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Obamacare and You: If You Are Uninsured…

Obamacare creates several new ways to get health coverage. If you are not offered health coverage through your job, you may be able to obtain it through Medicaid or through a new health insurance marketplace (or exchange) in your state.

New Coverage Options

By filling out a single application, you’ll learn your plan options and costs, and whether you qualify for coverage through Medicaid or help purchasing coverage in the new insurance marketplace for your state. You may qualify for Medicaid if you earn less than about $16,000 a year or less as a single individual, even if you are an adult without children at home who previously was not eligible for Medicaid coverage. Other family sizes can qualify at higher income. However, states are not required to expand Medicaid and more than two dozen are unlikely to move forward.

If you earn too much to be eligible for Medicaid, you may still be able to get affordable coverage in the new marketplaces. Whether state-based or federal, these marketplaces will serve as an online store where you can shop for health insurance plans offered by private insurance companies in your area. Insurance plans 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. You cannot be denied coverage because of a pre-existing condition and may need to obtain coverage to avoid paying a penalty.

Financial Assistance

Depending on your income, you may be eligible for federal assistance that will lower the premiums you pay and reduce how much money you must pay out of your own pocket when you seek medical care. In general, a single person with an annual income between about $11,500 and $46,000, or a household with income between $19,500 and $78,000 for a family of three, can get help if coverage is purchased through the marketplace. 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.

You can start applying for coverage that takes effect in January 2014 during the “open enrollment” period that runs from Oct. 1 through March 31. If you need help with the application there will be people who can assist you. A list of assisters near you should be available on the insurance marketplace website in your state. If you qualify for Medicaid, you can enroll at any time, not just during open enrollment.

If you don’t get coverage you may have to pay a penalty. The minimum penalty will be $95 in 2014, but could reach thousands of dollars depending on your income. Some people won’t have to pay the penalty even if they don’t have coverage. This includes anyone uninsured for less than three months, people who do not have to file a federal tax return, and people who would have qualified for Medicaid but their state decided not to expand the program, among others.

Questions

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

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