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Monday, March 17, 2014

Obamacare + You

Obamacare + You

Over the past year, I've studied Obamacare - the law, the website and the "chatter." This post is the result of some of my findings. Hopefully, it will help you decide whether or not you'll enroll (if you haven't already). 

To insure or not to insure?
The #1 reason people don't sign up for Obamacare is they don't see the value of insurance in general - life, property, disability and - most of all - health. The reasoning is something like this:
  • "I haven't been sick in a few years so I don't see why I need it."
  • "I'd rather save the money now and if I have to go to the hospital, I'll just pay for it myself."
While it's not my goal to argue for or against Obamacare or medical insurance, some facts are relevant: 
  • Health care costs are the #1 cause of bankruptcy in the U.S.
  • The average fees of a broken foot add up to $16,000 while cancer treatment can cost $30,000 or more. (Source: see Healthcare Bluebook)
March 31 is your last chance to enroll in 2014!
Unless you've already qualified for Medicaid or Medicare or have employer-provided health insurance, the window is closing on 2014 enrollment. The next open enrollment period begins in November and is for 2015 coverage. 

Non-enrollment tax penalty.
Taxpayers who are not enrolled by March 31 will be penalized 1% of 2014 household income or $95 per adult (plus $47.50 per child), whichever is higher. It will be assessed automatically unless you have a special exemption. Click here to see exemptions

Biggest objections.
In the past months, I've spoken with at least a dozen people who have no medical insurance but are not signing up for Obamacare - or even getting a cost estimate. Here's what they say:
  • "My friend says it costs too much and isn't worth it."
  • "It's cheaper to pay the penalty."
  • "I'm not comfortable getting it on the computer."
  • "I'm too busy to bother with it this year - maybe next year."
To get a feel for what they were saying, I sat down with them to get online estimates. In each case, they were surprised to see how low their monthly fees would be. For family, we found that the fee was actually zero dollars ($0.00) for a basic plan based on very low household income! (See examples below.)

Enroll online, by phone or in person.
Online - is the online "Marketplace" (often called an "Exchange") where you "shop" for a plan that best meets your needs and budget. The good news: the website is now very easy to maneuver and you can see many options in just a few minutes. If you like, you'll find this site even easier!

In person - If a person doesn't use or own a computer or wants extra help, they can call to make an appointment close to their home or office. In the Dallas area alone, for example, there are 116 "help" locations! Click here to find a U.S. location near you.

Toll-free phone line - call 1-800-318-2596 to ask questions if any part of the process is uncomfortable or difficult for you.
How plan "categories" affect cost.
Note: for individuals and families having lower incomes, fees may be significantly reduced as shown in this chart

Most people choose from one of three plan categories which range from lower- to higher-cost: bronze, silver and gold. A 4th category - platinum - is very expensive and therefore chosen by few. Any category you choose, however, will help pay your family's 10 most important medical expenses:
  1. Outpatient (ambulatory) care
  2. Emergency services
  3. Hospitalization
  4. Pregnancy (before, during and after)
  5. Mental health and addiction care and treatments
  6. Prescriptions
  7. Rehabilitation treatment, therapy and devices
  8. Lab and diagnostic tests
  9. Preventive and wellness services
  10. Pediatric care (medical, dentistry and vision treatment is covered for children
Pre-existing health conditions.
The biggest - and possibly most popular - change in current insurance plans and Obamacare is this: nobody can be denied coverage. In other words, if you have diabetes, high blood pressure, depression or even cancer, no insurance carrier is allowed by law to refuse to insure them. 

Examples: Cost estimates for a family plan as calculated on*
Remember: you and/or your family's monthly insurance payments will be based primarily on:
  1. Age(s) and total income,
  2. The plan category chosen (bronze, silver or gold), and
  3. The deductible amount selected.
The following examples are for three families of 4. Members are the same ages but have different household incomes.

Example #1: Family of 4 - low income:

  1. Total yearly income: $50,000
  2. Ages: 55, 52, 23 and 18
  3. Eligible for lower premiums as shown on this chart.
  4. Monthly premium estimates: start at $0/month (bronze); $285/month (silver); and $518/month (gold).
Example #2: Family of 4 - mid-income:
  1. Total yearly income: $75,000
  2. Ages: 55, 52, 23 and 18
  3. May be eligible for lower premiums as shown on this chart.
  4. Monthly premium estimates: start at $205/month (bronze); $558/month (silver); and $831/month (gold). 
Example#3: Family of 4 - higher income:
  1. Total yearly income: $135,000
  2. Ages: 55, 52, 23 and 18
  3. Not eligible for lower premiums as shown on this chart.
  4. Monthly premium estimates: start at $850/month (bronze); $1,200/month (silver); and $1,476/month (gold)
*Note: rates can fluctuate daily. Estimates presented above are for example only and are not exact. To get real-time estimates. go to


I would personally like to thank each one of you who has referred clients to us in the past months. This has been our busiest Spring tax season ever. Your trust means the world to everyone at Elwell & Associates and we do everything we can to live up to it.

If you refer any active or retired military personnel and/or their families, we extend a 20% discount to them. Just have them mention their status.

1 comment:

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