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Some Simple and Easy-to-Understand Answers to Questions about Obamacare

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Let’s be honest here. One of the biggest reasons people are still fighting about the Affordable Care Act (also called “Obamacare” and the “ACA”) is because most of us still don’t understand it. The damn bill is big. I’ve read that the condensed version is over 2000 pages long. I’ve seen other reports giving other estimates on its length, but I think everybody in both parties can agree with this statement: The Affordable Care Act is big and complicated.

In many ways I think it’s unnecessarily complicated, but there are also aspects that should be complicated. This is a complicated subject.

The downside, of course, is the fact that politicians (on both sides) use the complexity and size of the bill to distort the facts.

It’s time to stop listening to the politicians on this issue. Please. To them, the actual value of the Affordable Care Act is irrelevant.

The ACA could be the best thing for this country and republicans would still oppose it.

The ACA could be the worst thing for this country and democrats would still support it.

So let’s forget the politicians. House Speaker John Boehner is just pushing an agenda. Senate majority leader Harry Reid is just pushing an agenda.

So let’s just ignore them and think for ourselves, shall we?

With that in mind, I’m going to do my very best to answer most of the basic questions about the ACA. I’m just a guy, so if I post something here you think is inaccurate, tell me in the comments.

My goal is to give straight answers to these questions, without factoring in politics in any way. Straight, easy to understand answers. I’m a pretty opinionated guy, so I might give my thoughts on a thing or two, but when I give my opinion, I’ll preface it with “MY OPINION” so there’s no mistaking the parts that are just opinion.

My actual answers will be an honest attempt to only state facts.

Okay. Let’s get this party started. I’ll start with the obvious question…

What is The Affordable Care Act (the ACA)?

The simplest (and most nonpartisan) definition I could find is from Wikipedia: “The Patient Protection and Affordable Care Act (PPACA),commonly called Obamacare or the Affordable Care Act (ACA), is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the country’s healthcare system since the passage of Medicare and Medicaid in 1965.” Source: Wikipedia

What’s the difference between the Affordable Care Act and Obamacare?

There is no difference. They’re the same thing. “Obamacare” is just the politicized term for the ACA.

Is Obamacare socialism?

This one is debated furiously, but in the most technical sense… no, it’s not a socialist system. The insurance you obtain through the ACA is obtained from private, for-profit insurance companies. A truly socialist medical system is a system where the government directly provides healthcare. That’s not the case here.

However, opponents of the ACA have argued that this is a step toward a socialist healthcare system, simply because the government is so heavily involved in the process.

MY OPINION: We should ignore any and all arguments about the ACA that involve the word socialism. Many people don’t even know what that term actually means and many people don’t realize that many of our most valued institutions in this country are socialist institutions. When it comes to Obamacare, that word is used for one and only one purpose: To incite fear. If you’re afraid of Obamacare, it should be because of the facts of the bill, not because “It’s Socialism!” That’s a scare-tactic that preys on ignorance.

Is Obamacare a tax?

This is another one that has been heavily debated. Republicans called it a tax. Democrats said it was not a tax. In June of 2012, the United States Supreme Court ended that debate. Twenty-six states sued the Federal Government, saying Obamacare’s individual mandate was unconstitutional. The Supreme Court ruled in favor of Obamacare, which was a huge victory for supporters of the ACA. However, the victory was bittersweet because the ruling stated the mandate was constitutional because it is, in fact, a tax.

So yeah. It’s a tax.

More specifically, the individual mandate is a tax.

What is the “Individual Mandate”?

The mandate is part of the ACA that requires all Americans to buy health insurance. The mandate goes into effect on January 1, 2014.

However, if you can’t afford insurance, you will qualify for tax credits that cover that cost for you. How much it covers depends on your yearly income.

If Americans don’t want to purchase insurance, they can choose to pay a yearly penalty instead. This penalty increases each year. In 2014, the penalty will be 1% of your family income (or $95 per adult, whichever is higher). In 2015, the penalty will be 2% of your family income (or $325 per adult). In 2016, the penalty will be 2.5% of your family income (or $695 per adult). Source: CNNMoney

MY OPINION: If the penalty for not getting insurance is an amount you can’t afford financially, odds are good you’ll be better off just getting insurance through the Health Insurance Marketplace (I’ll explain the Marketplace later in this article). Most likely, the insurance will be cheaper or the tax subsidies will cover the majority (if not all) of your insurance costs.

How can I purchase health insurance?

