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Aug 07, 2013

“Well, it’s finally happening. After years of drama on Capitol Hill, a Supreme Court case, a presidential election, and a Mayan apocalypse that could’ve stopped it dead in its tracks (but didn’t), the marquis elements of the Affordable Care Act - sometimes called Obamacare - are about to kick in and big changes are coming to health insurance in 2014.”



That’s the first line of the video you’re about to watch: The YouToons Get Ready for Obamacare! 

I’ve been studying up on this topic quite a bit over the last year and this video does a great job of breaking it all down in under 7 minutes, making it simple and fun to watch at the same time (which is a big feat for a video about health insurance)! 

There are 4 main ways nearly all Americans will experience healthcare when the bill is in full affect.  How will you be covered?  Now is the time to get educated and figure it out, so watch the video and use the resources below!

1) About 50% of us will get insurance through an employer

If you’re employed by a larger company and already get your insurance through your job, there probably won’t be a lot of change for you.  A few advantages to you:  there will be caps on the amount you’ll have to pay out of pocket and your preventive care (annual physical, mammogram, etc.) will be covered (you’ve probably already had this for over a year). 

If you work for a larger company (with 50+ full time employees) that doesn’t offer insurance today, your employer must offer it to you or pay a penalty. You may have heard that this requirement was recently delayed to 2015. 

Smaller employers won’t be required to provide insurance to their employees, but they’ll be encouraged to.  The government is setting up special online marketplaces where  they’ll offer temporary tax breaks for employers who qualify  

2) About 33% will get covered through the government (Medicare/Medicaid)

Not much will change for seniors who have Medicare.

Medicaid is expanding to cover more poor Americans. Today, families of 4 making about $23,000 a year (or about $11,000 for a single – this is what’s known as 100% of the federal poverty level) or less are eligible for Medicaid. Expanding to more people is a state-by-state decision and some states have chosen not to move forward with this part of the bill.  Click here to see what your state is planning. 

3) About 10% will buy insurance on their own

If you’re self-employed, don’t get health insurance at work or find your employer’s insurance options too expensive, you have the option to buy insurance on a new Health Insurance Exchange.  This is like an online mega-mall where you can shop for plans and choose one that’s right for your family.  The video doesn‘t say it, but your local health insurance agent can help with this (at no cost to you).  Like any mega-mall, there will be tons of options to choose from.  A broker can help guide you through it all to find the best plan for your family.

Like Olympic medals, you can choose from 4 types of plans with increasing deductible amounts:  Bronze (lowest monthly charge - highest out of pocket costs), Silver, Gold, or Platinum (highest monthly charge - lowest out of pocket costs).  

All plans will cover the basics:  hospital/doctor visits, maternity care, mental health care and prescription drugs. 

Why should you use an Exchange to shop for insurance?  Because this is where/how the government is handing out the subsidies.  There will be subsidies for those earning up to 400% of the poverty level.  For example, that’s a family of 3 earning $78,120/year.  So, about 63% of all Americans will receive a subsidy of some amount for their health insurance.  Click here to see what your monthly premium and subsidy could be.

Insurance companies can’t charge you more for being sick or having a pre-existing condition.  Men and women will be charged the same price.  Compared to today, older people will typically pay less and younger people will pay more.  To keep costs down for young people, they’ll have lower monthly cost, higher out of pocket plan options . 

4) The rest (about 30 million) still won’t choose coverage

Some might say, “If I can’t be turned down, I’ll just wait to buy insurance until I need it.”  Not so fast!  You can only get insurance during special enrollment periods.  If you miss yours, get ready to pay out of pocket for that car accident or those cancer treatments.  Then, there’s the fine you’ll pay for not having insurance - $95 a year or up to 1% of your income (if you make $100,000 a year, that’s $1,000 a year) and that goes up to $695 or up to 2.5% of income by 2016.  The fines for families are higher. 

Now, where will the money come from to pay for all this insurance coverage?  Taxes!  Paid by the different players in the health insurance industry, wealthy Americans, and more.  Also, hospitals/doctors participating in Medicare will get paid less. 

As the video says, funding all this won’t be painless…”but somebody’s gotta’ pay.” 

Want to learn more about how you can Simply Survive Obamacare (SOS)?

Click here to read our most popular blog post “10 Ways Obamacare Will Affect You”

Click here to read our Simply Survive Obamacare (SOS) kickoff post

Click here to get simple definitions of 15 insurance terms

Click here to learn about how medical pricing is determined

Now, it’s your turn to tell us your plan!  Open enrollment in the new marketplace runs from 10/1/13 to 3/31/14. How will you get insurance coverage in the new world of Obamacare?


Heidi has a passion for helping busy families control their healthcare dime, time and peace of mind! She writes articles to do just that, while keeping it fun and simple for her readers! She also speaks on healthcare issues and is the owner of

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Tanya Boyd
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