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Obamacare and You: If You Buy Coverage in the Individual Market

If you buy your health plan on your own now (rather than getting covered through an employer), you will have new options for getting your coverage, but the law requires you to stay covered or be penalized.

What’s Covered

Under Obamacare, health plans must cover doctor visits, hospitalization, prescription drugs and maternity care without restrictions for pre-existing conditions, or physical or mental illnesses or conditions that existed before coverage began. These plans are generally more comprehensive than those on the individual market now and must cover any pre-existing conditions. They cover preventive services like immunizations, screenings and contraception at no expense to you. All plans must cover maternity care and childbirth without any extra coverage costs. You can no longer be required to give your detailed health or medical history to apply for coverage.

Where to Get Coverage

The law establishes new health insurance marketplaces (or exchanges) in every state that will allow you to compare plans and prices. Enrollment in such plans begins on Oct. 1 of this year and coverage takes effect on Jan. 1. Plans both in and out of the marketplace will come in four levels – bronze, silver, gold and platinum – that will vary in what they cover, what they charge in premiums and what deductibles and other out-of-pocket costs they require. If you are under 30, you may be able to get a “catastrophic” insurance plan that charges lower premiums but requires that you pay more of your own medical bills before coverage kicks in. Insurers cannot charge you more based on your medical history or if you are a woman. Insurers can only vary premiums based on your age and the number of the people in your family covered by the policy and whether you use tobacco.

Help with Premiums

If you choose to buy a new policy through your state’s marketplace, you may also be eligible for financial assistance based on your income to help cover the cost.  In general, you may be eligible for federal assistance if you are a single person and your annual income is between about $11,500 to $46,000, or if your household income is between about $19,500 to $78,000 for a family of three. The range will differ for families of different sizes. Use the Kaiser Family Foundation’s online calculator to get a rough estimate of the premiums and subsidies that may be available to you. If you are low income, you may be eligible for coverage through Medicaid.

If you choose to buy new coverage outside of your state’s marketplace, your plan will still offer the same protections that plans offered through the marketplace do — but you won’t be offered financial assistance.

If your current plan continues to offer coverage next year, you may be able to remain in that plan. However, you would not be eligible for tax credits for that coverage. You may want to compare your current premiums and benefits to what you might be able to get through the new state marketplaces before deciding which option is best for you.

Questions

The federal government has set up a toll-free 24-hour hotline – 1-800-318-2596 – to answer consumers’ questions. To find out more about Obamacare visit www.healthcare.gov.

This fact sheet is also available in Spanish: en español.