Misconceptions and myths about the Affordable Care Act (ACA; aka Obamacare) abound. That’s not good, says Ron Pollack, the head of FamiliesUSA, an advocacy group based in Washington, D.C. That’s why Pollack’s group recently put together a list of myths, along with the correct information, about this important law and the changes it will soon bring:
Myth #1: Starting in 2014, everyone must either have health insurance or pay a penalty—no exceptions.
Truth: The following groups are exempt from the ACA requirement to have coverage:
- People who are not required to file taxes are exempt.
- People with a legitimate religious reason for not believing in insurance.
- Members of Indian tribes.
- People who go without coverage for less than three months.
- People who truly cannot afford to purchase coverage. (Health insurance premiums cannot cost more than eight percent of a family’s income to be considered “affordable.”)
- There is also a general hardship exemption that covers unusual circumstances. For example, a family with unexpected costs associated with a natural disaster could be exempt.
Also, you don’t have to have coverage through an insurance marketplace to fulfill the requirement. You could get your health insurance through public or private coverage, a job, the military if you’re enlisted, or a veterans’ plan.
Myth # 2: If you’re insured through your employer, Obamacare won’t help you.
Truth: The healthcare law provides many new protections to those who already have health insurance through their jobs, and it also gives employers incentives to offer better coverage. Here are some of the things that are required, starting in January 2014:
- No annual or lifetime limits on the dollar amount your plan will pay for medical care
- Access to preventive health services with no cost-sharing (i.e., no co-pays)
- Coverage for dependents under the age of 26 (on their parent’s plan)
- The right to choose your primary healthcare provider and to see pediatricians and obstetricians/gynecologists without a referral
- The right to appeal coverage denials to an independent reviewer outside your plan
- Protection against unfair premium increases and rebates to you or your employer if your health plan spends less than 80 percent of premium dollars on healthcare services.
- Access to summaries of your plan’s benefits and costs in simple, plain language to help you understand your coverage and compare coverage options.
Myth #3: All businesses will be required to provide health insurance to their employees.
Truth: This is simply not true. The “shared responsibility” requirements in the Affordable Care Act apply to employers with at least 50 full-time employees. These large employers may have to pay a penalty if they don’t offer coverage to their full-time employees. The majority of American small businesses don’t have 50 employees.
Smaller employers will have new opportunities to purchase health insurance for their workers, but they are not required to provide this coverage. Under the Affordable Care Act, businesses with fewer than 25 full-time employees may already qualify for a healthcare tax credit to help them with the cost of health insurance for their workers.
Myth #4: Undocumented immigrants will receive federal aid to buy health insurance.
Truth: Undocumented immigrants are not eligible for either Medicaid or the new tax credits that will help pay for private insurance.
Myth #5: My state isn’t setting up its own health exchange, so it’s exempt from Obamacare.
Truth: If a state doesn’t set up its own health exchange the federal government will ensure that consumers in that state still have a place to get insurance by setting up an exchange for the state.
All of the other important consumer protections in the Affordable Care Act—like the prohibition on discrimination based on pre-existing conditions; the option for young adults to stay on their parent’s plans until they turn 26; and access to recommended preventive services with no copayments—will still apply to that state.
“Health reform is such a contentious issue and so complex that it’s no wonder people fall prey to myths about the law,” says Carrie McLean, senior manager of customer service at eHealthInsurance.com. “We talk to thousands of health insurance shoppers every day at our call center and we know they’re confused about who qualifies for coverage, how affordable it will be in 2014, and where they’ll be able to buy it.”
As 2013 moves along, you can expect to see more and more news stories, over every medium, about the changes that are coming with the ACA. And though you may be tempted to bury your head in the sand (we understand; it’s confusing), try to pay attention.
And since you probably don’t need to worry about smaller changes, here’s a timeline of the bigger ones you can tape to the fridge:
· July 1, 2013: State call centers open to answer your questions about health insurance options in your state.
· October 1, 2013: State health insurance exchanges in all 50 states begin enrolling new members,
· January 1, 2014: Health insurance coverage under the Affordable Care Act begins.
Of course, the law is not perfect. It’s complicated and some of the materials could definitely be more user-friendly. And there are some glitches in the way the law was written that could price some people out of the market for coverage, even though the whole goal was to not have that happen. (To change that provision, and perhaps some others, will require news laws to be passed by Congress.)
Thankfully, experts, including policy specialists at advocacy firms such as FamiliesUSA, are currently compiling lists of needed improvements to review with the Secretary of Health and Human Services (HHS will oversee the ACA changes).
And as imperfect as the law is, much of it does go far in helping provide affordable coverage to more Americans, in a fairly simple manner. “Each [state] marketplace will offer insurance shoppers a variety of tools, such as a consumer-friendly website, a toll-free hotline for assistance, and a network for one-on-one assistance—all intended to help the residents of that state find and purchase the quality, affordable health insurance policy that best suits their personal or family needs,” explains FamiliesUSA’s Ron Pollack.
Do you feel like you understand the Affordable Care Act? What do you find most confusing about it? What's clear?