Healthcare Changes: How They Will Affect You


October 1st, 2013 is looking to become an important date in the United States history books as it will mark an historic change in the accessibility of healthcare for the nation’s citizens. The first day of October starts the beginning of the 6 month open enrollment period for health care plans, and as the nation and healthcare system brace for the influx of applicants, due to the implementation of the Affordable Care Act, here is what you should know.

Do I Need to Get Health Insurance?

By January 2014, Everyone in the U.S. will need to be insured by a plan that meets the minimum essential coverage. If you already have health insurance through an employer, or are getting your coverage through a state or federal program, you are already in compliance.

What If I Can’t Afford Health Insurance?

People seeking health care coverage can be assisted financially in three ways:

  1. Tax credits- which can be used right away to offset the monthly cost of health insurance

  2. Cost-sharing subsidies- a reduction in out of pocket expenses that correlate to a person’s income

  3. Medicaid assistance- state or federal health insurance coverage

Are There Any Types of Coverage That Don’t Count?

Yes. The following types of health coverage that do not meet the minimum essential coverage:

  • 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

What Will My Health Insurance Offer To Me?

While all health coverage plans are different, there are several things that the Affordable Care Act has mandated that every person will have included in their coverage starting in January 2014. Those items are:

  • Ambulatory patient services

  • Emergency services

  • Hospitalization

  • Maternity/newborn care

  • Mental health & substance abuse care

  • Prescription drugs

  • Rehabilitation services & devices

  • Lab services

  • Preventative & wellness care

  • Pediatric services, including dental and vision

What Happens If I Don’t Have Insurance By January 2014?

If you do not have health coverage by January 1, 2014, you will have to pay a fee to the government. The fee for 2014 will be 1% of your yearly income or $95 per person for the year, whichever is higher. The fee for minor children is $47.50 per child. The fee increases every year until 2016, when it will reach 2.5% of your yearly income or $695 per person, whichever is higher.

It's important to remember that someone who simply decides to pay the fee won't get any health insurance coverage, and they will still be responsible for 100% of the cost of their medical care. After open enrollment ends on March 31, 2014, you won't be able to get health coverage until the next annual enrollment period, unless you have a qualifying life event (marriage, divorce, new child, moving to a new state).

Is The Fee Avoidable?

If you can afford health care and choose not to buy a coverage plan you will be assessed the fee. However, there are a few circumstances in which the fee will be waived for those without insurance:

  • If you are uninsured for less than 3 months of the year

  • If you are determined to have very low income and coverage is considered unaffordable

  • If you are not required to file a tax return because your income is too low

  • If you would qualify under the new income limits for Medicaid, but the state has chosen not to expand Medicaid eligibility

  • If you are a member of a federally recognized Indian tribe

  • If you participate in a health care sharing ministry

  • If you are a member of a recognized religious sect with religious objections to health insurance

Many people are unsure of how the new rules and policies of the Affordable Care Act will affect them, and having someone that you can trust talk to you about your individual situation is a great help. While our government at both the federal and state levels have websites that you can visit for information, we know that it can still be confusing. Here at Kearby Insurance, we’d love to be that trusted resource for you to utilize, as you look at all your health coverage options.  Please give us a call at (530) 674-3430 to ask any questions you might have regarding any of your insurance needs today.


Posted on September 17, 2013 .