Americus Times-Recorder, Americus, Georgia

Local News

November 19, 2013

‘Obamacare,’ACA explained

AMERICUS — So – what’s happening to my health insurance?

By way of introduction, I am an Americus insurance agent that is pretty well versed in the intricacies of the Affordable Care Act – Obamacare – the Marketplace – the new health insurance system.  I served as President of the National Association of Health Underwriters – America’s Health Insurance Professionals in 2010 and since that time have headed their “Exchange Working Group,” dealing with health insurance reform.

I am here to explain a little about how the Marketplaces or Exchanges are supposed to work, how you might obtain help in purchasing insurance and to answer questions you might have about the new system.

So I thought I would start by explaining how the new “Marketplaces” or “Exchanges”(same thing-different name) are supposed to work, including the assistance you might receive if your employer does not provide insurance.  (I think everyone has heard the systems are currently having problems enrolling members).

Anyone under 65 can buy health insurance on the Marketplace.  You can go there even if you have coverage at work or on your own now.  Those over 65 already have another government program, Medicare, so they are the only group excluded.  But not everyone can receive assistance in the way of premium subsidies to buy insurance.

To receive assistance, you must earn between 100% and 400% of the federal poverty level and not have access to qualifying, affordable coverage through your employer.  For an individual this would be earning between $11,490 and $45,960; for a family of four, $23,550 and $94,200.  If you earn less than 100%, you are assumed to qualify for Medicaid, even though, in Georgia and many other states, you may not.

The Federal system of assistance may seem complicated, but works this way – at a given income level, depending on family size, you are expected to spend a given amount of money toward your insurance coverage, then the government pays the rest.  The Government’s contribution is based on a mid-level plan, termed the “Silver” plan, which in Georgia would be a plan with an individual $2000 deductible and then 80% coinsurance until you reach the individual out of pocket maximum of $6,350.  

So let’s look at an example here in Sumter County.*  Let’s assume we have a family of 4 with a family income of $45,000 (the technical term used is Modified Adjusted Gross Income or MAGI) Let’s also assume, in this traditional family, that the father is 42, the mother 38 and they have two children under the age of 18. Also no one uses tobacco.  We input this information and the Kaiser Family Foundation (asterisk above) site gives us several pieces of information.

First, the family is at 191% of the federal poverty level.  At that level, they are required to spend 5.89% of their income toward the purchase of a standard Silver plan with a total cost of $17,357 per year.  So their cost for that plan, 5.89% of their income, is $2,650 or about $221 per month.  They can use the subsidy they receive, $14,706, to purchase a more expensive plan or a less expensive plan and the only change would be to increase or decrease their part of the premium.

I would suggest that, should you think you might be eligible for a subsidy, go to the Kaiser site at KFF.org/interactive/subsidy-calculator/ and input the numbers for your family.  Then contact a local insurance agent to help you enroll in a plan that works for you, whether or not you receive a subsidy.

Please send us your questions for our next column.

NEXT TIME:  What happens if the subsidy I receive turns out to be wrong? Then - What happens if I don’t buy insurance? And answers to your questions

Provided as a community service by Russ Childers, CLU  229-924-3864 or childr@bellsouth.net

*the example is determined by the Kaiser Family Foundation Health Insurance Subsidy Calculator and, while not perfect, is a tool many experts have been using to estimate subsidies while the official sites are not readily available.

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