The Scoop on What’s Changing for Health Care

Passions run pretty strong when it comes to the nation’s health reform law, the Affordable Care Act (OK, Obamacare). Still, a lot of families don’t know much about the law or what’s set to change when it takes effect in the next few months. That’s too bad in a place like Texas: we have the country’s highest rate of uninsured working-age adults and the second-highest rate of uninsured children.

We also have a lot of self-employed workers, people with part-time jobs, and folks with incomes that either are pretty modest or that land them in the middle-class. These also happen to be the people who most need to know what’s changing because of Obamacare. For example, did you know if you have a child who was born in this country there’s likely a low-cost health insurance option for your kid available soon? Did you know if you work, even it’s part-time or for yourself, you’ll probably get to have health care at a price you can afford? Did you know, chances are, you’ll get some help paying for it?

The Austin-based Center for Public Policy Priorities and the Texas Well and Healthy campaign are “counting down to coverage” to make sure Texans know about new health care options starting on October 1. Stacey Pogue is a health reform expert, mom and senior analyst with the Center. I ran a few questions by Stacey about what it is folks need to know.

What’s one thing families need to understand about the changes coming up for health insurance?

Stacey: Something new and wonderful is beginning on October 1: the new Health Insurance Marketplace. It’s a new way to compare and shop for health insurance that fits your budget. Many of the 1 in 4 Texans who are uninsured now will be able to benefit from the easier shopping experience and financial help offered in the Marketplace.

What sort of financial help will folks get with buying health coverage in the Marketplace?

Stacey: Most people who enroll in the Marketplace will also qualify for the financial help with the cost of coverage. Financial assistance is based on your income and family size.

An individual could qualify for lower monthly insurance premiums if he/she earns between about $11,500 and $46,000 a year.  A family of four with income of about $23,600 to $94,200 could qualify for lower premiums.  The lower your income is within this range, the more help you’ll get with premiums.

Some people can also qualify for reduced deductibles and copayments (if their income is below about $28,700 for an individual, or $48,800 for a family of four).

The Kaiser Family Foundation has a great subsidy calculator that lets you enter information on your age, family size, and income and then get an estimate of the premiums YOU will pay and how much subsidy help you will get in the new Health Insurance Marketplace.

So how does the Marketplace work?

Stacey: The Marketplace will offer a variety of private health insurance plans. All plans will have a comprehensive core set of benefits including doctor visits, hospitalization, maternity, mental health care, and prescriptions.

Comparing health plans in the Marketplace will be easy, with all of your options in one place and information on prices and benefits written in simple language. Through the Marketplace you can compare plans before you enroll based on what is important to you: price, benefits, quality, etc.
AdvertisementIs the Marketplace for everyone?

Stacey: The Marketplace is for lots of people, including people who purchase their own insurance and people whose health insurance offered through their job costs more than 9.5% of their income or isn’t up to the standards of the health policies sold on the marketplace. Employers with 50 or fewer employees will also be able to compare and buy job-based coverage for their business through the Marketplace. The Marketplace is open to people who live in the United States; are U.S. citizens or nationals, or are lawfully present; and are not currently incarcerated.

But, the Marketplace isn’t for everyone. People enrolled today in Medicare, Medicaid, CHIP, TRICARE, and the VA and people with job-based insurance that meets their needs have already satisfied the “individual mandate” requirement for coverage in 2014 and do not need to go to the Marketplace.

I understand that this option starts October 1, but when does the time to enroll end?

Stacey: In this first year, open enrollment will last 6 months, so you have to enroll by March 31, 2014. You cannot enroll outside of open enrollment unless you have a “qualifying life event”—a change in your life like marriage, divorce, child birth, loss of coverage through your job, and loss of Medicaid or CHIP coverage. (Small businesses can buy a new plan at any time during the year; open and closed enrollment times apply only to individuals and families.)

To have coverage right at the start, you’ll need to enroll between October 1, 2013 and December 15, 2013 and make your first premium payment. Then your new health coverage will start on the first day possible: January 1, 2014.

Anything else?

Folks can learn more about the Marketplace, financial assistance, how to enroll, small employer coverage, new consumer protections and more at or by calling (800) 318-2596. And if you only have a few minutes available to learn about the ACA, consider spending it watching “The YouToons Get Ready For Obamacare.”  It’s a short, understandable video that explains upcoming changes and helps people understand their coverage options, including job-based coverage, Medicare, Medicaid, and the new Marketplace.

Will you be enrolling in the Marketplace this fall? Are there more questions you need to have answered first?

[author] [author_image timthumb=’on’][/author_image] [author_info] Christine Sinatra works for Texans Care for Children, a nonprofit dedicated to improving policies that affect kids in Texas that also has a weekly column in the Austin American-Statesman. She is a mom to a first-grader, a former newspaper reporter and a former high school teacher.[/author_info] [/author]



About Christine Sinatra 53 Articles
Christine Sinatra is the communications director for Texans Care for Children and mom to a kindergartener. Her past experience includes working as a reporter for the Austin American-Statesman and the Oakland Tribune company, being a Peace Corps volunteer for high school girls in Africa, and studying at UT’s LBJ School of Public Affairs.

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