order. Tax returns are used to verify income in order to provide discounts and premium assistance.
- Learn the language. HealthCare.gov has a glossary of common health terms to give you a basic understanding of terminology.
- Pick the right plan type. Understand the options each plan offers, especially in terms of which physicians you may access.
- Choose the best coverage for your needs. ACA plans are divided into four metal tiers: Bronze, Silver, Gold and Platinum (plus Catastrophic plans, for which restrictions apply). As you move from Bronze to Platinum, premiums go up and out-of-pocket costs go down.
- Use free tools such the HealthCare.gov comparison tool to price the actual plans available in your area.
- Don’t get scammed. Use the official sites to direct you to your authentic state-run, marketplaces. You also can access the ACA marketplace in person, by phone or by mail.
But what if you’re a healthy, young person? Can’t you just pay the penalty and take your chances? Well, yes, but going without health insurance can be risky. You never know when you might get in an accident, need an emergency procedure or contract a serious illness. Medical debt is the leading cause of bankruptcy, so it pays to have coverage.
Paying the Penalty
If you go without insurance, you will have to pay the penalty. In 2016, the annual fee for not having insurance is $695 per adult and $347.50 per child under 18 (up to $2,085 for a family), or 2.5 percent of your household income above the tax return filing threshold for your filing status – whichever is greater.