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Confused by the Affordable Care Act? 3 things every Michigander should know about healthcare

It’s coming.

In just six months, the Affordable Care Act will be going into full-effect. While many changes are already in place, 2014’s the big year for the law — it’s the year when all citizens are required to get insured.

But what if you already have insurance? How will you know what subsidies you’re eligible for? And where do we find these subsidies?

We wanted to know too, so we talked to Karen Pollitz, a senior fellow at the Kaiser Family Foundation, a health policy group. Here are three of some of the biggest changes we’ll see in the year to come.

1. Ex-ch-ch-ch-changes
By January 2014, all Americans are supposed to have health insurance. For nearly 60 percent of the country, this change doesn’t mean much — if you’re covered through your employer and continue to be, you’re all set.

But for the 48.4 million uninsured Americans, coverage will now be required.

Affordable health insurance can be found through health care exchanges, which are websites that connect the uninsured or those looking for new options with the best plan available for them.

You’ll fill out a generic form with your information — sort of like a Common App for health care — and then the exchange can give you information about what subsidies are available and if you’ll be eligible for Medicare coverage.

Credit Massachusetts Health Connector, Business Express Exchange
Massachusetts Health Connector, Business Express Exchange
The new health care exchange will let you compare health insurance options side by side.

A big change under ACA is the availability of subsides that make insurance cheaper for those looking for coverage.

“Estimates say 80 to 90 percent of those who come to the exchange for private insurance will not pay the full price,” said Pollitz.

If you’re having trouble figuring out what plan works best for you, the exchanges will have navigators, or folks that can walk you through the insurance process. These free assistors will be available over the phone, and in person.

“There are real life human beings you can meet with in person to help you with your choices,” said Pollitz.

On October 1, the exchanges will go live. And though you have until January to pick out your plan, Pollitz recommends not waiting until the last minute, partly because Michigan has an exchange run by the federal government.

“When Congress passed the ACA, they offered unlimited amounts of money to states that set up their own exchanges,” Pollitz said. “But they only appropriate a limited amount of money for the federal government.”

"You may have to persist a little bit more in Michigan to land in the right place with subsidies."

Since Michigan’s exchange is federally-funded (against Gov. Rick Snyder’s recommendation), there’s limited funding — meaning there may be less navigators than other states with unlimited funds for their exchanges.

“Resources to help consumers will be much more constrained [in Michigan],” Pollitz said. “You may have to persist a little bit more in Michigan to land in the right place with subsidies.”

2. Uninsured? You might have to pay up.

Part of the controversy surrounding the Affordable Care Act is the penalty imposed on both businesses and individuals who don’t buy health insurance by the January 2014 deadline.

The penalty will be tacked on to your 2014 tax return — not through monthly fees or even jail time, as some postulated. 

”For the first time, you’ll see a line that says ‘Did you have health insurance coverage each month of last year,’ “ said Pollitz.

If you’re covered through the exchange or have existing coverage, you’re good — the exchange will report that information directly to the IRS. But if you’re uncovered, you may have to pay up.

For a single person, a $95 fee will be imposed on your 2014 return, or one percent of your taxable income, whatever is greater. Families are charged half as much for children, and there’s a cap on how much families can be charged for non-enrollment.

Fees increase each year, with the 2015 fee set at $325 per adult and $695 for adults in 2016 and beyond.

But not all uninsured adults will face penalties.

“The penalties are waived for very low income people,” Pollitz said. “So if Medicaid [expansion] doesn’t go through in Michigan, many won’t have to pay a penalty. They’ll just continue to be uninsured.”

Other exceptions to the penalty include those with religious objections to having health insurance and undocumented immigrants, as well as special hardship exemptions for those who can’t figure out how to make healthcare work for them.

3. What about Medicaid?

The future of Medicaid expansion — a key part of the Affordable Care Act — is still up in the air in Michigan. While the state House and Senate didn’t include the federally-backed expansion in their proposed budget, Snyder has vowedto make Medicaid coverage increasingly available in the state.

If Medicaid is indeed expanded in Michigan, then some 400,000 adults are likely to be eligible for the low-income healthcare plan.

But don’t expect a card in the mail from the Feds letting you know you’re eligible. Those interested in Medicaid coverage will have to go to the exchange to find out if they qualify for the program.

- Melanie Kruvelis, Michigan Radio Newsroom 

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