Many myths have circulated about the Affordable Care Act. Below are ten myths and facts about Obamacare health insurance.
Since the Affordable Care Act requires plans on the individual and family market to cover essential health benefits that were not required in the pre-reform market, many plans in the pre-reform market are not qualified health plans. Unless these plans are grandfathered, then enrollees would not be able to keep them in 2014.
The Affordable Care Act's employer mandate requires employers to provide their employees with affordable health plans that cover at least 60% of covered health care costs for a typical enrollee, or face a tax penalty. The employer mandate was supposed to start in January 2014, but it was delayed until 2015 for employers with at least 100 full time equivalent employees (FTE) and until 2016 for employers with between 50 and 99 FTEs.
Although some plans have narrow provider networks, every plan will have a list of covered doctors and hospitals. People will be able to choose their primary care doctor from the doctors in this list. Some plans will provide coverage for doctors and hospitals outside of their networks, but usually enrollees will have to pay higher copayments and coinsurance percentages for coverage provided out-of-network.
Bronze plans are required to cover 60% of covered health care costs for a typical enrollee and silver plans are required to cover 70%. However silver plans can have lower premiums than bronze plans. Moreover bronze plan deductibles in the federal marketplace ranged between $2,000 and $6,350, while silver plan deductibles ranged between $0 and $6,250. Read more about cost-sharing ranges in metal plans.
The tax penalty for not being insured in a qualified health plan in 2014 is the maximum of either 1% of household income or $95.
People can go uninsured for three consecutive months before they have to pay the uninsured penalty. Thus people can avoid paying a penalty if they enroll in a qualified plan by March 31.
Short term health plans are not required to adhere to the Affordable Care Act, so they may use underwriting to reject applicants based on health history and they do not have to cover the essential health benefits. Therefore short term health plans are not qualified health plans and enrollees will still have to pay the penalty for not being insured in a qualified health plan.
Enrollees in marketplace plans can get subsidies for out-of-pocket costs if their household income is up to 250% of the federal poverty level. Some people with income up to 400% of the federal poverty level can get premium subsidies. However premium subsidies also depend on the cost of the second cheapest silver plan in the enrollee's rating area, so many young adult enrollees cannot get subsidized premiums if their income exceeds 300% of the federal poverty level.
The Affordable Care Act stipulated that small group health plans must not have deductibles over $2,000 for individuals and over $4,000 for families. However the HHS allowed plans to exceed the caps in order to maintain their specified actuarial value. Therefore nearly all bronze plans had deductibles over the limits.
Qualified health plans can also be purchased off-exchange. However off-exchange plans do not qualify for subsidies.
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