Congressman Luke Messer

Representing the 6th District of Indiana

What you need to know about the Affordable Care Act

Jan 10, 2014
Editorial

What you need to know about the Affordable Care Act

As most know by now, I fought to repeal, delay and change the Affordable Care Act.  I worked to shield Hoosiers from some of its harshest fines and penalties, but Republican efforts in the House were pushed aside by the Democrat controlled Senate.  It is now the law of the land.

In this column I do not intend to debate the merits of the President’s health care law. As your representative in Congress, it is my responsibility to make sure you have the information you need to comply with the law and avoid its fines and penalties.  In that spirit, below is a list of the commonly-asked questions I have received about the Affordable Care Act.

When is the deadline to enroll in a health insurance plan and avoid penalties?

The enrollment period started on Oct. 1, 2013, and ends on March 31, 2014.   If you fail to enroll in qualified health care coverage by March 31, 2014, you could face fines and penalties. If you are uninsured for more than 90 days in a calendar year, you are subject to a fine of $95 or 1% of your 2014 taxable income. That fine will be assessed in 2015. The penalties and fines increase over the next two years.

Who is required to enroll?

Under the President’s health care law, just about everyone is required to have health insurance.  Some of you may have health insurance provided by your employer.  If so, you probably do not need to apply for health insurance through the Federal exchange website.  If you do not have insurance provided by your employer or through a program like Medicare or Medicaid, you are now required by law to purchase insurance either through the individual marketplace or through the Affordable Care Act exchange.  You can contact a local insurance agent to explore your options in the individual marketplace or you can go to www.healthcare.gov and select “Indiana” to see what insurance plans are available to you through the Affordable Care Act exchange. 

What are my options?

For many in the 6th District, health insurance options on the exchange are limited and vary by county.  Seventeen of the 19 counties in our district are limited to one or two insurance providers—MDWise and/or Anthem.  If you live in Delaware or Randolph counties you have three providers from which to choose including Anthem, PHP and MDWise.  Because of these limited options, you may have to switch physicians and preferred hospitals if you select health insurance through the exchange website instead of in the individual marketplace.   

What are the costs?

When comparing health insurance plans on the Federal exchange website, you will notice Bronze, Silver and Gold plans.  Those categories determine your deductible, yearly out-of-pocket maximum, and your share of the cost for medical care after you’ve paid your monthly premium.

  • Bronze Plan: Lowest monthly premium, but highest out-of-pocket costs. After your monthly premium, you pay 40% of the cost for doctor visits, medical procedures, tests, etc. The plan pays 60%.
  • Silver Plan: Monthly premiums are higher than the bronze plan, but out-of-pocket costs are slightly less.  You pay 30% and the plan pays 70% of your medical costs after your monthly premium is paid.
  • Gold Plan: Highest monthly premium, but lowest out-of-pocket cost.  After your monthly premium, you pay 20% and the plan pays 80% of your medical costs.

Your monthly premium, your deductible and out-of pocket maximum will vary based on the plan you select, your age, income and where you live. Let’s walk through what that might mean for a typical consumer.  Based on estimates from healthcare.gov, if, for example, you live in our district and have a family of four with a combined income of $40,000 a year, your monthly premium could be as little as $7 a month after receiving a government subsidy.  Your deductible will range from $7,000 to $12,600 depending on the plan you choose.  Gold plans have lower deductibles and out-of-pocket expenses, but premiums are much higher.  It is also important to keep in mind, your children could be eligible for free or low-cost health care through the Healthy Indiana Plan, and you could be eligible for a federal subsidy to off-set the costs of your monthly premium.  You can find information on the Healthy Indiana Plan at http://www.in.gov/fssa/hip/

Are there any exemptions?

There is a litany of exemptions to the President’s health care law and you may qualify for one of them. Exemptions are included for those whose household income is less than the filing threshold for federal income taxes and those whose required contribution for coverage exceeds 8% of their household income.   There are other possible exemptions for those with certain religious beliefs and individuals in a health care sharing ministry.

For more information on the Affordable Care Act, how it will impact your family’s health care and what options are available to you go to www.healthcare.gov, the Federal exchange website.  If you still have any questions, do not hesitate to reach out to our offices in Muncie, Shelbyville or Richmond.  Or you can email me by visiting my website www.Messer.House.gov

You can also attend one of our upcoming Affordable Care Act town halls which will take place near the end of February.  Specific dates, times and locations will be announced at the beginning of next month.  I encourage you to look closely at the costs, coverage and in-network providers in each plan before purchasing health insurance in the individual market place or through the Affordable Care Act exchange.

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