Affordable Care Act: What does it mean for you? - New York News

Affordable Care Act: What does it mean for you?

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The Affordable Care Act was passed Thursday morning by the Supreme Court, upholding the constitutionality of the Obama administration's health care law, citing the individual mandate as a tax. The act will be in full force in 2014. What will it mean for you?

If you already have health insurance can you keep it?

  • Most likely. According to the Urban Institute's Health Insurance Policy Simulation Model, 95% of those with some type of insurance coverage without reform will have the same type of coverage under the ACA. The remaining 5% will receive coverage route. 

If you don't have insurance will you need to buy it?

  • Probably. The majority of Americans will have to have health insurance by 2014. The law does require employers to provide at least minimal benefits via a health plan to employees. If you don't have health insurance and you don't meet an exemption you will be penalized.

What if you can't afford insurance? (

  • According to, if even the cheapest option is still too expensive you may qualify for Medicaid.
    • The eligibility rules are different for each state, but most offer coverage for adults with children at some income level.
    • Beginning in 2014, most adults under the age of 65 with individual incomes up to about $15,000 per year, will qualify for Medicaid in every state.
    • However, if a state wishes to not take part in the Medicaid expansion, the federal government will not be allowed to deny the state's existing Medicaid funding.
    • Under the new law states have the option of expanding Medicaid to cover everyone who earns less than 133% of the federal poverty level. According to Family Doctor, that means, as of 2012, you may be covered if your yearly income is less than $14,856.

  • Can I be exempt from the tax? Yes. The economic hardship exemption is available to avoid the tax penalty. You're eligible if:
    • You have a religious objection
    • You are not lawfully present in the United States
    • You are in prison
    • The cheapest health care plan available on your state's insurance exchange would cost more than 8% of your annual income
    • You are a member of an Indian tribe
    • You experience only short gaps in coverage
    • You have suffered a hardship with respect to the capability to obtain coverage

  • You also may qualify for financial assistance from the government starting in 2014. It will help you purchase private health insurance through a state-based health insurance exchange that will allow you to compare benefits and prices among different insurance plans to decide which is best for you.

What's the penalty if you don't pay for insurance?

  • The tax will change yearly and eventually reach up to several thousand dollars a year.
  • Starting in 2014 the cost will be either 1% of your household income, or $95 per adult and $47.50 per child, whichever is more expensive. However, the maximum penalty per family will be $285.
  • In 2015 the cost will increase to $325 per adult, or 2% of your income.
  • In 2016 the penalty will be $695 per adult and $347.50 per child or 2.5% of an individual's household income, whichever costs more. Families can be charged a maximum penalty of $2,085. 
  • The yearly penalty will be taken straight out of the your tax rebate.

What if you have a preexisting condition and were denied health insurance in the past?

  • As part of the act insurers will have to accept everyone, regardless of medical history.
  • Insurers cannot charge unhealthy individuals higher premiums or only offer them limited coverage.
  • This also helps make sure that individuals don't wait until they get sick to buy insurance. 

Does this violate the Constitution?

  • No. The mandate is not a legal command to buy insurance. Instead, it makes going without insurance another thing the government can tax.
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