Well, if you already have insurance through your employer, odds are, you don’t have to change anything. I know, I know. You’re hearing a bunch of talk about that. Well, I’ll address that in a bit. For now, let me say that most businesses that offer insurance won’t be denying you insurance because of this.

If, however, you don’t get insurance from your employer, you can get it by utilizing Obamacare’s  Health Insurance Marketplace, also called the Health Insurance Exchange.

What is the Health Insurance Marketplace?

Simply put, the Marketplace is a government run database that allows you to shop for insurance in a pool of insurance providers that comply with certain regulations meant to benefit the consumer. The Marketplace opens to the public on October 1, 2013. You can access the Marketplace online, by mail, or in-person. There will also be a telephone help line. By enrolling in the Marketplace, you’ll be able to browse what insurers are available in your area, compare costs and benefits, and see if you qualify for tax credits based on your income.

One potential downside to the Exchange is the speculation that some insurance companies will take other measures to offset the costs of meeting the Obamacare requirements and offset the cost of lower rates. This means they might end up having a smaller circle of healthcare providers they cover, thereby limiting the number of doctors and hospitals available to consumers. The New York Times recently posted an article discussing this exact issue. Source: NYTimes

MY OPINION: Since the Marketplace offers a side-by-side comparison of available insurance companies, I think the benefits of the Marketplace will greatly outweigh the potential downsides. This is capitalism at its purest. Competition usually breeds better service. Truth is, though, we’ll just have to wait and see how it pans out. Right now, it’s all speculation because this is something new for us.

When can I start using the insurance I buy on the Marketplace?

Open enrollment started on October 1. Coverage begins on January 1. Open enrollment ends on March 31.

What kinds of insurance is available?

You’ll be able to browse four tiers of insurance plans on the Marketplace: Bronze, Silver, Gold, and Platinum. Lower plans cover less but cost less. Higher plans cost more but cover more. For example, if you get a bronze plan, you’ll have lower monthly premiums but your out-of-pocket costs for healthcare (deductibles, copays, percent of bill covered) will be higher. If you get a Platinum plan, your monthly premium will be higher, but it will cover more, have lower deductibles and copays, and it’ll pay for more of the medical bill.

How much will I save on insurance through tax credits?

That obviously depends on your income. The lower your income, the more tax credit you get. The tax credits are among the most valuable aspects of Obamacare, but determining those credits can get very confusing. It’s a complex process.

Anybody earning up to 400% of the national poverty level will be eligible for tax subsidies. The less you make, the more subsidies you qualify for. For example, if you make $17,235 a year, you’ll never have to pay more than 4% of your yearly income ($57 a month). If you make between $34,470 and $45,960 you’ll never have to pay more than 9.5% of your yearly income ($364 a month). In addition to insurance subsidies, those making less than 250% of the poverty line ($28,725 for a single person and $58,875 for a family of four) will be eligible for extra subsidies to defray out-of-pocket costs, such as deductibles and co-payments. Source: CNNMoney

It’s all very confusing, but for many folks, the credit will be significant. The Kaiser Family Foundation created a very good tool to help calculate your insurance costs after you receive your tax credit. You can check it out here. Keep in mind, this calculator is an estimate, but it will give you a very good idea of what you’re going to be paying. Source: The Kaiser Family Foundation

When will I get my tax credits?

I’ve seen a ton of misinformation about this question, so I’ll do my best to clear it up here.

You can choose to pay the costs up front, then get it back during tax time or you can opt to have the tax credits applied up front (called an “advanced payment”), based on an estimate of your yearly income. If you choose to have the tax credits up front, the payment goes directly to the insurer. If you end up making more than your estimate, you’ll need to pay the difference on your taxes. If you end up making less than your estimate, you’ll get a refund on your taxes. Sources: CNNMoney, Fox Business

NOTE: The second option is where I’ve seen some misinformation. I’ve seen people complaining that – even if they get the tax credits at the end of the year – they can’t afford to pay them up front. Well, the ACA has a provision so you won’t have to.

Are there penalties for smokers?

Yes and no. While the ACA does not apply active penalties for smokers, it does allow the private insurance companies to apply penalties for smokers.

MY OPINION: If you smoke, I recommend quitting . I personally think smokers are going to be hit hard by insurance companies after Obamacare is fully implemented. Think about it. Smokers are the perfect targets for them to charge very high premiums without ever having to take any public relations backlash. So if you smoke, I say now’s a good time to quit. It’s better for you anyway, and I think it’ll save you a ton of money.

