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By MICHAEL HOGUE
Staff Artist mhogue@dallasnews.com
The Patient Protection and Affordable Care Acts biggest impact so far begins on Jan. 1, when millions of Americans will be added to the rolls of health insurers. People on Medicare, Medicaid and other government insurance programs are not affected. Those who get insurance at work will basically see no change. Heres a look at how it will work.
Texas is not running an exchange, so the federal site is where Texans can shop for five levels of private health insurance. The site is:
www.Healthcare.gov
TRICARE/military coverage 34,554 Medicare plus Medicaid 78,234 Employer-based and direct-purchase coverage 103,043 Medicare only 211,249 Medicare plus employer or private 216,146 Direct-purchase health insurance only 310,836
31
MAR
$94,200
400% FPL
Taxpayers can apply for the premium assistance subsidy if their income is between 133% and 400% of the FPL.
Taxpayers can apply for the cost-sharing subsidy if their incomes are less than 250% of the FPL. 132% FPL FPL Medicaid is expanded to individuals with income of 132% of the FPL. However, Texas is opting out of this expansion.
Bronze The next level of care. Once again, the deductible is likely to be thousands of dollars before insured coverage starts. Bronze plan insurers then cover 60 percent of medical care until youve spent $6,350 as an individual, or $12,700 as a family. Silver Higher premiums than Bronze, but lower deductibles. Insurance covers 70 percent of care. Out-of-pocket maximums are the same as Bronze. Gold Again, higher premiums and lower deductibles, with
insurance covering 80 percent of care. Same out-of-pocket maximums.
Platinum Highest premiums of the plans offered, with low deductibles and insurance covering 90 percent of care. Same out-of-pocket limits.
Insurers will have to lower the out-of-pocket maximums for essential health benefits for individuals making less than $28,725 and for families of four making less than $58,875.
NOTE: Figures do not total 100 percent because of rounding. SOURCES: The Lewin Group, Families USA; McClatchy-Tribune; H&R Block; Healthcare.gov
With plans competing against each other, people will have an opportunity to look side by side at what's best for them and what's the cost. Having that marketplace competition is whats holding the cost in check. Mimi Garcia, Texas director of Enroll America, a nonprofit supporting Obamacare
How well the exchanges work remains to be seen. Several issues still need to be ironed out. Jim Landers, staff writer, The Dallas Morning News