Health Care Reform Basics

The Basics of the New Health Care Reform Law and The Individual Health Coverage Mandate

What is the goal of the new health care reform law?

  • To reduce the number of Americans without health care coverage
  • Make it easier for people to get coverage by offering new places to buy coverage and remove any pre-existing conditions restrictions and lifetime limits
  • Make it more affordable for some people to get coverage by offering premium subsidies

Will my coverage be free?

  • Most likely not. Most people will need to pay their portion of an employer sponsored health plan or purchase their own coverage through the insurance marketplace.
  • Coverage could be free under Medicaid if you qualify for Medicaid coverage. Medicaid coverage will be expanded, in most states, under the new law to include individuals and families making up to 133% of the poverty level ($15,281 for an individual, $31,321 for a family of 4).
  • In Oregon, coverage may be available at no or low cost for uninsured children under age 19, through Oregon Healthy Kids for families at or below 300% of the federal poverty level. Coverage cost is based on monthly income and number of family members. Visit oregonhealthykids.gov for more information.

Will I get a premium subsidy?

  • Individuals who are eligible for an affordable, minimum value plan through their employer will not be eligible for a subsidy. A plan is considered affordable if an employee pays less than 9.5% of their W-2 wages for employee only coverage.
  • If the employee only cost of the health plan is “affordable” to you, then you will not be eligible for a subsidy under the new law. If you have access to an affordable plan, under the law, your dependents are also ineligible for a subsidy. Children may still qualify for coverage through the Oregon Healthy Kids program.

How much will I pay if I do NOT enroll on any health insurance plan in 2014?

  • The tax in 2014 is $95 or 1% of household income, whichever is greater. Fines increase each year.
  • The tax will be collected with your federal income tax. If it is based on the flat dollar amount, it will be owed for you, your spouse and children. Children are charged at 50% of the individual rate and families are capped at 3 times the individual rate.

If I quality for a subsidy, how do I get it?

  • You must purchase the coverage through an insurance marketplace, In Oregon this is called the Federal Facilitated Marketplace.
  • To be eligible, your annual income must be between 100 percent and 400 percent of the federal poverty level (FPL). In 2013, for a single person this is between $11,490 and $45,960 and for a family of four this is between $23,550 and $94,200.

How can I learn more?

Go to our Personal Health Insurance quote page for help deciding whether or not you may qualify for financial assistance. KPD can provide options for personal medical and dental insurance through the Federal Facilitated Marketplace or directly with our preferred insurance markets.