Forum Fall 2013 - page 7

Forum, Fall 2013
website. For the first time, uninsured Americans now have
the option to purchase medical insurance coverage. Also,
depending on household income, individuals may receive a
subsidy to offset the cost of having medical insurance.
For example, insurance coverage for a family of four in
Pennsylvania with a combined income of $35,000 would
cost $7,517. However, due to income, the family would
receive a subsidy of $6,144 towards the cost of medical
insurance, leaving the premium expense for the family of
$1,373 per year. To calculate your own potential expenses,
There are five types of plans being offered:
• Bronze
• Silver
• Gold
• Platinum
• Catastrophic - only for individuals under 30; covers
only catastrophic illness
Each plan differs in cost based on level of coverage
elected: Bronze (60/40), Silver (70/30), Gold (80/20), and
Platinum (90/10). There are also maximum out-of-pocket
(MOOP) expenses ($6,350 for an individual and $12,700
for a family). After the MOOP is reached, the plan covers
healthcare costs at 100%. The price of the plans is based
upon the type of coverage elected (i.e. a bronze plan is less
expensive than a platinum plan) as well as the individual’s
age, geographic location of residence and tobacco use. To
reiterate, insurance prices or coverage can no longer be tied
to pre-existing medical conditions.
The Individual Mandate...
Perhaps the most controversial part of the law, the
individual mandate, requires most individuals to have
health insurance and imposes penalties on those who chose
to remain uninsured. The penalty for not having health
insurance is collected annually as a fine through annual
IRS tax filings. In 2014, the penalty for NOT having health
insurance is $95. This penalty will increase incrementally
to $695 or 1% of individual/family income by 2016.
Individuals who are NOT required to purchase health
insurance through the healthcare marketplace include those
• Religious objections
• Financial hardship
• Taxpayers with income <$9750 (single under 65-filing
• Members of Indian tribes
• Member of healthcare sharing ministry
• Incarcerated individuals
• Americans living abroad for > 1 year
One argument against the individual mandate is that the
penalty for not having insurance is much let expensive then
purchasing health insurance through the marketplace. A
word of caution though, taking a chance with NOT having
insurance is exactly that, a chance. Should the individual
have an accident or illness and have no coverage, he/she
will be responsible for medical costs incurred. It is unclear
how the ACA will impact the acquisition of care for the
uninsured beyond emergency care---stay tuned.
Affordable Care Act...continued on page 9
The Cancer Insurance Checklist is your
guide to shopping for insurance on the
Marketplace/Exchange if you have cancer,
have a history of cancer or are at risk for
The CLF collaborated on the checklist with 18
other cancer advocacy organizations with
the goal of creating a resource for anyone
who is purchasing insurance through the new
system. It can be overwhelming to figure out
which policy is best, especially if you have a
cancer diagnosis. The checklist is a guide to
help you choose the right plan, taking into
account special coverage issues that cancer
patients may have.
learn more.
To learn more about the new healthcare law
and insurance visit these additional online
- supported by the Patient
Advocate Foundation, Patient Action
Council, and National Patient Advocate
Let’s Ask 4
The New Health Care Law and
- produced by the Institute of Medicine’s
Health Literacy Roundtable
Cancer Insurance Checklist
1,2,3,4,5,6 8,9,10,11,12
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