How to Make Obamacare Work for You

In its program, the Government Accountability Office identified 10 recommendations that, if fully implemented, would create a payment system that would restore confidence in the marketplaces and potentially improve affordability. However, the one proposed change that would have the greatest impact on price — and the only one that would, to our knowledge, provide direct help to consumers — was one that had been rejected by the White House before: using the same premium prices to rate two private insurance plans so that consumers can compare between them, and thus, make better choices.

How to Make Obamacare Work for You

One of the major factors at play here is income, but what does that mean in practice? With all the time and money that’s spent and wasted on arguments about politics, it’s often all but forgotten that this is a tangible thing that affects the countless lives around us. Therefore, do the math and come up with a realistic household income that will put you in a position to afford coverage on your own. Here’s how.

Applying for health insurance through your employer

Though most Americans work for some sort of company, health insurance usually comes from their work. If your work is self-insured, it is your employer’s duty to inform you of whether or not it will accept your application for coverage. While there is no minimum coverage requirements here, the employer should at least cover basic preventive care and complete appointments for routine checkups. It’s up to you, however, to ensure you’re eligible for coverage that fits your needs.

Because this is your first point of contact with your employer’s health insurance provider, that’s where it’s most important to start. The amount your employer is willing to pay will determine whether or not you qualify, so start the numbers game by determining what you make each month from your current income and take a guess as to what your income might look like in the next six months. If this amount is below the minimum required by your employer, or in the middle of the pack, chances are you won’t qualify for coverage from your employer. However, if it’s above your current income but is still in the middle of the pack, you might get lucky and be placed in a non-subsidized spot. Your employer should provide guidance as to your eligibility, which, when you take into account the cost of premiums and the need for deductibles, won’t be cheap.

Applying for health insurance through the individual marketplace

Obamacare is an individual health insurance marketplace. It’s a place where you can shop for plans with your own money and self-insure, eliminating the need for an employer in most cases. Unfortunately, what you pay for coverage there is determined by your income.

Let’s say you earn $40,000 a year and need health insurance, but are still unwilling to go on a pre-existing condition insurance plan. You can buy coverage through the Obamacare individual marketplace, but if you want to shop within the basic marketplace, you’ll be responsible for paying the full price, just like you would be if you went to work for another company. If, however, you can’t afford the premium and instead opt for a wider range of plans, you can tap into subsidies, which drop your monthly premium significantly. These subsidies will also get passed on to your employer, which will, of course, pay a fair bit to make this all work. Again, the goal is to figure out your income and apply for coverage that’s affordable.

Applying for health insurance through an exchange

Just as the individual marketplace doesn’t provide any subsidies, Obamacare exchanges do not provide any subsidies, either. Basically, if you want to buy insurance through your employer or on the exchange, either option will leave you responsible for paying the full cost. As it stands, there are two possibilities: you can get subsidies or go without insurance. Assuming you can get a subsidy, that means you can pay only the cost of your insurance without paying a penalty. Keep in mind, however, that you’ll be paying a lot more than you would have in the past. If you’re eligible for a subsidy, your monthly premium will also be much higher than what you were paying previously. As a general rule, your premium should be between 9% and 12% of your income. Although you can work around this by either keeping up with your deductible payments, making monthly payments on time, or both, the alternative is to go without insurance. Unless you’re certain you can hold down a job and be insured for full time, this is something you shouldn’t do.

While it’s understandable that certain things, like the aforementioned Obamacare subsidies, are difficult to determine on the individual exchange, it’s still worth being aware of. With even the best of intentions, you may be able to go through the process in the confines of your income. If not, you’ll need to figure out your current situation and apply on the exchange or work with an advocate at a nearby resource. Just remember, it’s your first point of contact with the marketplace and always something that should be carefully calculated.

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