Planetary Ink

A half-dozen things to know about the Affordable Care Act

October 1 is the first day of open enrollment for 2014 health insurance in the United States—and that seems a fitting day to debut the Planetary Ink blog. This is my first blog entry, and like health care reform, it’s been a long road.

To mark the first-ever open enrollment for the Affordable Care Act (ACA) health insurance exchange plans, which begins today, I have compiled a list of the six most frequently asked questions I have been getting via email and text in the past several months. (Some of these—like #2, #3, and #4—are verbatim questions.) Many people think that because I am a medical journalist, the answers to complex questions surrounding the ACA—aka, Obamacare—roll off my tongue. While that’s not the case—the responses below did not come without research, fact-checking, and re-fact-checking—I do enjoy investigating this topic immensely. I look forward to your continued comments and feedback.

Without further ado…

1. If I qualify for a tax credit through the health care exchange plans, will I need to wait until next year to get it?

No. Unlike tax credits that you claim by completing your income tax return, the ACA authorizes what’s called an “advanced premium tax credit.” The credit is based on what you report as your adjusted gross income (found on line 37 of your 1040 or line 4 of your 1040 EZ). If you qualify for a deduction when you enroll in a health insurance exchange plan, the advanced premium tax credit will be lopped off each premium payment you make on the plan. So rather than getting a big check at tax time, you will have a reduced health insurance bill each month.

2. How many people are really going to use this health exchange system, anyway?

National estimates vary, ranging from 7 million Americans (Congressional Budget Office estimates) to 8.5 million Americans (USA Today estimates).  In Minnesota, from which Planetary Ink hails, roughly 1.3 million people–one out of five Minnesotans–are expected to buy their insurance through MNsure over the next three years.

3. I heard a rumor that preventive care must now be covered free of charge under my health insurance. Is that true?

Possibly. It depends what you will have for a plan in 2014. All plans that are part of the health care exchange are subject to the ACA mandates, which include free coverage for preventive services. However, some plans do not have to offer free preventive care because they are considered “grandfathered plans” that were created before March 23, 2010, when the ACA became law. So if your neighbors are in a health exchange plan, they will not pay for their mammogram or colonoscopy, but if you are in a grandfathered plan, you may still have to pay a portion of the cost for those screenings.

4. WHAT? Mammograms count as preventive care that I don’t have to pay for?

Yes. As long as you are not in a grandfathered plan, mammograms are covered at no expense to you (eg, no cost-sharing). This provision of the ACA has actually been in place since 2012. See a list of other preventive services that are covered. Be sure to read all three parts; the comprehensiveness may come as a surprise.

5. We’re in the midst of a government shut down. How does this affect open enrollment?

Ironically, despite the government shutdown, the health insurance exchanges will still open on October 1—and they will remain open. The federal government funds the operation of the exchanges, but the money they have earmarked to run them does not rely on appropriations from Congress.

6. How long does open enrollment last?

Until March 31, 2014. If you want your coverage to take effect by January 1, 2014, though, you will need to enroll in a plan by December 15, 2013.

If you have other questions or comments you would like addressed in this blog, please contact me. As always, I welcome your comments below, too.