How many companies are going to cancel insurance because of Obamacare?

We’re all seeing the claims that businesses are going to cancel insurance or go out of business or lay off employees because of Obamacare.  Honestly, there’s no real answer to this that doesn’t involve some speculation, but let me start by giving some facts:

The ACA will eventually require all businesses with 50 or more employees to provide health insurance for their full-time employees.

This mandate does not go into effect until 2015.

The mandate will affect some small businesses. But how many?

Of all the small businesses in America, roughly 3% will be required to provide insurance (because 97% of small business don’t have 50 employees).

Of that 3%, the overwhelming majority already offer insurance that adheres to the requirements of Obamacare.

At the end of the day, Obamacare will impact about 1% of the small businesses in America. These companies, however, will qualify for tax credits based on these changes. Sources: Forbes, CNNMoney

That said, some businesses will take actions because of Obamacare. Some businesses will move employees from full-time to part-time status. Some already have. Some businesses have already stated they’ll be raising their product prices because of this.

That said, despite the rhetoric, the literal impact of Obamacare will be relatively small on businesses. Of course, if you’re one of the employees who work for one of those businesses, the impact won’t feel small at all.

MY OPINION: The businesses that are making these kinds of changes based on the ACA are despicable. That has nothing to do with whether or not I like Obamacare. They are using it as an excuse (in my opinion) to take advantage of their employees and the public. I’ve seen businesses raise prices because the mandate was expected to come in 2014. Well, the mandate was delayed until 2015, but guess what? I’ve not seen them making any press conferences saying, “Cool! I guess we can lower our prices again!”

How will Obamacare affect Medicare?

There are many fears about how Obamacare will affect Medicare. From everything I can find, almost all of those fears are unfounded. For example, people are afraid Medicare premiums are going to go up. Well, yes, they are, but it has nothing to do with Obamacare. They’re going up because of a pre-existing formula that was created long before Obamacare.

From what I’ve found, there’s only one area in which Medicare is negatively affected by Obamacare. High income recipients of Medicare (beneficiaries receiving more than $85,000 a year) will pay slightly higher prices for medications. This amounts to about 5% of Medicare recipients. Most Medicare recipients, however, will see lower prices for medication.

Everything I could find states that the ACA will actually lower most of the Medicare costs, working to close the “Donut hole.”

With Obamacare, will my taxes pay for abortions?

Simple answer: No. Under Obamacare, your tax dollars are not paying for abortions.

This is because of two reasons:

1. The ACA allows each state the option to forbid abortion coverage if they choose to do so.

2. Even if abortion coverage is allowed by a state, that insurance company cannot use federal dollars to pay for those abortions. The insurance company is required to keep those funds separate, so your tax dollars do not go toward those abortions. Sources: Fox News, The Huffington Post, Wikipedia

I spend my retirement traveling. I have private insurance that supplements my Medicare. Will I still be able to receive medical care wherever I go? Also, will my company push me into the ACA and drop my insurance?

On the Medicare side of things, nothing changes for you. Just keep on doing what you’re doing. You don’t have to enroll in the Marketplace. The only difference is that you might be paying less for certain services because the ACA has worked toward making the “donut hole” smaller. There is, however, an exchange program that’s specifically for Medicare recipients if you’re interested. Starting on Oct. 15th, seniors can shop for prescription drug or Medicare Advantage managed-care plans in online exchanges (separate from the ACA Marektplace) that let them compare features and prices. Source: Reuters

As for your second question, that’s a little more complex. To combat the costs of insuring retirees, some companies have made changes to retirees’ insurance programs (most notably Time Warner and IBM). What these companies have done is this: Instead of providing insurance to retirees, they gave the retirees money to purchase their own plans. If that happens with your company, the plan you purchase should still be okay. The ACA makes it illegal for any company to deny coverage based on pre-existing conditions, which is often the biggest barrier for retirees. Source: NBC News

So the short answer: It’s very unlikely anything will change for you, even if you do travel regularly. However, if you’re concerned about changes coming from your company, I would advise contacting the company.

I should note here that finding information for retirees is exceptionally difficult. Most of what I’m finding simply says nothing will change for folks on Medicare. That said, this system is still based on private companies, so there are going to be variances. If you have questions about how your private insurance company is going to respond to Obamacare (if at all), my best recommendation is to contact that company and ask them.

