The Affordable Care Act Part 8 – Where to Get Health Insurance

Beginning on January 1, 2014, in order to satisfy the individual mandate, people will have access to health insurance through the following sources:

  • From an Employer
    • The most common way of getting health insurance has been and will continue to be through an employer-sponsored group plan. Generally speaking, employers contribute toward the cost of the premiums, with employees paying the balance of the premiums plus other cost-sharing features such as deductibles, co-payments and coinsurance.
  • From a Health Insurance Marketplace
    • The Affordable Care Act creates Health Insurance Marketplaces in each state through which individuals and small businesses can purchase qualifying health insurance policies from private insurance companies and may receive premium tax credits to help pay the cost of the insurance. Open enrollment in the Marketplaces began October 1, 2013, with coverage taking effect on January 1, 2014.

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  • From a Grandfathered Plan
    • Many health care plans that existed before the Affordable Care Act was signed into law do not contain some of the law’s consumer protections and would not be qualifying health care plans under the ACA’s individual mandate. The Act, however, exempts most plans that existed on March 23,2010, the day that law was enacted, from some of the law’s consumer protections, which preserves consumers’ rights to keep the coverage they already had before health care reform and satisfy the individual mandate. If you have health coverage – individual or through an employer – from a plan that existed on March 23, 2010 – and that has covered at least one person continuously from that day forward – your plan may be considered a grandfathered plan. These plans can lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs to consumers.
  • From Medicaid/CHIP
    • Medicaid and CHIP are public programs that provide health care coverage to specific categories of lower-income adults and children. Beginning January 1, 2014, Medicaid will be expanded to include all U.S. citizens and some legal residents under age 65 who meet specific income requirements, assuming the state in which the individual resides does not opt out of the ACA Medicaid expansion. The Affordable Care Act maintains the Children’s Health Insurance Program (CHIP) eligibility standards currently in place through 2019 and extends CHIP funding until October 1, 2015, with authority for the program extended through 2019.
  • From Medicare
    • Individuals 65 and older, together with some younger individuals with qualifying disabilities, will continue to receive health care coverage through Medicare.
  • From TRICARE/Veterans Health Program
    • Uniformed Service members, retirees and their families receive health care benefits through TRICARE. Veterans separated from the service under and condition other than dishonorable may qualify for VA health care benefits.

 

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