ACA exchange enrollment is open! Here is a (hopefully) easy to use basic Resource Guide

[Zorra]

Last edited Tue Oct 1, 2013, 03:43 PM - Edit history (10)

to help folks sign up for the Health Insurance Marketplace exchanges.

Affordable Care Act Basic Resource Guide

This is a compilation of links to websites that I have gathered, designed to give you fast, easy access to basic resources providing information that you may find helpful for understanding your health insurance options in the new Health Insurance Marketplace Exchanges.

Please keep in mind, because this is a new program, it may change as they work the bugs out.

Marketplace open enrollment is a 6 month period, from October 1 to March 31.

Health Insurance Marketplace: You can create your Marketplace Account beginning on Oct. 1.

https://www.healthcare.gov/

https://www.healthcare.gov/quick-answers/#step-1

https://www.healthcare.gov/creating-an-account-and-logging-in/

Kaiser Foundation Subsidy Calculator. There is important information for you at this link, and you can get an estimate of the insurance subsidy you may be eligible for here: *(Note: Because Exchanges are now open, this link will be deleted once traffic on Healthcare.gov slows down and becomes accessible to everyone.)

http://kff.org/interactive/subsidy-calculator/

There are four types of plans:

• Bronze: Your plan pays 60%. You pay 40%.
• Silver: Your plan pays 70%. You pay 30%.
• Gold: Your plan pays 80%. You pay 20%
• Platinum: Your plan pays 90%. You pay 10%.

How to find the Health Insurance Plan that is right for you:

https://www.healthcare.gov/blog/how-to-find-the-health-insurance-plan-that-s-right-for-you/

Prices will be available for Marketplace Insurance Plans on Oct. 1:

https://www.healthcare.gov/how-much-will-marketplace-insurance-cost/

10 Essential Benefits you receive from the Affordable Care Act – What is covered under Marketplace Insurance Plans:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management, and
10. Pediatric services, including oral and vision care

http://www.healthinsurance.org/learn/health-reforms-10-essential-benefits/

Kaiser Foundation: The Requirement To Buy Coverage Under The ACA:

http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/

Who is required to obtain insurance under the ACA:
http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision

The ACA and Women:

http://www.hhs.gov/healthcare/facts/factsheets/2012/03/women03202012a.html

Premium Tax Credit

https://www.healthcare.gov/glossary/premium-tax-credit/

Qualifications For Lower Premiums:

https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/

Some FAQ

http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/

Medicaid Eligibility

http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

The main ACA IRS homepage is:
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

What is the Affordable Care Act?

The Patient Protection and Affordable Care Act (PPACA),[1] commonly called Obamacare[2][3] 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.[4]
The ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government. It provides a number of mechanisms—including mandates, subsidies, and insurance exchanges—to increase coverage and affordability.[5][6] The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex.[7][8] Additional reforms aim to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of health care. The Congressional Budget Office projected that the ACA will lower both future deficits[9] and Medicare spending.[10]
http://en.wikipedia.org/wiki/Affordable_Care_Act

Full Text of the Affordable Care Act (this is a pdf file):

http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

[UncleTomsEvilBrother]

1. Thanks.

I appreciate this!

[beveeheart]

2. Thank you!

Just sent this on to a couple of friends who don't understand what it's all about.

[Skittles]

6. try plugging in some numbers to test

I did it for a friend of mine barely scraping by on $26,000 - according to this even WITH subsidy and selecting the shittiest plan he'd pay over 150 bucks a month and the out of pocket costs could exceed 5000 dollars. WTF

[Safetykitten]

7. That Bronze plan? Three doctor visits. Yes, just three a year.

[Skittles]

8. and these are just the INTRODUCTORY prices

[Safetykitten]

9. Yes, the introduction to a nightmare.

[Ms. Toad]

15. Please explain.

None of the plans limit you to three doctor visits a year.

[pnwmom]

14. What would one trip to the emergency room cost your friend?

[Ms. Toad]

16. Not to mention trying to buy any plan today for $150 a month

unless one's health is pristine.