***

Okay, so that’s it for now.

As time goes by, I’ll be adding more questions and possibly altering existing answers based on new information.

Let me wrap this up by saying I’m not an Obama zealot. The man has let me down in many ways (especially when it comes to personal liberty).

I’m also not a blind supporter of Obamacare. It has many problems I’d like to see addressed.

But I personally think that if we can strip away the politics, Obamacare will benefit many Americans of low and middle income.

If you have any suggestions, don’t hesitate to suggest them. If you have questions you’d like me to add, don’t hesitate to ask. If you have opinions you’d like to give, don’t hesitate to give them.

My only goal here is to give accurate information about Obamacare. If I’ve failed in any way, I promise it wasn’t intentional. I’m not trying to influence you here. I’m just trying to give accurate information.

Thanks.

–Jerry

21 responses »

  1. Insightful and well written. Still on the fence about it, so far. One of the reasons is that no one, that I have seen, has taken the time to explain even small parts of it as you have here. This includes those who are opposed to it as well as those who are for it. Everything written on it seems to be Democrat or Republican, therefore, for or against.

    I have many concerns, such as, as a working man and tax payer, I expect to see my taxes going up, to cover those that cannot, for whatever reason, (not pointing fingers) but cannot afford what I can afford. I am opposed to abortion (for other than health of the mother) and do not like my taxes being used to fund it. Nor do I like the fact that my taxes would be used to fund a heavy smoker who now has emphysema or a heavy drinker with liver failure.

    So the question becomes, how much government intervention to our individual habits as we move forward.

    I get it, it is not socialism (maybe, on the fence about that one too), however, the facts are, those more well off will end up funding those who are not so well of. Got it, understand, and (to a degree) have no problem with that. I know I make more than my nieces and nephews, etc., and I would be helping them as well, not an issue. I am not saying I should not help my fellow man, but at what point do we lose personal choice in the matter. Do we make drinking or smoking illegal, because of the health risks and therefore the health costs? (these are only a couple of easy examples without getting into sexual preference, HIV, morning after pill, etc.)

    Reply
  2. Extremely valid concerns, James. In the next day or so, I’ll do some research and try to add your points to the list with honest, nonpartisan answsers.

    At the end of the day, I think your concerns can’t be answered with facts and figures. Eventually, you’ll just have to ask yourself if the ends justify the means. Are the sacrifices the ACA asks of you (both philosophically and financially) worth the benefits it brings?

    That’s a tough one. Maybe they are worth it; maybe they’re not. That’s only a question you can answer.

    I fully admit I tend to lean left on many social issues, but I honestly tried to put that aside when writing this article. I didn’t write this to win anybody over on Obamacare. I wrote it so folks can make an informed decision about it based on the facts. If that means they oppose it, that’s perfectly fine as long as that opposition comes from a place of understanding.

    And the same is true for people who support Obamacare. Don’t support it because democrats created it. Support it because you understand it and agree with it.

    Ignorance is the most powerful tool our politicians have when it comes to manipulating us.

    You, James, are clearly not coming from a place of willful ignorance, so props to you for that.

    Reply
    • I truly try not to, it is important to actually try to find out what is involved, especially with something like this that will affect so many people, good or bad. I am very, while not ‘anti-government’, more towards just less government and right now the government is getting way to involved in our lives, which is a whole different story, drones for example, police state. And I firmly believe that part of what is killing ‘obamacare’, is Obama. Here he is trying to sell us the affordable care act, while waffling on Syria, letting Putin take the lead, signing treaties with the UN to take away the 2nd amendment, Armed IRS agents that are targeting conservative groups disproportionately.

      Reply
  3. James, I added an answer to the abortion question. I think you’ll be pleased with what I found.

    Reply
  4. Pingback: This And That

  5. My wife and I are retired. Sold our house and travel the US in an RV. Our life’s dream. I retired from a company in Texas and have insurance through them to supplement Medicare and Silverscript. As we travel the US and need medical care will our medical care be available outside of Texas. Also seeing how we are retired will our company elect to drop us into the ACA? We are both in our early 70’s.

    Reply
    • Good question, Bob, and one I don’t have the answer to off the top of my head. I’ll do some research and add that question to the blog. I should have an answer in a day or so.

      Reply
    • Bob, I’ve done my best to answer the question. It’s added to the above blog. To be honest, I feel like retirees are seeing the least amount of available information in regards to Obamacare. Most of the information out there is relatively vague.

