Obamacare: What, Who & When

What’s Covered Under PPACA Health Insurance Plans?

For individuals and small groups purchasing health insurance there are around 10 different categories of medical events and conditions that will be covered by PPACA insurance. These covered events include the regular benefits under health insurance plans such as doctor visits, emergency room visits, treatment for broken bones and common illnesses, in-patient treatment for serious health conditions, prescription drugs charges, dental work, and injuries from accidents. In addition, preventative care visits are covered (including cancer screenings, mammograms, and some health checks), plus immunizations for required diseases. Maternity care will be covered, as will cover for newborns and children. Lab costs (for health checks and screenings), prescriptions, and services related to mental health are also covered. The specific coverage and exceptions provided by a plan vary depending on the provider, the state, and the terms of coverage. US citizens and others that are eligible for PPACA insurance are advised to check the conditions of the insurance before signing up for a particular plan.

Who Can Use the Health Insurance Marketplace to Buy PPACA Insurance?

The Health Insurance Marketplace is a health insurance exchange where uninsured Americans (and other eligible residents) can buy affordable health insurance. Any citizen, legal resident or national can use the Health Insurance Marketplace to buy federally-recognized insurance but not every citizen, resident or national can buy insurance at discounted prices. Anyone making less than 400 percent of the Federal Poverty Level will be able to buy discounted insurance – 400 percent is roughly $46,000 a year for individuals and $93,500 a year for families.

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Countdown to the PPACA

March 23rd 2010: President Obama uses his power to sign the Patient Protection and Affordable Care Act into law.

October 1st 2013: Open enrollment for insurance under the Patient Protection and Affordable Care Act begins in the Health Insurance Marketplace.

January 1st 2014: Coverage begins in the Health Insurance Marketplace for any health insurance plans bought before December 15th, 2013. From this date forward most US citizens and others will need to have health insurance of will be eligible for a financial penalty.

March 31st 2014: Open enrollment in the Patient Protection and Affordable Care Act Health Insurance Marketplace ends.

What are the Financial Penalties for Getting it Wrong?

Most US citizens and residents, apart from the exemptions listed above, must have insurance by January 1st 2014. For anyone eligible under PPACA that does not have health insurance minimum cover, there are penalties. The penalties are tax related and rise each year under the roll-out of PPACA.

Tax penalty calculations:

2014: $95 per person (up to 3 people) or 1 percent of taxable income – whichever is higher.

2015: $325 per person (up to 3 people) or 2 percent of taxable income – whichever is higher.

2016: $695 per person (up to 3 people) or 2.5 percent of taxable income – whichever is higher.

Individuals are considered to be covered if they have a a job-based health insurance plan, a plan purchased through the Health Insurance Marketplace, Medicare, Medicaid, CCOBRA, CHIP, VA health coverage, or retiree coverage, among others. You won’t have to pay a penalty if you have a coverage gap of three months or less (or one month if you have more than one coverage gap in the year).