[pnwmom]

19. I checked our state's site

for our 26 year old. All of the gold policies cost a couple hundred a month less than the COBRA he's had since he aged out of his dad's plan.

I think many people will be pleasantly surprised.

[Ms. Toad]

20. COBRA and HIPAA plans are tremendously expensive -

but are currently virtually the only option for anyone who has ever experienced a medical situation more complicated than a hangnail.

They will not be fun for people who require lots of medical care every year (and who - like my daughter - will have to pay the full out of pocket max each and every year), but those people are relatively rare.

[Heddi]

23. My husband and i are per-diem RN's, so we're not eligible for benefits at our jobs

the prices we'd pay through these exchanges are ridiculous. $5,000-$25,000 deductibles? fuck that shit. $50+ copays. $300 for an emergency room visit, $600 if you're admitted to the hospital, $600 for outpatient surgery

The cheapest monthly premium is $450/month (estimated...approximately 22% of people were charged more) gives us $50 MD copay, $80 if I go to the OBGYN. $10,000 family deductible. several meds I take aren't covered by the formulary. Doesn't cover seeing ARNP or PA's (both of my providers are mid-levels).

Makes me vomit



$5400 + $10,000 deductible before anything kicks in.

Yeah, that's an AWESOME fucking plan. Makes me tingly in my lady parts just thinking about it.

And if we don't do it, we're fucking FINED?

Mr. Obama, how about increasing my pay by $15,400 a year and then I'll think about your generous insurance plan. Until then, you're taking $15,400 out of my household every year for insurance that I, as a 2-income RN family, can't even fucking afford.

Really, you shouldn't have. You really, really shouldn't have

[Skittles]

25. I have a hard time believing this is what is popular in Massachusetts

are we missing something? I don't get it at all.

[Heddi]

26. I don't get it either

because of our salaries, we're not eligible for any subsidies...which is okay with me. I mean, we make an okay salary.

But our salary is greatly decreased when the cost of healthcare is factored in. GREATLY decreased. and that's just for the basic premium + deductible. God forbid something actually happen above and beyond those costs. It's not like, oh once you reach your $10,000 deductible everything is covered 100%. Nope, labs are covered at 20%. MRI and radiology at 20%, diagnostic tests at 20%....ONCE the deductible is met.

I just don't see how this is helping people. This is not helping people. This is making people more BROKE.

Obama wants me to buy a house and have a baby and spend spend spend that recession away...kind of hard when my household income is cut by a MINIMUM of $15,400 every year. And it's not like prices won't go up. They will go up.

Looking at that, I'll never be able to buy a house. I sure as fuck can't afford to have a baby....holy shit. Not only do babies cost money, but then the cost of having the baby...fuck that.

and fuck this nonsense bullshit insurance company suck job.

[Skittles]

27. essentially it looks like what they want

is for you to fork over the money you might save for retirement to insurance companies

[Demo_Chris]

34. If it wasn't mandated you wouldn't do it as it would be foolish...

You gain NOTHING from this. Neither do I. But some people do.

Insurance company execs and investors, obviously, make out like kings. They will be the only industry in American HISTORY in which purchasing their products are a mandatory price of citizenship. You donh't have to buy a gun, you don't have to buy a home or a car, you don't even have to buy food, but by God you'll buy their insurance -- at any price they choose to sell it -- or you'll be hammered with a fine.

Others benefit as well of course. The main beneficiary is affluent people who already have insurance. These fine folks will see their rates stabilize and even decline, as the cost of their care is offset by the premiums of the poor and the young -- who own policies they cannot afford to take advantage of as the co-pays and deductibles are too high. The same applies to the wealthy with pre-existing conditions. They couldn't get healthcare before, but now they can as the poor and the young are picking up the tab for them.

But folks like you and me, the millions and millions of us just barely scraping by as it is? We get another bill, and the thrill of hearing those who benefit at our expense telling us that we aught to be greatful for the chance to contribute to their healthcare. And that's ultimately what it comes down to: THEY get healthcare, we just get fucked.

Welcome to Obamacare. Enjoy your stay.

