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The Affordable Care Act and you

Staff Writer

Staff Artist

The Patient Protection and Affordable Care Acts biggest impact so far begins on Jan. 1, when millions of Americans will be added to the rolls of health insurers. People on Medicare, Medicaid and other government insurance programs are not affected. Those who get insurance at work will basically see no change. Heres a look at how it will work.

Whats a health care exchange?

An online federal marketplace where insurance is offered for sale, where coverage options are described, and where eligibility for tax subsidies is checked and, if available, offered to defray the cost of the insurance.

Who needs it?

People who dont yet have coverage. Heres where people in D-FW get health insurance now:
26% of Dallas County residents dont have health insurance 5% already buy their own health insurance

Texas is not running an exchange, so the federal site is where Texans can shop for five levels of private health insurance. The site is:

Employer-based health insurance only 3,045,895 VA Health Care 18,048

Total D-FW population 6,474,674

TRICARE/military coverage 34,554 Medicare plus Medicaid 78,234 Employer-based and direct-purchase coverage 103,043 Medicare only 211,249 Medicare plus employer or private 216,146 Direct-purchase health insurance only 310,836

No health insurance 1,440,932

Medicaid only 761,045

Why buy health insurance?

When do I have to get it?




Fixing a broken leg: up to $7,500

Average cost of a three-day stay in a hospital: $30,000

Enrollment opens Oct. 1 and lasts until March 31.

Penalty for not having insurance

in 2014 $95 for an individual $285 for a family Or 1 percent of income, whichever is greater. Penalties mushroom in 2015, and by 2016... $695 for an individual $2,085 family Or 2.5 percent of income, whichever is greater.

Do I qualify for subsidies?

A tax subsidy is available for an individual with income less than $45,960; for a family of four, subsidies are available for those making up to $94,200, which is 400 percent of the federal poverty level (FPL). Bigger families can get premium help at higher incomes. The lower your income, the higher the tax subsidy. The tax subsidy is like a tax credit you get it whether you owe income tax, are 400% of the FPL getting a refund or dont owe anything. for a family of four


400% FPL

What plans are available?

Catastrophic Care For those under 30 who want the
cheapest premiums. Some types of preventive care will cost very little. But youll have to pay several thousand dollars for any health care you receive before the insurance kicks in. Once the insurance begins, it pays half the cost of care until youve spent $6,350, or double that ($12,700) for a family. After that, youre covered 100 percent. 250% FPL

Taxpayers can apply for the premium assistance subsidy if their income is between 133% and 400% of the FPL.

Taxpayers can apply for the cost-sharing subsidy if their incomes are less than 250% of the FPL. 132% FPL FPL Medicaid is expanded to individuals with income of 132% of the FPL. However, Texas is opting out of this expansion.

Bronze The next level of care. Once again, the deductible is likely to be thousands of dollars before insured coverage starts. Bronze plan insurers then cover 60 percent of medical care until youve spent $6,350 as an individual, or $12,700 as a family. Silver Higher premiums than Bronze, but lower deductibles. Insurance covers 70 percent of care. Out-of-pocket maximums are the same as Bronze. Gold Again, higher premiums and lower deductibles, with
insurance covering 80 percent of care. Same out-of-pocket maximums.

A demographic look at who is eligible for subsidies:

Most are white ...
White 58% Hispanic 23% Black 11% Other 8% Under 18 21% 35-54 30% Working 88%

... young adults ...

Over 54 13% Age 18-34 36%

... and working

Not working 12%

Platinum Highest premiums of the plans offered, with low deductibles and insurance covering 90 percent of care. Same out-of-pocket limits.
Insurers will have to lower the out-of-pocket maximums for essential health benefits for individuals making less than $28,725 and for families of four making less than $58,875.

NOTE: Figures do not total 100 percent because of rounding. SOURCES: The Lewin Group, Families USA; McClatchy-Tribune; H&R Block;

The bottom line

If only the sick sign up, the plans are going to get costly very quickly. Thats what the insurance industry is worried about. John Goodman, president of the National Center for Policy Analysis and a critic of Obamacare

With plans competing against each other, people will have an opportunity to look side by side at what's best for them and what's the cost. Having that marketplace competition is whats holding the cost in check. Mimi Garcia, Texas director of Enroll America, a nonprofit supporting Obamacare

How well the exchanges work remains to be seen. Several issues still need to be ironed out. Jim Landers, staff writer, The Dallas Morning News