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Obamacare and You: If You Have Job-Based Coverage

If you are now covered by job-based health benefits through your (or a family member’s) employer, then you likely can keep that coverage and will not have to make any changes.  In most cases, your employer coverage will satisfy the law’s requirement that you obtain insurance.

Changes to Employer Coverage

Some features of your employer coverage may already have changed as a result of the law.  For example, if you are a parent, your children may now stay on your policy until they reach age 26.

Your plan also now likely covers preventive services like immunizations and screenings at no cost to you, though some employer plans in place in 2010 are exempted from this requirement.

Beginning in 2014, your plan cannot set an annual dollar limit on your benefits that could leave you without coverage if you get seriously ill.  Your plan also can no longer limit anyone’s coverage for pre-existing conditions. Your plan also can no longer limit the total dollar amount of benefits you may receive over your lifetime.  Employer plans are also required to limit the amount of cost sharing (such as deductibles and co-pays) that you are required to pay for covered services to $6,350 per person per year.  This provision will take full effect in 2015.

In some cases, your employer may need to change your health benefits to meet the law’s requirements.  For instance, if you currently get only bare-bones coverage through your employer — such as help paying for routine doctor visits, with little or no coverage for hospitalization of other serious illnesses — that coverage can no longer be offered in 2014.  Your employer may decide to offer more comprehensive coverage, as most employers already do, or your employer may decide not to offer any coverage to its workers.

Employer Mandate

The law encourages employers to offer health insurance. Large employers — those with at least 50 full-time workers (or the equivalent in part-time workers) may face penalties if they do not offer affordable coverage to full-time workers.  These penalties will begin in 2015, a year later than originally called for in the law.  Smaller employers — those with 50 or fewer full-time workers — are not required to offer coverage, but may get tax credits if they do.

If your employer offers coverage that is too costly for you to afford based on your income, you may want to buy coverage through the new health insurance marketplace (or exchange) in your state instead.  The marketplaces are like an online store for people buying their own health insurance and would allow you to compare plans based on price and other factors.  You may qualify for tax credits to purchase this coverage if your employer does not offer you coverage that meets the law’s requirements and your household income falls below a certain level — about $46,000 for an individual or $78,000 for a family of three.   If your income is very low (less than about $16,000 for a single individual) you might also qualify for coverage under Medicaid.

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.