[mrmpa]

53. I'm taking the fine................

I don't have a job, I can't get Medicaid, I have no income......so therefore I can't afford health insurance. I'll take the $95 fine.

[Demo_Chris]

54. You are being fined for the crime of poverty...

Our party used to fight for the poor. Now we penalize them.

[Keefer]

55. Fines

Increase every year.

[mrmpa]

58. So either I get a job by the 2nd year, when.....

fines go up or if I do get sick, I do what every other red blooded American does in these instances, have a fundraiser.

I WANT MEDICARE!! If it's good enough for my 83 year old mother, it's good enough for her 56 year old daughter.

[winter is coming]

61. Given your financial situation, you may be eligible for an exemption.

You still won't have any insurance, but at least you won't be fined for it.

[mrmpa]

66. I forgot about that, I appreciate the reminder. Thanks! eom

[antigop]

44. yes, Heddi. I've tried to draw attention to this....if you make one penny more than 400% FPL

you are not eligible for subsidies.

Now take a look at what an older pre-Medicare couple in their 50s or 60s will have to pay.

400% FPL (single or couple) ain't exactly living high on the hog, especially in an area with a high cost of living.

And then you throw in co-pays/deductibles/max OOP. IT'S NOT AFFORDABLE.

Cue the "but you get a gaggle of tax breaks" posts.

[Cha]

3. Mahalo Zorra! Quite a

compilation of good work here!

[Zorra]

4. Thanks! nt

[krawhitham]

5. K&R

[Cha]

10. KICK!

[grahamhgreen]

11. Thank you. Tweeted.

[Zorra]

12. kick

[Zorra]

13. kick

[ladyVet]

17. I may have filled out the calculator wrong.

But according to that one link, I'd have to pay nearly $8,000 a year for medical coverage. Such as it is. That's going to be awfully hard to do with zero income.

The last time I looked into getting Medicaid, I wasn't eligible. Maybe that will change, but with pukes in charge of NC, I'm not holding my breath.

[Ms. Toad]

18. If the state rejects expanded Medicaid,

that is unfortunately correct. You will not be eligible for a subsidy and will have to pay the full premium (around $3000), and some portion of your medical expenses up to the out of pocket maximum.

That's the result of the Supreme Court decision which permitted states to opt out of expanded Medicaid. The legislation would have given you access to Medicaid at no charge. Currently, it appears North Carolina is one of the states that is rejecting the "Free" federal money to provide you with coverage.

[Sirveri]

21. She has zero income, so she would be exempt under the ACA.

She might qualify for medicaid as it is currently set up due to his current lack of income, however they may have asset limits that the ACA expansion would have eliminated. I'm not an expert on North Carolina's implementation of medicaid so I can't provide any useful information on that front. However she would still be exempt from any sort of fees or requirements to maintain his insurance due to income. I believe that the fed will be setting up the state level exchanges for North Carolina given their current rightward tilt, she might be able to find relieve there and still receive some sort of subsidized health care service.

[Ms. Toad]

24. Unfortunately, being exempt from an obligation to purchase or pay a fine

doesn't get you access to health care. The subsidy for people in the lowest income range was to come through expanded Medicaid - which is the piece of the program which the Supreme Court threw out and some states (North Carolina included as of the most recent article I could find) are refusing to implement even though it is fully funded for the first couple of years.

[Ms. Toad]

60. Unfortunately, the law isn't set up to provide subsidies

for people who were supposed to be eligible for the expanded medicaid. Really stinks that the tea party obstructionists are taking it out on the poorest (by refusing to expand Medicaid, even though there is full federal funding for it) and on the country (by threatening to shut down the government if Obamacare is not defunded).

[Lars39]

51. Plugged in a relative's info...

9,600 income per year in TN, and she's expected to fork over more than 5,000 for catastrophic ins or be fined!

[Ms. Toad]

59. Unfortunately, Tennessee rejected the medicaid expansion

That means that poor individuals who would have been eligible for Medicaid under Obamacare (as written) are not because their elected officials are being jerks (since the Supreme Court told them they could).