      At the end of the day, here’s what I think (and I’m not a legal expert; I’m just a guy studying this stuff): It’s very unlikely anything’s going to change for you. To be sure, the best thing you can do is contact your insurance company.

      Reply
  6. I’m retired and 66. Its difficult for my wife to find employment in our small community,. With our current income, if we have to pay as little as $57.00 a month for her health insurance, more than likely we’d be eating cold cereal three times a day. . .

    Reply
    • Hello there, Mr. B.,

      From what I understand (keep in mind, Jerry is the real genius on this one – he’s the brains, and I’m the…well, the other end of this horse), you should be in good shape. With one of you retired and living on a fixed income – especially if you’re enrolled in Medicare – and if you’re to the point that $57 a month can break you (and I don’t doubt you one bit on that number), then you should qualify for exemptions.

      If you’re already enrolled in Medicare, then your prescription prices might even go down some, and the donut hole (if you have Part D) will be smaller.

      As for your wife having trouble finding employment, I’m sure that makes it even harder to find gainful employment with worthwhile insurance, so maybe this will make things easier.

      I suppose we’ll just have to wait and see. But if you get any information, please be sure to pass it along to us! We’d love to know what you know – as Jerry said, information for retirees is kind of sparse at the moment.

      Best,
      Clyde O. Watson

      Reply
  7. Helpful and Insightful. The only attempt at a HONEST breakdown I have ever seen. I’m still not for it as I believe Government regulation and Mandates as well as Taxes are to high and overreaching now. I am not a Trusting person of Government in general as the Politicians exempt themselves and their Union Cronies from this and raise their own salaries without our voting on it. IF IT IS SO GOOD FOR THE COUNTRY WHY DO THEY EXEMPT THEMSELVES, JUST LIKE THEY DID ON SOCIAL SECURITY. Politicians cannot be trusted with our money as they have proved in the past from Raiding the Social Security funds over the years and causing it to be in the dismal state it is in now. Too much of the Good Old Boys doing what they want, on both sides of the isle, that is NOT in the best interest of the public. I appreciate your explanation of the “ACA”. Still not for it due to the above, but Thanks again for the Honest breakdown. Jerry B in Oregon

    Reply
    • Jerry, that’s perfectly reasonable. My purpose on this blog was not to try to influence anybody to be for or against Obamacare. My only goal is that people base their opinions – whatever those opinions are – on understanding, not ignorance.

      Reply
      • I understand and accept your premise. I believe you are putting forward facts you have of the ACA. I am opposed to it being “FORCED” on the American People but EXEMPTING POLITICIANS and UNIONS.. Make it optional for all to choose with NO PENALTIES and I would be for it. Something OBAMA and POLITICIANS will probably not even consider. Again I thank you for your ACA breakdown and I believe you made it Clear and Understandable. Thanks. JERRY B. in OREGON

  8. Thank you so much for this explanation. This has all been so confusing and I have only just begun a week or so ago to tackle the issue. I especially appreciate your comments about the politicians. I am so sick of both sides … all any of them want is to be in power. I don’t believe most of them care one bit about what is best for the country. I have no idea if the ACA will end up being a good thing or not. I have huge doubts simply because the government is in control.
    The thing that I notice, and I hope you will comment on this, is that after reading some of the info on healthcare.gov, it appears to me that a lot of what the ACA is purported to do isn’t actually what will happen. The whole idea as I understand it was that “every” American would have health insurance. However, look at the info below straight from their website. A lot of these people didn’t have insurance before the ACA and still won’t. Am I missing something?

    If you have any of the circumstances below that affect your ability to purchase health insurance coverage, you may qualify for a “hardship” exemption:

    You were homeless.
    You were evicted in the past 6 months or were facing eviction or foreclosure.
    You received a shut-off notice from a utility company.
    You recently experienced domestic violence.
    You recently experienced the death of a close family member.
    You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
    You filed for bankruptcy in the last 6 months.
    You had medical expenses you couldn’t pay in the last 24 months.
    You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
    You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
    You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.

    Also, my husband and I are full-time RVers. Our permanent address is in Texas although we are rarely there. I understand that we would have to purchase insurance in Texas, but how would we be covered out of state?

    Reply
    • Hey Sue,

      I think Jerry might have overlooked this comment, so I’ll answer this one for him.

      The “hardship exemptions” don’t mean that the people listed in your example are going to be exempt from having insurance. They’re exempt from having to pay for it. It will be provided for them because they’ve had trouble with any of the things you listed there, and they’re now financially unable to afford the insurance.

