Affordable Care Act Basics - Part 1

, Posted: Thu, September 26 2013 at 9:11 PM, Updated: Thu, September 26 2013 at 11:47 PM

It's been a political hot button. The Affordable Care Act, also known as Obamacare, is set to kick in on January 1st. Enrollment begins in just days, on October 1st.

There's good reason people file in by the hundreds at local seminars on the Affordable Care Act. It's complicated and confusing.   When we asked Mary Beth Lee if she was confused she said "Yes!"

So just what do you have to do to be in compliance?  Let's begin with who doesn't have to do anything:

  • If you're currently on Medicare, Medicaid, or the Oregon Health Plan
  • If you get health insurance through your employer, or if you already purchased private health coverage.

You don't need to sign up.

According to Jeff Caulley, a spokesperson for Asanta, "It's only going to affect you if you're under 65 or if you have health insurance that's unaffordable."

If that's you, then you need to enroll by December 15th in order to get insurance coverage to kick in on January 1st, but enrollment remains open until March 31st, 2014.  Anyone without insurance by then faces a yearly fine of $95 per person, $47.50 per child, OR 1% of your household income -whichever is higher.  And those fines go up in the following years.

So let's say you want to sign up, how much will it cost? Well, the exact answer is a mystery since the costs and policy details aren't being posted until October 1st, but has estimates.

In Southern Oregon it's estimated you pay approximately:

  • A 21 year old - $188 to $346
  • A 40 year old - $241 to $442
  • A 60 year old - $511 to $939

But, anyone earning up to 4 times the national poverty level qualifies for a subsidy. So a single person can earn up to just under $46,000 a year and still get a discount. A family of three can earn up to $78,120 and still qualify for a subsidy.  For a family of five it's $110,280.

Here are more changes: All insurance, by law must now cover 10 essential services:

  • Hospitalization
  • Maternity and newborn care
  • Pediatrics
  • Ambulatory services
  • ER visits
  • Lab work
  • Mental health
  • Preventative and wellness
  • Rehabilitation
  • Prescription drugs

And no one can be denied coverage or charged more for per-existing conditions. You can't be charged more based on gender either.  Currently women typically pay more for insurance.

In addition: By law your annual out of pocket cannot be more than $6,350 per person or $12,800 per family.

In part 2 of this story we'll look closer at the Cover Oregon portal. That's Oregon's insurance marketplace.  We'll show you how you can sign up, and also what challenges you can expect to face during the first few weeks.

In the meantime, you can get more information at

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