What do you need to know about the Affordable Care Act, aka Obamacare, the health-reform law or the “federal health-care overhaul”? It’s big, it’s far-reaching and it will change many things about the way you get health care.
Here are 20 things to know about the new law:
1. Next year, you must have health insurance, one way or another, or pay a penalty. There are exceptions, but they won’t apply to most people.
2. Very likely, you already have insurance, so don’t panic. If you are covered by an employer-sponsored plan, Medicare or Medicaid, military or veterans programs, an individual plan or other group plans, you’re golden. If it’s very skimpy or unaffordable, you can buy on the state’s exchange marketplace, where you might get financial help.
3. If you have an individual plan, you’re considered covered, but your plan is likely going to change, and you’ll have to pick a new one.
4. Insurers can no longer reject you or charge you more because you have a health condition.
5. Your kids can be on your policy until they’re 26.
6. You can’t sign up for insurance coverage all year long. You’ll be able to sign up only during specified open-enrollment periods. This year, a special six-month period lasts from Oct.1 to the end of March 2014.
7. If you’re a mom, you’re the most-trusted adviser to over-26 kids. So you’re the one who needs to explain that, yes, they can pay the penalty and skip insurance.
8. There is a new way to compare and sign up for individual insurance. In Washington, the insurance-exchange marketplace will appear Oct. 1 as the Washington Healthplanfinder, a one-stop shopping site that will take care of a lot of messy details for you.
9. The Healthplanfinder will do some whiz-bang stuff behind the curtain. You’ll be able to find out, for example, if your income qualifies you for free or lower-cost insurance.
10. The exchange isn’t the only way. You’ll still be able to buy individual insurance through a broker, or through the insurer the same way you signed up before. But there are no subsidies for purchases outside the exchange.
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11. If you work for a big, self-insured company, you won’t see many changes. At least not right away.
12. Expect new arrangements between insurers and doctors and hospitals. In general, they may lead to better coordination of care, but you may also see fewer choices of doctors, clinics and hospitals.
13. You might want to call way ahead of time to make that doctor’s appointment. If it turns out that more people are insured, there just might be a few more patients in the waiting room.
14. Don’t expect costs to go down soon. Once most people are in the pool, expect some slow ratcheting down of costs as businesses, insurers and health systems find ways to reward care that works and discourage care that doesn’t.
15. Expect more pressure from every direction to adopt healthful habits and choices.
16. Businesses aren’t required to insure workers this year. The federal government in July delayed the mandate for business coverage for a year. But in 2015, employers of more than the equivalent of 50 full-time workers will have to insure or pay a penalty.
17. Undocumented immigrants won’t get any subsidies. But legal immigrants can buy insurance on the exchanges and qualify for subsidies, if their income qualifies them for help.
18. Watch as hospitals pull out all the stops to sign up patients for insurance.
19. Soon, there will be information everywhere. There will be assisters and seminars and advertisements and info packets about the exchange and the ACA everywhere you turn.
20. Despite what you may have heard, Obamacare doesn’t change the world as we know it. There will still be hospitals, and doctors and insurance companies. Employers will still offer insurance to workers. Brain surgeons will still make a lot of money.