|October 17, 2013
Affordable Care Act comes with a price tag but it is minimal
ST. IGNATIUS ó There are costs and payments associated with the Affordable Care Act. Costs for both job-based and individual insurance vary. Beginning in 2014, many Americans, including American Indians and Alaska Natives, will be eligible for new tax credits to help them afford the cost of insurance purchased through Affordable Insurance Exchanges. Also American Indians and Alaska Natives are exempt from some of the ACA fee mandates and that will eliminate or reduce an individualís out-of-pocket payment requirements.
How much should my health insurance plan cost?
Policies that cover more tend to cost more. In addition, in most states, premiums for individual health insurance depend on your health status, age, gender, and other characteristics. However, under the Affordable Care Act, this will change.
Starting in 2014, new individual insurance policies and employment-based plans wonít be allowed to charge you more based on your health status, pregnancy, or disability. Also, insurers wonít be allowed to charge you more based on your gender, and there will be limits on how much premiums can vary based on age.
For employment-based health plans, itís up to tribal governments or other employers to decide how much of the premium to pay on behalf of you and your family. Your employer will tell you how much of the premium for health coverage you must pay.
What can I do if I am pregnant and cannot afford my premiums or co-payments?
You may be able to qualify for Medicaid coverage during your pregnancy. If so, Medicaid can help you pay for the premiums and other cost sharing under your job-based health plan. Medicaid income eligibility rules vary by state. In all states pregnant women are eligible if their income is below about $20,000 a year, and in most states women with higher incomes can qualify.
What tax credits are available? ?
Starting in 2014, if your job doesnít offer health coverage, or your job-based plan costs more than 9.5 percent of your income, you can apply for a tax credit to help pay for insurance coverage purchased through an Health Insurance Marketplace. An HIM is a new transparent, competitive marketplace where individuals and small businesses can buy affordable health benefit plans. Marketplaces will offer you a choice of plans that meet certain benefits and cost standards.
Are there special cost exceptions for American Indians and Alaska Natives?
Under the Affordable Care Act, American Indians and Alaska Natives who are below 300 percent of the Federal Poverty Line and are enrolled in any qualified health plan through the Marketplace are exempted from cost sharing.
You might also be exempt from a payment if: You are eligible to receive services from Indian Health Service; You have insurance through your employer or purchase individual insurance on your own; You have insurance through Medicare, Medicaid, Healthy Montana Kids, Veteranís Administration and/or Tricare for active duty and retired military, or a health care sharing ministry; and You would have to spend more than 8 percent of your household income on the cheapest qualifying health insurance plan, even after tax credits and subsidies.
Does the new law restrict access to IHS services?
Itís simple: if you had access to a local IHS, tribal, or urban clinic, you can still go there. You will have access to the same services as before at the same level. There is no reason to worry about decreased services or longer wait periods due to changes under health reform. In fact, under the new law, IHS, tribal (CSKT Tribal Health and Human Services Department) and urban clinics will have greater incentives to serve more patients with greater efficiency.
People who have access to employer-assisted health insurance, where the employer, in this case the CSKT pay 72 percent of the cost of the premium, there are various levels of coverage from individual to family coverage that includes spouses and children up to 26 years of age.
For more information, visit websites: www.ihs.gov or www.tribalhealthcare.org or www.healthcare.gov or www.hhs.gov