On Jan. 1, just about everyone must have health insurance (with government help, if sorely needed) or face a penalty, and everyone must be able to get coverage, no matter how sick.
To make that happen, insurance exchanges in the 50 states and the District of Columbia are scheduled to start selling policies online Oct. 1. The largest overhaul of the country's health system since Medicare was launched in 1966 will finally be up and running.
And with its arrival comes widespread confusion, made worse by delays, price scares, and continued political rancor. "Survey after survey shows there is enormous uncertainty on the part of consumers about what is coming in 2014," says Kev Coleman, head of research for HealthPocket.com, a website that compares and rates plans.
Got questions? Here are answers to the 12 most pressing ones.
1. Will the new insurance exchanges make buying insurance on my own easier?
Every state and D.C. will have an online marketplace where you can compare policies, sign up for coverage, and claim a government subsidy if you quality. Find your state's shopping portal at healthcare.gov. Since a majority of states opted not to create their own exchange, 35 will be at least partially run by the federal government, but that won't make much difference to shoppers.
On every exchange you'll see plans grouped by tier -- platinum, gold, silver, and bronze, plus a low-cost catastrophic option for those under 30. The finer the metal, the more you'll pay in premiums and the more of your costs the policies will pick up -- 90% for platinum plans, 60% for bronze.
Premiums will vary within each tier, as will the deductible, co-pay, and co-insurance rate in most states. You'll find basic screening tools, such as the doctors in each network; consumer reviews and quality ratings are probably a year or two away.
"Firms are eliminating scope in order to get up and running by Oct. 1," says Dan Maynard, president of Connecture, which helped build the Maryland, Minnesota, and D.C. exchanges. You'll have until March 31 to shop in the initial enrollment period (or any time, if you undergo a life change such as a job loss).
The number of insurers on your exchange will vary. So far a dozen are signed on in California, but states with less competition to begin with will see fewer. "The level of insurer participation is pretty striking," says Ceci Connolly, managing director of PricewaterhouseCoopers Health Research Institute. "This is a big business opportunity."
2. I've already got insurance at my job. Why does any of this matter to me?
For the nearly two-thirds of Americans under 65 who get health coverage through a job, you probably have a sweet deal already, and that's unlikely to be soured. Companies pick up about 70% to 80% of the tab on average, according to the Kaiser Family Foundation.
And chances are your plan's in-network out-of-pocket spending cap is already lower than the new Obamacare maximums: $12,700 for a family, $6,350 for singles. (Employers that use multiple vendors to manage medical, drug, and other types of expenses got a one-year extension on the cap.) And in 2014 your plan can't put limits on annual payouts (the same goes for individual policies). Yes, the federal government gave employers with 50 or more full-time workers another year before they have to offer insurance or pay a fine, but that delay shouldn't affect those who already have a workplace plan.
Still, you may not want to be tethered to a company indefinitely. Maybe you'd like to strike out on your own, switch to part-time contract work, or retire before you quality for Medicare at 65. Because insurers can no longer turn you down based on your health, you're guaranteed to be able to find a comprehensive insurance policy. "A lot of people delay retirement just for health care coverage, so this offers more flexibility," says Lisa Zamosky, health-reform expert at Web MD.
You'll also have more long-term security if you find yourself out of a job. After a layoff, you can usually stay on your company plan for 18 months through COBRA, but without your firm's subsidy, that coverage is pricey: The average group family policy tops $16,000 a year, says the Kaiser Family Foundation. The second-cheapest silver-tier plan for a family headed by 40-year-olds should run about $11,500 on average, Kaiser reports, and a job loss may entitle you to a subsidy. Plus, your coverage won't expire if you fail to land a position with benefits in 18 months.
If you work for a firm with 50 or fewer employees, however, you may see one change. To give workers at small companies more insurance choice (in theory), Obamacare created separate small-business insurance exchanges.
Your employer can send you to your state's exchange with a set amount to spend; you choose a policy and pick up whatever exceeds the budget. So far, only 16 states, including Colorado and New York, have set up small-business exchanges with a choice of plans. In the rest, the employer can offer workers one plan only on an exchange until 2015.
Buying your own insurance? Here's what changes. (Continued)
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