“Medicaid, Medicare, ObamaCare—what does it all mean? And how does it affect me?”
Shopping for Health Insurance
As an older woman, those questions may be on your mind, especially with open enrollment either coming soon, or recently past, depending on when you read this. Let’s have a look at all three programs:
According to healthcare.gov, “Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.”
Notice that word, “some.” It applies not only to low-income people, but also to all the groups mentioned above. Qualifying low income, for example, is figured as a percentage of the Federal Poverty Level. In 2013, 100 percent of that level for a family of four came to $23,550. But even if you didn't qualify for Medicaid in the past, you may qualify under new rules. To find out, click on healthcare.gov.
Eligibility for Medicare starts at age 65, but age is not the only test. To see if you are eligible, go to medicare.gov and type “eligibility” in the search box. Up will come the Medicare Eligibility Tool, which will give you a definite answer.
Medicare isn’t part of the Affordable Care Act (ObamaCare), so if you have Medicare right now, you’re covered under health care law. Do not enroll in an Affordable Care Act plan.
For more on Medicare, go to Medicare in 2 Minutes.
Affordable Care Act (ObamaCare)
If you’re not a low-income person and still not 65 or more, you’ll need to explore ObamaCare. This is a media-created term for what is more formally called the Affordable Care Act, passed in 2010. The open enrollment was from November 15, 2014 through February 15, 2015.
ACA (ObamaCare) is based on six main ideas:
- Every American should have access to affordable medical insurance, including those with pre-existing conditions.
- To make sure there are enough healthy people in the “risk pool” to hold down costs, there is a mandate: All adults have to buy health insurance, even if they’re currently healthy.
- To keep the mandate affordable even for low-income people, there are subsidies to hold down premiums as a share of income. To see if you’re eligible for a subsidy, go to kff.org-calculator.
- Many healthy, affluent people will pay more for health insurance than they currently pay.
- You can buy coverage through Healthcare Exchanges, which offer a selection of healthcare plans that include hospitalization, doctor visits, and medications. The Exchanges allow you to compare prices, benefits, and choice of doctors.
- Coverage comes in a choice of four levels, which vary in costs and benefits: Platinum, Gold, Silver, Bronze. Platinum covers 90 percent of costs; Bronze, only 60 percent.
Critics of the ACA say it will prove too complicated, may cost too much, and may lower the overall quality of healthcare. Defenders point out that a very similar system has been in place in Massachusetts since 2006 and seems, by most accounts, to be working fairly well. It was signed into law by then-governor Mitt Romney.