The Affordable Care Act
Published: Tuesday, October 22, 2013 at 6:01 a.m.
Last Modified: Monday, October 21, 2013 at 4:39 p.m.
Q: The Affordable Care Act is so confusing. Can you clarify, please!
— Renee C., Briggs, Texas
A: We've gotten lots of questions about the Affordable Care Act, so here are the basics. But remember, some regulations apply to everyone in the U.S., while others differ from state to state. For detailed information, go to www.healthcare.gov and select your state.
How do ACA exchanges work? If you don't have insurance through work, can't afford insurance or what you have doesn't meet the law's minimum standards, an exchange is a marketplace that lets you compare costs and coverage to get what's best for you. Happy with your insurance or want to buy through a broker? Don't change a thing.
How can I choose the best plan? The plans are ranked Bronze, Silver, Gold and Platinum. Bronze is least expensive and pays about 60 percent of costs; Platinum is most expensive and covers about 90 percent. There's catastrophic coverage — for hospitalization only, if you qualify. Determine how much you can pay every month, and if that kind of plan offers you the protection you need from medical expenses. In addition, make sure your doctors accept the plan you want to choose.
Will costs go up? Or down? 11.5 million Americans with an income of less than $15,000 (individual) or $31,000 (family of four) will become newly insured under Medicaid, and annual out-of-pocket expenses could fall from $1,463 to $34. Not all states have agreed to expand Medicaid; in those states, the poorest may see costs rise.
People without insurance from work who earn around $46,000 (individual) and $94,000 (family of four) get discounts through the exchanges. And if the cost of your employer-provided insurance exceeds 9.5 percent of your income, you can buy insurance through the exchange and may be eligible for Medicaid help.
The biggest cost increase hits the newly insured who earn at least $44,680: Around 3.3 million consumers may spend $7,202 annually, compared to a typical expense of $5,368 if the law were not in effect.
For everyone newly insured: Pre-existing conditions are covered; your plan can't boot you off if you develop a condition or disease; preventive care is covered 100 percent (mammograms, colonoscopies, etc.); and there are no annual or lifetime caps on essential health benefits (hospitalization, prescriptions and maternity services).
Email your health and wellness questions to Dr. Oz and Dr. Roizen at firstname.lastname@example.org.