      As for the out-of-state insurance, someone else asked the same question, and I still don’t know the answer. Maybe Jerry has had time to look into that.

      Best,
      Clyde O. Watson

      Reply
    • Sue, to answer your question about out-of-state coverage…

      Short answer: From everything I’ve found, Obamacare doesn’t change anything in regards to your question about coverage while traveling.

      My recommendation: Call your insurance company and ask them. They will have the definitive answer on what they cover.

      Longer answer: I’ve found nothing where the ACA addresses this issue. If the ACA doesn’t address it, that means there are no changes involving out-of-state coverage in the ACA.

      What does that mean? It means it’s exactly the same as it was before the ACA was implemented, which means it varies with each insurance company.

      When it comes to emergencies, some (but not all) insurance companies do provide medical care for emergencies that happen when you’re out of the state (but still in the country). However, when it comes to regular medical care, that will be up to the individual insurance companies and it can vary wildly.

      Now, I should note that this answer is based on the fact that I’ve not been able to find anything addressing this issue with Obamacare. If it turns out there is a provision and I’ve missed it, I’ll update immediately. Truth is, since you’re an RVer and it’s not in the ACA (that I can find), you are probably more informed on insurance for travelers than I am.

      Either way, the people who will have the answer to that question will be your insurance providers.

      Reply
  9. Becky from Florida

    Per Sue’s Comment:

    “You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.”

    Per Clyde’s Comment:

    “The “hardship exemptions” don’t mean that the people listed in your example are going to be exempt from having insurance. They’re exempt from having to pay for it. It will be provided for them because they’ve had trouble with any of the things you listed there, and they’re now financially unable to afford the insurance.”

    I’m confused because it is my understanding that since Florida opted out of expanded Medicare coverage that there would be no coverages available for those persons that were under the “poverty” level and were not old enough for Medicare/Medicaid coverage. Was I misinformed?

    Thanks for the plain and simple explanations of the Affordable Care Act. What the “politicians” are not seeing is the number of middle class Americans who worked hard their whole lives only to have their life savings, their self respect and confidence, their jobs and their health insurance taken from them through no fault of their own. There are unknown and undocumented numbers of cases of depression from these circumstances because of the vast numbers of Americans who can no longer afford to go to a doctor. I would only hope that this “light at the end of the tunnel” does not get delayed any further because of the politicians who have very good health care coverage and never had to go through what these Americans are living through.

    Reply
    • Hi Becky,

      I think I may have worded my reply to Sue poorly. Let me try and break it down some more.

      If someone cannot afford health care, there are tax credits that will help them with their monthly premiums. There’s a whole page that deals with different questions about getting lower costs on health care. You can find that one here:
      https://www.healthcare.gov/getting-lower-costs-on-coverage/

      As for exemptions, that page is here:
      https://www.healthcare.gov/exemptions/

      The page deals with the “individual shared responsibility payment”. This is the fee that people are losing their minds over. You pay this fee only if you choose to not buy insurance. This is where the exemptions come in. If you choose not to buy insurance and meet certain requirements (those listed by Sue originally, and there are more on the website listed above), you will not have to pay the fee for choosing to not buy insurance. This page also tells you how to apply for the exemption.

      I can tell you that the rules for exemption status from the fee are the same for each state.

      As for Florida, Medicare/Medicaid and the poverty level, here’s what I found:

      This page says “The Federally-facilitated Marketplace (FFM) will be offering health coverage in Florida in 2014. The FFM will make assessments of Medicaid/CHIP eligibility and then transfer the applicant’s account to the state agency for a final eligibility determination. Florida is not expanding Medicaid coverage to low-income adults effective January 1, 2014.”

      So you’re correct, Florida has opted to not join the expansion of Medicaid.

      It’s all still a little confusing, especially since each state can choose to do their own, have a federal marketplace, etc. If you’re confused about anything, your best bet is to contact either your current insurance provider or use the Find Local Help link on the HSS website. They can help you find someone who has a better idea of what’s going on, and since they’re local to you they’ll be more versed in what’s going on in your state.

      Once again, here are all the links I’ve mentioned above:

      Getting Lower Costs On Coverage

      Exemption Information

      Medicaid/CHIP Information for Florida

      Find Local Help With Health Insurance

      Hope this helps at least a bit.

      Best,
      Clyde O. Watson

      Reply

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