Easy steps to understand Obamacare

Dear Readers,

As a way of helping her own patients, Dr. Pennie Marchetti, a board member of the Summit County Medical Society, prepared this easy Fact Sheet on Obamacare — formally called the Affordable Care Act (ACC). It’s a great reference for those who would like a simple explanation.  Thank you, Dr. Marchetti!

Learn about Obamacare in this Quick Q&A

What is a Health Care Insurance Exchange?  An Exchange is an online shopping center for health insurance.  Ohioans are among the Americans who can buy health insurance policies via an Exchange run by the federal government. To access it, go to www.healthcare.gov.

What if I don’t have easy Internet or computer access?   You can contact the Exchange representatives by phone.

For individuals, the phone number is 1-800-318-2596 (TTY number- 1-855-889-4325)

For small businesses, the phone number is 1-800-706-7893  (TTY: 1-800-706-7915)

Who in Ohio can buy health insurance on this Exchange?

1)      You must be younger than 65.  People over 65 are expected to use Medicare.

2)      If you do not qualify for Medicaid, you can use the Exchange. Find out if you qualify for Medicaid at www.benefits.ohio.gov.

3)      You can use the Exchange if you meet the above criteria and your employer does not provide health insurance.

4)      You can use the Exchange if your employer provides health insurance, but your share of the premium is greater than 9.5% of your annual income. If you pay less than that, then you cannot use the Exchange. (For example, if you make $100,000 a year but have to pay more than $9,500 a year for employer-sponsored health insurance, you can use the Exchange.)

5)      Small businesses with fewer than 50 employees can use the Small Business Exchange (Small Business Health Options Program, or SHOP) at https://www.healthcare.gov/small-businesses/.  Due to technical difficulties, online enrollment on the Small Business Exchange website will not be available until November 1st.  However, small businesses may call the toll free number and send application materials in by mail.

What if I don’t buy insurance?  If you do not qualify for Medicaid, and you are younger than 65, you will have to pay a penalty to the federal government. For the first year, the penalty is $95 per person or 1 percent of household income, whichever is greater. It increases to $695 per person or 2.5 percent of household income in 2016. After that, it will increase based on a cost-of-living formula.

What kind of prices can I expect?

It depends on how many people you want to cover, their ages, whether or not they smoke, and how much money you make. The larger your family, the higher the premium. The higher your income, the more you will pay in premiums.

One other variable is the type of plan you choose. There are four choices on the Exchange, all named after metals- — bronze, silver, gold, and platinum. Bronze plans have the lowest monthly premiums, but higher out of pocket costs for each encounter with the healthcare system for doctor visits, hospital stays, and pharmacies. Platinum plans have the highest monthly premiums, but the lowest out of pocket costs.  If you are younger than 29, you can also purchase a very cheap catastrophic plan that only covers hospitalizations.

When do I have to buy insurance?    You can purchase insurance through the Exchanges from October 1, 2013 through March 31, 2014. Actual insurance coverage won’t begin until January 1, 2014 at the earliest.

Deciding which insurance to buy is a big decision. Approach it as you would approach buying a car. Consider the Exchanges as a tool to help you compare plans and prices.  You may want to print out the premium details and information about co-pays and deductibles and think it over for a few weeks before deciding which plan to purchase. You may also want to consult an insurance agent if you find the details of the various plans confusing.

Speak Your Mind


Because healthcare information changes rapidly, you should always verify information with your providers.