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What Obamacare means for you


9/26/13

The federal Affordable Care Act (ACA) requires everyone to obtain some form of health insurance next year. This is the individual mandate in the Affordable Care Act (ACA), commonly known as “Obamacare.” 

If you get your healthcare through your job, Medicare, Veteran’s benefits, Medi-Cal or a spouse or domestic partner who has “adequate and affordable” coverage, you have met the individual mandate and will not be subject to a tax penalty.

Most people will have to have insurance by Jan. 1, 2014. If you do not have or obtain health benefits, you will likely be subject to a tax penalty. However, if your employer’s insurance plan(s) does not generally allow individuals to enroll after the beginning of the plan year, you will have until the beginning of the plan year in 2014 to obtain insurance.

For example, an employee eligible to enroll in an employer’s insurance plan with a plan year beginning Oct. 1, 2013 and ending on Sept. 30, 2014 would not be liable for the federal tax penalty until Oct. 1, 2014. 

Depending on your household income, you may qualify for financial subsidies to help pay for health insurance premiums and out-of-pocket costs if you do not have access to adequate, affordable insurance through your job. To access these federal subsidies, you must purchase your health insurance through the new state insurance exchange, Covered California.

Californians can continue to purchase healthcare coverage from any insurance company that offers policies in the state. The new Covered CA Exchange is meant to offer consumers an additional marketplace where the insurance policies will meet uniform standards for easier price comparison.  Many of the same large insurance companies that sell individual policies will be offering insurance policies through the Covered CA Exchange.
 


           
More Information
Get more information about the ACA.

Download 
CSEA's Guide to the Affordable Care Act


        

Specific Groups

While the media have focused extensively on the individual mandate, other provisions of the ACA will impact specific groups of people. 

Uninsured
Full-Time Workers
Early Retirees
Medicare Participants
Children
Young Adults


 
Uninsured

If you do not have access to “affordable and adequate” health insurance through your employer, you may qualify for financial subsidies to help pay for health insurance premiums and out-of-pocket costs if you purchase your health insurance through Covered California (depending on your household income). Under the ACA, the employer’s insurance is considered “unaffordable” if it costs more than 9.5 percent of your household income for self-only coverage.

You may also qualify for Medi-Cal if you’re under the age of 65 and earn up to 138 percent of the federal poverty level: $15,856 for an individual and $32,499 for a family of four (2013 figures). You may also be eligible for more affordable coverage if you earn between 138 and 200 percent of the federal poverty level ($15,856 to $22,980 for individuals).


It’s a tragedy that a lot of us are working, and we really need the medical coverage but we don’t have it. Everyone needs to have some sort of medical coverage. I think it’s very important. I know that I need to start looking. I don’t know about it that much—I have a lot of reading to do.” -- Denise Espinosa

 
Denise Espinosa, ESL Instructional Assistant 
Irvine Unified School District, Chapter 517
 
Full-Time Workers

Under the ACA, employees who work 30 or more hours per week are considered “full-time.”

Employees who have an affordable healthcare plan through their employer will likely see no immediate changes.

If your health benefits are specified in your CSEA contract, your employer has to negotiate any changes with the union. It will be very important for you to pay attention to bargaining updates this year and next year.

 
Ben Gamboa, Research Analyst 
San Bernardino Community College District Chapter 291
 
Early Retirees

Retirees aged 55 to 64 who are not yet eligible for Medicare (often called “early retirees”) will have new options through the Covered California Exchange. You can easily compare prices, benefits and performance of all health plans offered through the Exchange.

Starting in 2014, Americans who cannot afford quality health insurance may qualify for Medi-Cal or tax credits through the Exchange (depending on income). The ACA also prohibits insurance companies from denying coverage or charging more based on a person’s medical history.

“I don’t know everything (about Obamacare). I’m still trying to learn more about it. As an early retiree, Alameda does pay you a little over $200 toward your insurance for five years, so that’s nice. But in a couple of years, it’s going to be a little tougher.” -- Celia Moyer

 

Celia Moyer, Retiree Unit
Alameda

 
Medicare Participants

The ACA gradually phases out the so-called “donut hole” in Medicare’s prescription drug program. In 2012, people with Medicare in the donut hole received a 50-percent discount on covered brand name drugs and a 14-percent discount on generic drugs, saving an average of $609 per beneficiary.

The ACA also requires Medicare to cover certain preventive services with no deductible or co-pay. With cost no longer a barrier, seniors and people with disabilities who want to stay healthy will be able to get earlier treatment for health problems. In California, more than 2 million Medicare beneficiaries used one or more free preventive services in 2012.

“When they do away with the ‘donut hole’, retirees will be able to afford their prescription drugs better than they do now. I think it’s good for retirees. It’s going to help them with the cost of healthcare and their prescriptions.” -- Bill Regis

   
Bill Regis, Retiree Unit Chairperson
Santa Barbara
 
Children

Under the healthcare law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, more than 3 million young Americans who would
otherwise have been uninsured have gained coverage, including 435,000 young adults in California.

More than 2 million California children have some type of pre-existing health condition. Insurers can no longer deny coverage to children because of a pre-existing condition, such as asthma or diabetes.

"As the mother of two children, it’s really important that I have access to healthcare and doctors for my children. (One) is going off to college in a couple of years, and just being able to have them on my insurance for that long will be great. It will actually be cheaper than any type of insurance he might be able to afford on his own.” -- Melissa Meadows

 
Melissa Meadows, Administrative Assistant 
Barstow College, Chapter 176 

 
Young Adults

About 40 percent of the uninsured in California (more than 2.2 million) are 18-35 years old.

As mentioned above, children can now remain on their parents’ policy until age 26.

In addition, the Covered California Exchange will offer what are often called “catastrophic” plans to those who are under 30 years old or who can demonstrate that they are without affordable coverage or are experiencing financial hardship.

However, these cheaper insurance plans typically have much higher deductibles and co-pays, and less insurance coverage. Plus, if the employer offers an affordable insurance plan, members will not be eligible for the federal subsidies on the Exchange.

“I see this as a plus for younger people like myself. I’m glad I have healthcare, but I’m also paying a lot out of my pocket monthly. I’m looking forward to seeing how it’s going to benefit our members.” -- Adam Weinberger

 
Adam Weinberger, Campus Advisor 
Perris Senior High School District, Chapter 469