Affordable Care Act (Obamacare)

affordable_care_act_300x300In March 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (ACA), into law. The law makes preventive care – including family planning and related services – more accessible and affordable for many Americans.

You and your family have many new low cost, quality health insurance options available through the Individual Marketplace. You can quickly compare health plan options and apply for assistance that could lower the cost of your health coverage. You may also qualify for health care coverage from Medicaid or Child Health Plus through the Marketplace. Sign up as early as October 1, 2013 for coverage that begins January 1, 2014.

 

OVERVIEW AND FAQ’S FOR INDIVIDUALS AND FAMILIES

Beginning January 1, 2014, you and your family will have many new health insurance options available through the Individual Marketplace. You can quickly compare health plan options and apply for assistance that could lower the cost of health coverage. Individuals and families may also qualify for free or low-cost coverage from Medicaid or Child Health Plus through the Marketplace. Anyone who needs health coverage can apply.

What is the Individual marketplace and who can get coverage?
New York State of Health, the Official Health Plan Marketplace, is a new way for people to shop for, compare and enroll in health coverage. It is also the only place to get a new kind of financial assistance provided by the federal government to lower the cost of your health coverage.

If you’re a New Yorker, to shop in the Marketplace, you:

  • Must live in New York
  • Must be a U.S. citizen, national or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid based on your income)
  • Cannot be currently incarcerated.

What is available through the individual marketplace?
The Marketplace gives you an easy way to compare health insurance plans so you can choose the one that’s right for your health needs and your budget. Health insurance offered through the Marketplace will include a comprehensive set of benefits and coverage. Open enrollment begins October 1, 2013 for coverage that will start as early as January 1, 2014.

What kind of assistance is available?
In the Marketplace, you can apply for help to lower the cost of your health coverage.

You may qualify for new tax credits to help pay for your monthly health insurance premiums. You may qualify for tax credits if you are an individual earning up to $45,900 a year or a family of four earning up to $94,200 a year. You may also be eligible for assistance to help pay for copays, deductibles, and other out-of-pocket costs.

The Marketplace will also see if you qualify for free or low-cost coverage from Medicaid or Child Health Plus.

What are Insurance Affordability Programs?
Insurance Affordability Programs include Medicaid, Child Health Plus, Advance Premium Tax Credits, and Cost-Sharing Reductions. The Marketplace will determine if you qualify for any of these programs, which can lower the cost of your coverage.

Do you need health coverage before January 1, 2014?
If you don’€™t have health insurance now and need health care coverage, you don’€™t have to wait until the Marketplace opens. You may qualify right now for Medicaid or Child Health Plus. Click here to see where you can apply in your neighborhood.

What is an exemption?
Starting in January 2014, most people will be required to have insurance if they don’€™t already have it. Most people who do not have insurance in 2014 will have to pay a penalty to the Internal Revenue Service (IRS) when they file their taxes. Some people will not have to pay this penalty if they qualify for a special circumstance. These special circumstances are called exemptions. Click here to learn more about exemptions and how to apply for an exemption.

Can I give someone else permission to get information about my application?
Anyone can call us to ask general questions, but we cannot discuss specific information about your application with anyone else, unless you give us permission to do so. You can give a trusted friend, relative, partner, or lawyer permission to talk with us about your application, and to act for you on matters related to your application. This person is called an authorized representative.

What do I need to apply for coverage through the Marketplace?
We ask about income and other information about you to tell you what coverage you qualify for and if you can get help paying for it. We keep all of the information you provide private, as required by law. For everyone applying for help paying for your health insurance through the Marketplace, you may need:

  • Social Security numbers (or document numbers for legal immigrants who need health insurance)
  • Birth dates
  • Employer and income information for everyone in your family
  • Policy numbers for any current health insurance
  • Information about any job related health insurance available to your family

What if I speak or read in a language other than English?
New York is a diverse state with many people that may speak or read in a language other than English. Call the Marketplace at 1-855-355-5777 for more information or help applying for coverage in your language. All help is free.

Why do I need to provide a Social Security number (SSN)?
The Marketplace needs Social Security numbers for everyone who has one and is applying for health insurance. We use SSNs to check federal and state data sources to help speed up the application process. Providing your SSN can be helpful even if you do not want health coverage. If you don’t have a SSN, call the Social Security Administration at 1-800-772-1213 or visit http://www.socialsecurity.gov to see if you can get a SSN and to apply for one.

Who should I include on my application?
Your income and family size help us decide what programs you qualify for. Include these people on your application for health coverage:

  • Yourself
  • Your spouse, if you’re married
  • Any children you are caring for who live with you
  • Your partner who lives with you
  • Anyone you include on your federal income tax return

You do not have to file taxes to apply for health insurance coverage for the Marketplace. Anyone else who lives with you will need to file their own application if they want insurance. Not everyone has to be living at the same address to apply on the same application.

OVERVIEW AND FAQ’S FOR INDIVIDUALS AND FAMILIES

Small Businesses with 50 or fewer eligible employees can offer health and dental insurance coverage to their employees through the NY Health Marketplace.

Your employer must participate in the Small Business Marketplace for you to receive coverage. If you have not received an invitation to participate, talk to your employer. If you have not received an invitation code, talk to your employer about offering health coverage through the Small Business Marketplace.

There is no time limitation for your employer to join the Marketplace. Monthly effective dates allow small businesses to join at any time during the year. Employees must enroll in coverage during their employer’s open enrollment period.

If your employer has offered you coverage through the Small Business Marketplace, click here to Register. You will need your invitation code emailed to you to enroll in employer sponsored coverage.

If your employer does not offer you health coverage, you can get health insurance through the Individual & Family section of the Marketplace. Click here for more information.

Can I get help applying if I do not speak English?
Yes. Meeting the language needs of consumers has been a critical part of planning the New York Health Benefit Exchange. When open enrollment begins on October 1, 2013, the website where you will apply on-line will be available initially in English, followed shortly by Spanish, and later expanded to other languages. A toll free customer service center will be open on October 1, 2013 to assist you in nearly all languages.

Can I participate if my Employer has not enrolled in the Marketplace?
No. Your employer must offer you coverage for employees to be eligible to participate in coverage through the Exchange.

Can I get assistance to help me enroll?
Yes. Certified Brokers and Navigators are available through the Marketplace to assist you in selecting and enrolling in coverage. Our site will help you find a Broker or Navigator to assist you. Customer service is also available to assist you. If your employer has a broker assisting them, you must use the same broker.

Do I have to have a computer or online account to participate?
No. You will be able to enroll in coverage with the assistance of a Broker or Navigator. The Marketplace is designed as an online system, so having an online account will provide you with all of the benefits of our website, including the ability to monitor your account activities 24 hours a day, register changes in circumstances that affect your coverage, etc.

Can I enroll my family members?
If your employer offers coverage to family members, you will be able to enroll them in coverage through your Marketplace account.

Source: Healthcare.gov; NYStateOfHealth.ny.gov