Of course you'd like to avoid it, and who can blame you? Whether you think the Affordable Care Act is a government healthcare takeover or that it needs a strong public option, you probably watched in fascinated disgust as it burst upon the country, a tangled mess of contradictions and incompetence. But here it is, and if you currently lack health insurance, or are considering early retirement, it may just have to do. And if you need another reason, there's the Individual Mandate.
If you've been denied health insurance or have been unable to afford it, if you don't have job-based insurance or have learned that your present policy won't be offered next year, the Affordable Care Act, for all its imperfections, just may have a plan that will meet your needs until you are eligible for Medicare. To find out, take a few moments to learn the basics.
All plans offered in any state by any company must cover the same essential health benefits, but beyond those basic requirements plans can vary quite a bit. You'll quickly notice five major categories of plans — bronze, silver, gold, platinum, and catastrophic. These categories denote the coverage limits that you can choose from, and as the video below explains, there are trade-offs. You can choose a bronze or a catastrophic policy with a lower level of coverage and pay a lower monthly premium, but if you have major medical expenses, you'll end up paying more expenses out-of-pocket than if you had chosen the higher monthly premiums of a gold or platinum policy. In general, the out-of-pocket limits for 2014 are $6,350 for an individual plan and $12,700 for a family plan. It's good to know that whatever plan you choose, and no matter how much medical care you need, your out-of-pocket expenses are capped.
For an overview of what's actually available and what it might cost, check this link to detailed information about the actual plans available where you live. If your state has its own exchange, you will be directed there. If not, the information will come from the federal exchange. Either way, just keep clicking along until you see a list of plans and providers. Many people experience “sticker shock" when they first see these prices: This is affordable? Not for me. But remember there are no penalties for pre-existing conditions. Notice, also, that the prices shown may not reflect your actual cost due to subsidies for individuals with incomes under $46,000, or under $94,000 for a family of 4. Use the calculator at the Kaiser Family Foundation to see what subsidy level you qualify for and to estimate your actual cost.
The closer you get to actually choosing a plan, the more details matter. For instance, most plans have deductible limitations, meaning that you are responsible for all expenses up to that deductible level when your plan's benefits kick in, at which point your plan would start paying 60% (bronze), (70% silver), 80% (gold) or 90% (platinum) of expenses, until you have spent your maximum out-of-pocket, after which the plan would begin paying 100%. These deductible levels can vary widely from plan to plan, as can the out-of pocket maximums and the premiums. Ideally, you'll want a low deductible, a low premium, and a low out-of-pocket max, but that combination is tough to find. Study the policies carefully, consider the trade-offs of perhaps paying a higher premium but getting a much lower deductible or out-of-pocket max.
You can sign up online either through your state exchange or through healthcare.gov. And that's fine if you know exactly which policy you want, but if you have any doubts, get help. Consider applying by phone. Call 1-800-318-2596 (TTY: 1-855-889-4325), 24 hours a day, 7 days a week to speak with a customer service representative. You can also download instructions and submit a paper application form.
Yes, America's complex and fragmented healthcare system leaves much to be desired, and it may be modified in the future so that it is leaner, clearer, and more consistent across age and income levels. But for now, this is what we have. And if you're in the gap years between 50 and 65, without good health insurance, perhaps with a pre-existing condition, Obamacare may just have to do until the real thing comes along.
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Just for fun, hear Billie Holiday sing “Until the Real Thing Comes Along.”
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