With Tuesday’s launch of the health insurance marketplaces, Obamacare becomes a numbers game. How many people will sign up? What will the premiums be? How many people will pay the no-insurance penalty? Soon we will have actual data to prove either the Obamacare optimists or the Sen. Cruz crowd right.
As I read all the news about I kept finding new details about the law that I did not know, like what is considered affordable. Here is a list of dates and definitions important to the latest Obamacare changes. Thanks to Dan Munro on Forbes for highlighting many of these numbers and linking to even more details.
How much is affordable?
Policies on the exchanges must cost no more than 9.5% of a person’s W2 income. Government subsidies will bring down that cost for some people, depending on family situation and other factors. Kaiser Family Foundation has a calculator to help individuals estimate the final cost of a policy.
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Open enrollment
For 2014 coverage only, people can sign up for a policy on the insurance marketplaces until March 14, 2014. Open enrollment for 2015 and beyond will be the more traditional 90 days.
Percentages behind the policy labels
The generosity of the various plans is described with a metal. Here are the benefits of each type of plan.
- Bronze – the most basic plan covers 60% of medical claims
- Silver – 70% of claims
- Gold – 80% of claims
- Platinum – 90% of claims
Penalties
Scofflaws get off easy the first year but after that the fines for not carrying insurance go up fast.
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- 2014 – $95 per uninsured person (or 1% of household income over filing threshold)
- 2015 – $325 per uninsured person (or 2% of household income over filing threshold)
- 2016 – $695 per uninsured person (or 2.5% of household income over filing threshold)
10 required benefits
In addition to defining cost, the ACA requires all policies offered in the marketplaces to cover 10 essential services. They are:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehab services and devices
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services, including dental and vision care
Here is a detailed list of the new rules about coverage.
There are also 15 preventative screenings that policies must cover.
[Image from flickr user Mark Morgan Trinidad A]
