Q: As of 2014, will I be required to have health insurance?
A: Yes. The Affordable Care Act requires almost everyone to have health insurance. There are a few exceptions, but beginning in January 2014 most individuals of all ages must have health insurance—or pay a special tax. For 2014, that will cost either $95 or 1 percent of taxable income per adult, whichever is greater. The tax will increase each year as follows:
- 2015: $325 or 2 percent of taxable income per adult, whichever is greater
- 2016: $695 or 2.5 percent of taxable income, whichever is greater
- 2017 and beyond: the tax penalty will increase annually based on cost-of-living increases
The tax for a child is half the adult penalty.
Q: Will I be able to keep my current health insurance?
A: If you currently have health insurance through your employer you are covered and do not need to do anything. If you have individual insurance coverage you are now able to evaluate your coverage options on the health insurance marketplace. To learn more about your coverage options, visit GetCoveredIllinois.gov.
Q: How will the Affordable Care Act impact my health insurance premiums?
A: If you buy or are planning on buying individual insurance, the impact on your premiums depends on a lot of factors—including where you live, your age, and your health status. For an estimate of these costs, please use the Health Insurance Subsidy Calculator.
Q: What can I do to reduce my health insurance costs?
A: In order to find out if you qualify for the Advance Premium Tax Credit, you will need to apply to your state’s Health Insurance Marketplace. This tax credit is based on your household income and family size. In 2014, if you are single and earn up to about $45,000, or you are part of a family of four that earns up to about $94,000, you may qualify for lower premiums. The reduced costs would be handled through a federal tax credit that can be applied directly to your monthly premiums. It is important to keep in mind that not everyone can reduce costs by going to the health insurance market place. For many, the options provided through an employer will be more affordable.
Based on your income and family size, you might also be eligible for free or low-cost care through Medicaid. Alternatively, if you earn too much money to qualify for Medicaid, your children may be eligible for low-cost health coverage through the Children’s Health Insurance Program (CHIP). If you apply to your state’s Health Insurance Marketplace, you’ll be told if you also qualify for other such insurance programs.
Q: How far into 2014 can I purchase health insurance through my state’s Health Insurance Marketplace?
A: The open enrollment period for purchasing health insurance runs through March 31, 2014.
Learn more about open enrollment deadlines »
Q: How do I know if I can go to the Health Insurance Marketplace to buy insurance? Where can I buy it?
A: Most people are eligible for health coverage through the Marketplace. You must live in the United States, be a U.S. citizen or national and cannot currently be incarcerated for eligibility.
You can buy health insurance by applying online, over the phone, in person or on paper. Counselors are available to help you select the best plan for your healthcare. For more information about purchasing insurance, visit healthcare.gov.
Q: What if I have a pre-existing condition? Will I be denied coverage?
A: Beginning in 2014, health insurance plans cannot refuse to cover you, deny treatment coverage, or charge you more because you have a pre-existing condition.
Q: What about larger businesses?
A: The mandate that businesses with more than 50 full-time employees either provide affordable, minimal health coverage or else pay an assessment has been delayed until 2015.
Q: What if I am self-employed?
A: If you are self-employed and have no employees, you can purchase insurance through the individual Health Insurance Marketplace or continue to buy an individual plan.
Q: What if I have Medicare—do I need to do anything?
A: No. Anyone with Medicare is already covered. Medicare has nothing to do with the Health Insurance Marketplace and there will be no changes to your benefits. So stay on Medicare. If you're already on Medicare, don't let anyone try to sell you a Marketplace insurance plan. It's illegal for them to do so, and you don't need it.
Q: I'm on Medicare but my spouse isn't because he's under 65. How does that affect our access to health insurance coverage?
A: Let's start with you. You're on Medicare, so you're covered. There's nothing you need to do. Your spouse, however, may want to take action.
The Affordable Care Act (ACA) requires that most people have health care insurance in 2014. If they don't, they must pay a penalty. The fee is either 1% of the person's yearly household income or $95 per person per year. (The fee will increase each year.) This is paid on the federal income tax form.
If your spouse doesn't have coverage, he or she can receive it from an employer or through the Health Insurance Marketplace. Or, he or she can buy an individual policy on his or her own – through a health insurance company that is not on the Marketplace. To use the Marketplace, your spouse must be a United States citizen or national. He or she also must live (unincarcerated) in the United States.
Does your spouse already have health insurance through an employer, or on his or her own? If so, and your spouse is happy with it, no need to do anything. But if the insurance costs too much for your spouse, he or she can look for other coverage – either on the Marketplace or on his or her own.
If your spouse buys insurance through the Marketplace, he or she might be able to receive financial help to pay for it. This is called a subsidy, in the form of a tax credit. The credit is applied to monthly premiums, so you'd both see the savings right away. To receive this help, your spouse's total household income must be under 400% of the Federal Poverty Level. For a family of two, that comes out to $62,040. He or she also must meet other eligibility criteria.
For more information about the Affordable Care Act, visit www.healthcare.gov. There, you can also find information about Medicare, or visit www.medicare.gov.
Q: I already have Medicaid. Should I do anything?
A: No, if you already have Medicaid your benefits will not change and you do not need to do anything.
Q: How do I find out if I qualify for Medicaid?
A: Medicaid will now be available to all low-income individuals regardless of parenting or health status. This includes expanding care to former foster children (ages 18-25) who were on Medicaid and exited foster care, and to adults (ages 19-64) without dependent children that are at or below 138% of the federal poverty level.
Those who qualify for Medicaid can complete an online application at Get Covered Illinois.
Q: Where can I get additional information?
A: For further information about Health Care Reform, visit: