Home » Health Insurance » Your New Insurance World: Obamacare Explained

Your New Insurance World: Obamacare Explained

Open enrollment on the exchanges where you can shop for coverage, began October 1 and runs through March 31. The new coverage begins in 2014.

Obamacare is NOT for people enrolled in Medicare, who have a separate open enrollment season.

For Obamacare, go to    

The exchange is having problems.  Check  information on How Do I Apply   

And there also is local assistance

For Medicare information, go to

Here are some of the Obamacare highlights:

  • Nobody can be turned down for an insurance  policy because of pre-existing health conditions.
  • There will be  no annual or  lifetime limits on the amount of benefits payable under any insurance policy.
  • The out-of-pocket spending limit for the year will be $6,350 for an individual and $12,700 for a family. These totals include all co-payments and deductibles, but do not apply to premium payments.   But if companies use a separate firm to handle drug benefits, there may be a separate annual cap of $6,350 for drug costs. This exception applies only to 2014. In 2015 and beyond, there will just be a single out-of-pocket cap on spending.
  • You have the right to see a gynecologist or obstetrician without getting a referral from your primary care doctor,
  • Insurance coverage will be mandatory. The penalty for an individual will be $95 or 1% of income, whichever is larger, with a family maximum of $285.  The penalty will be levied in 2015 on income figures for 2014.  The penalty will increase to $325 a person or 2% of income, whichever is larger, for the year 2015. In the year 2016 and beyond, it will be $695 per person or 2.5% of income, whichever is larger. After that, it will be adjusted each year for inflation.
  • The employer mandate, which requires all companies with 50 or more workers to offer health insurance, has been delayed until 2015. The penalty will be $3,000 for each worker who is not covered.

Mandate is Something New

The individual mandate, which has gotten considerable publicity and is highly controversial, means that, for the first time, the federal government is requiring all Americans to buy a particular product, namely health insurance.

But relatively few people, only about 3% of the population, will be subject to the mandate, according to research by the Urban Institute. If you already are covered at work, and 160 million people have this coverage on the job,  you don’t have to buy a new policy. If you are covered by Medicare (about 50 million), the federal program for people 65 and the disabled, you are not subject to the mandate. Nor are the 50 million people enrolled in Medicaid, the federal-state health program for the poor. If you are under 26, you can stay on your parents’ health policy. If your income is low enough so that you don’t file federal taxes, you don’t have to buy coverage. And you also are exempt if health insurance would cost more than 8% of your income. Members of Native American tribes, and people who qualify for a religious exemption, also won’t be required to buy a policy.

Publicity surrounding the ACA has given rise to lots of myths and misinformation, and opened the door for scammers.  Some things to watch out for:

  • There is NO ACA insurance membership card and anyone who asks you to get one is seeking to get personal information such as a Social Security number to run a scam.
  • Don’t give your Medicare number to anyone who calls on the phone. Medicare and your doctors already have the number.
  • Watch out for e-mails from phony websites disguised as the place where you can enroll for the policy.

Crooks are making calls and even going door- to- door, posing as government employees for agencies such as the Department of Health and Human Services and Medicare. The marks — that would be you — are told they are among an initial group of Americans selected to receive the new ACA insurance card. To get it, all you must do is provide your Social Security and bank account numbers. The caller may also ask for a Medicare number, which is the same as your Social Security number. Never give out this information.

Written by Bob Rosenblatt

Bob Rosenblatt is a researcher, writer and journalist who helps people looking for up-to-date answers and information on the perplexing issues at the intersection of finances and aging. Bob publishes a weekly report — please take a moment to subscribe in the upper right hand corner of this page.

Leave a Reply

Your email address will not be published. Required fields are marked *

WP-Backgrounds by InoPlugs Web Design and Juwelier Schönmann