The law only provided for subsidies to those with income above the level that would make them eligible for the expanded Medicaid. It isn't Obamacare that is the problem - it is the fault of the same people who are threatening to shut down the government in a few days if Obamacare is not defunded.

Your relative would have had completely free insurance, had the Supreme Court not given states the right to opt out of expanded Medicaid.

http://www.knoxnews.com/news/2013/sep/16/obamacare-help-not-poorest-states-rejected-medicai/

[Lars39]

62. There ought to be a go around at the federal level

to fix it then.

[Ms. Toad]

64. Unfortunately, it would require an amendment

since the scheme for covering the lowest income people was limited to expanded Medicaid, and the chances of an amendment to the ACA act passing are slim to none.

(Not that I don't agree in theory - just the reality of trying to implement the theory is less likely than knocking some sense into the heads of folks in Tennessee to enact expanded Medicaid.

[Demo_Chris]

35. Then you will be fined by our party for the crime of being poor. nt

[Pretzel_Warrior]

72. Troll much?

Poor people are the ones most likely to be helped by Obamacare. If the poster truly does have zero income them they would qualify for Medicaid unless they are not telling us all of the info such as having large savings or assets.

[Demo_Chris]

76. Actually, the affluent are the ones MOST helped by Obamacare...

Think of the insurance "pool" as a pool of money. It is collected, in the form of premiums, and goes out in expenses and benefits. The purpose of the mandate is to increase the size of this pool by forcing people to send the insurance company their money. Further, this mandated influx is HEAVILY suplimented by federal taxpayer subsidies going straight to the insurance companies -- so the pool of cash is suddenly as vast as the ocean.

Obamacare was sold with the idea that this pool of cash would be used to provide healthcare for the poor. But in order to access care, a poor person needs to do more than simply pay premiums he can ill afford. He must ALSO come up with his co-pays and deductibles. And in a nation in which 75% of the population cannot afford to save ANYTHING this is a ludicrous idea. Of course they cannot afford the co-pays and premiums, this is America, these people can often barely affording food, power, and their government mandated Obamacare bill.

And the ocean of cash the insurance companies have collected? Well some goes to "expenses" like salaries, executive jets, and speaking fees for former White House staffers who drafted the thing. Then they are allowed to keep 20% as profit, and the rest goes to keep down the healthcare costs for the people this was really designed to benefit -- our nation's affluent. As usual, this is nothing more than a thinly disguised bit of corporate welfare, but in this case the disguise is bloody thin indeed, and the amount of money we are funneling to these ghouls staggers the imagination.

[B Calm]

22. K&R

[HappyMe]

28. Good lord, woman!

Props for all this work and info you have provided.

Thank you so much.

[Hekate]

29. Many thanks. Once again I will try to get someone who needs this to look at it.

You've done a very good thing.

[Zorra]

30. kick

[Zorra]

31. kick

[msanthrope]

32. Thank you! nt

[Zorra]

33. My pleasure. If this exchange program is successful, it will help many people, and will

give us greater advantage in the 2014 elections.

And I'm hoping it is a major step toward universal public health care.

I know some here don't like it, but it is what it is, so it seems to me we should take what good we can from it and use it to our advantage to the greatest degree possible.

[Demo_Chris]

36. This is going to KILL us in future elections...

There are millions and millions of Democratic party faithful who supported Obama for healthcare reform, and the only thing they are getting is another bill they cannot afford to pay.

And the GOP is going to be waiting in the wings saying "We told you so!"

[Zorra]

38. Well, let's hope you're wrong. It is what it is, so I'm hoping to help make it as successful as

Last edited Tue Sep 24, 2013, 10:44 PM - Edit history (3)

possible, cuz there ain't nothin' else we can do about it now.

[Zorra]

37. kick

[Brigid]

39. I don't know how you found the time to do this, but

[Zorra]

47. Well, I can't say it was all totally altruistic.

I am on a mission to wipe "for profit" insurance companies, and the republican party, off the face of the earth. And I'm hoping the success of Obamacare will be the beginning of the end for both of them.

[Brigid]

48. We can only hope.

[steve2470]

40. thank you for this, good information all in one place :) nt

[kentuck]

41. Bookmarked!

Thanks!

[dmr]

42. Thank you so much, Zorra.

I'm sending this thread's link on to my family.

Thanks again.

[Liberal_Dog]

43. K & R

[deerheadgal]

45. Thank you for the most useful post I've read here in a looooong time! n/t

[Zorra]

49. I'm glad you find it useful! nt

[City Lights]

46. Thanks, Zorra!

Bookmarked.

[Zorra]

50. ^

[villager]

52. Thanks for this!

n/t

[DevonRex]

56. And the 24/7 call center: 1-800-318-2596. And live chat

https://www.healthcare.gov/contact-us/
Contact Us
By phone
We’re available 24/7

1-800-318-2596

TTY: 1-855-889-4325

Small businesses resources
Have questions about the SHOP Marketplace for businesses with 50 or fewer employees?

Call: 1-800-706-7893

TTY: 1-800-706-7915

Monday through Friday, 9 a.m. to 5 p.m. EST. Agents and brokers may also use this number.

Chat Online
A great way to ask simple questions

START LIVE CHAT

Find local help
Get personal help finding and managing your health coverage...

Enter city and state or zip code (Example: "Austin, TX" or "33109&quot

FIND HELP

Want answers fast?
Just answer a few quick questions to find out what programs you may qualify for and learn about topics that matter most to you.

START NOW

Help in your community
In all states, there will be people trained and certified to help you understand your health coverage options and enroll in a plan. They will be known by different names, depending on who provides the service and where they are located. All will provide similar kinds of help:

Navigators
Application assisters
Certified application counselors
Government agencies, such as State Medicaid and Children’s Health Insurance Program (CHIP) Offices
Insurance agents and brokers can also help you with your application and choices.

Visit LocalHelp.HealthCare.gov to find help in your area. You can search by city and state or zip code to see a list of local organizations with contact information, office hours, and types of help offered, such as non-English language support, Medicaid or CHIP, and Small Business Health Options Program (SHOP).

When open enrollment starts October 1, 2013, these organizations will be able to assist you in finding the kind of help that works for you. Some may be available earlier to set up a future appointment to help you in the Marketplace.

Get news and updates by email or text
You can sign up for Marketplace emails and texts now to learn about key dates, news, and information that will prepare you to enroll.

[Buns_of_Fire]

57. You've done a great job on this. Thank you.

As someone who's been uninsured for the last 20 years or so (and been extremely lucky), it's nice to see that my Kaiser estimates are coming in at around $100/month (give or take).

[onestepforward]

63. Thank you!

Bookmarked!

[slipslidingaway]

65. Do all facilities accept all 4 types of plans ...

or are you limited in where care is covered by the plan. Many times it is not about the extra dollars per year, but where you Can Go for care that is ultimately important.

Please post if you know, it is not just about the money, thanks.

[Zorra]

67. Good question. I believe this information will become available when the plans become available

on Oct 1.

[Zorra]

68. ^

[Zorra]

69. ^

[Zorra]

70. ^

[Zorra]

71. ^

[Maeve]

73. Thank you. I was able to find a few answers I needed

Hubby and I are self-employed Boomers with a lower than average AGI, so the new Silver insurance plan will cost less than the catastrophic plans we've been getting by with. Now to wait for the load on the healthcare exchange servers to ease...

[Zorra]

75. Yeh, I tried to log in but no dice so I am giving up for today.

Best of luck with getting a great deal on your health insurance!

[grantcart]

74. One of the best posts of the year. Thanks.

[PoliticAverse]

77. Now that the exchanges are actually open, you should no longer use the Kaiser site for estimates

as you can get actual numbers from the exchanges.

[Zorra]

78. Thanks! I'll edit out the link once traffic on healtcare.gov slows down. Also,

thank you for your other helpful suggestions that made the page more effective and informative.

[Old and In the Way]

79. excellent resource - bookmarked for future use.

Nt

[Zorra]

80. ^

[Zorra]

81. ^

[Zorra]

82. ^

[Zorra]

83. ^