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The Affordable Care Act: What you need to know about the individual mandate

By: Victoria Maranan Email
By: Victoria Maranan Email

SHERMAN, TX-At the heart of the budget battle Monday, Obamacare.

We're less than 24 hours away from open enrollment for health insurance under the Affordable Care Act, also known as Obamacare. Texomans we spoke to said they are confused and concerned about what to expect on their health insurance with the new law. Many said not enough information was provided.

Under the Affordable Care Act, citizens are required to have health insurance or face a penalty. Austin College professor, Dr. Melanie Fox said it's a common misconception that the U.S. government itself will provide public health insurance.

"The government is sponsoring what's called 'health insurance exchanges.' So these are ways where people can purchase private insurance but in a central location where you can easily compare plans from each other depending on what they cover," she said.

The insurance companies taking part in the exchange have not been named yet. Fox said they'll be listed on the healthcare.gov website Tuesday. She said all companies in the exchange will offer four plans: bronze, silver, gold or platinum. The minimal coverage bronze plan would pay for 70 percent of a patient's doctor visit costs and up to 70 percent of their prescription drug costs.

There's also a limit for out-of-pocket expenses: $6,300 for individuals and $12,000 for families of more than two people.

Under the Affordable Care Act, most insurance plans can't exclude you for having pre-existing conditions nor charge you different because of gender. But, they can still charge you differently based on age.

Also under the new law, if you don't sign up for health insurance you could face a penalty of $95 per adult, $45 per child or one percent of your annual income--whichever is greater.
But Fox said there are exemptions.

"If you're unable to purchase health insurance at the lowest level because it adds up to more than 8 percent of your adjusted gross income, you're exempt from the penalties," she said.

If you're opposed to health insurance for religious reasons, or if you are an undocumented immigrant, in jail, a member of an Indian tribe or you earn $10,000 or less every year--you are also exempt.

Health Insurance Texoma's Sue Gregory said they have been busy trying to keep up with the changes that are about to take place and clients have been calling with questions.

"We've seen some plans but they haven't been finalized. We've seen rates, some of the rates will be less expensive, there's some that's gonna be more, there's gonna be a lot of plan options," she said.

Gregory said while sign-ups for health coverage starts Tuesday, October 1st, she advised everyone to do their research because they have six months before penalties kick in.

"Take the time to get educated. Don't rush. And get the information you need to feel comfortable before you make the choice that is so important like getting health insurance," she said.

Dr. Fox said if you're signing up for health insurance this year, coverage won't start until January 1st, 2014. But you have until March 31st of next year to sign up.

If you'd like to calculate your estimate or compare insurance plans, we have the links below.


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