Your Health Health Care Law
The Supreme Court upheld it, and more changes will phase in
What You Need to Know Now By Marsha Mercer
The Supreme Court on June 28 gave the Afordable Care Act a mostly clean bill of health. The court upheld the law’s
constitutionality, keeping provisions already
in efect and allowing other measures to phase
in as scheduled. On a major new expansion of
Medicaid, however, the court gave states the
right to opt out without jeopardizing their ex-
isting Medicaid programs. It wouldn’t be easy,
but Congress, under prodding from a future
president, could change or repeal the law. This,
though, is where things stand now:
a low to middle income, you may be eligible for
a subsidy to help with the cost. For example, an
individual with income of $44,680 now would
qualify for a refundable tax credit to purchase
insurance on the exchange.
What happens if I don’t buy health
insurance? Could I go to jail?
Most taxpayers who do not have health insurance by Jan. 1, 2014, will be required to pay a
special tax on their returns. If you have Medicare, Medicaid or insurance through your job,
you have insurance. Exempt from the tax are
people for whom insurance would cost more
than 8 percent of their 2014 income and a few
other groups. The annual tax in 2014 is the
I’m uninsured and don’t qualify for Medicare
or Medicaid. How can I get health insurance?
Starting in 2014, you’ll be able to shop for insurance on your state’s health insurance exchange.
Even if your income is too high for Medicaid,
you may be eligible for a refundable tax credit
to help pay the premiums.
greater of either 1 percent of income or $95. The
amount will increase annually in later years.
Jail? No, there is no criminal enforcement. But
you could lose all or part of a tax refund.
Will I be able to get health care
It depends. The nation’s health program for low-income people is a joint federal-state program,
with states setting the eligibility rules. The Affordable Care Act called for every state to expand
Medicaid to low-income adults under 65 starting
in 2014. An individual with income up to $15,415
and a family of three with $26,344 in 2012 would
meet income guidelines. The law was expected
to bring 16 million uninsured into Medicaid. But
the Supreme Court ruled that states may opt out
of the expansion. About a dozen governors have
said they won’t expand Medicaid or are weighing that course of action. Check with your state
How will provisions coming in the next
few years affect me?
In 2014, you’ll be able to find insurance through
a health insurance exchange in your state. Even
members of Congress will get their health insurance on the exchanges. If states fail to set up
exchanges, the federal government will step in.
If you’re one of the 129 million Americans
with a preexisting condition, you
no longer will be charged more,
be denied benefits or be denied
coverage. Insurance companies
won’t be able to charge women
higher premiums than men.
Starting in 2013, Medicare payments will be reduced to hospitals that have too many patient
readmissions within 30 days. Patients may get more home attention, including visits from a social
worker or coach, telephone calls or electronic
monitoring devices to check their progress.
You or your employer may get an insurance
rebate. The law requires insurance companies
to devote more of the money they receive for
premiums to patient care—or send consumers
rebates. About $1.1 billion in refunds is expected
to be returned to millions of consumers this year.
Rebates will average $151 per eligible family.
If you’re a high-wage taxpayer who makes
over $200,000 as an individual, or $250,000 for
a couple, you’ll have to pay higher Medicare hospital insurance taxes on income and earnings. ;
How does the law affect my Medicare?
Your guaranteed Medicare benefits are safe, and
you can keep your own doctor. Many preventive screenings, including colo-noscopies and mammograms,
are free. Prescription drugs
will cost less as the “doughnut
hole,” the gap in Medicare Part
D coverage, shrinks until it is
eliminated in 2020.
Taken together, various measures in the law will save the
average Medicare beneficiary
$4,181 over 10 years. A beneficiary with high drug costs will
save about $16,000.
Some Medicare patients may receive more
intensive follow-up care after hospitalization
to keep them from being readmitted.
The law changes some payments to doctors,
hospitals and other providers. It reduces payments to Medicare Advantage, and some companies ofering these plans may charge higher
premiums or cut benefits.
High-income beneficiaries will continue to
see higher premiums for Medicare Part B and
Part D prescription plans.
My employer provides my health coverage.
How does the ruling affect me?
If you like your employer’s coverage, keep it and
do nothing. If you find you can’t aford it or you
don’t like the benefits, in 2014 you’ll be able to
buy coverage through your state’s health insurance exchange, an online marketplace where
companies compete for consumers. If you have
Marsha Mercer is an independent journalist.
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