Obamacare (Obama Care or Affordable Care Act) News from NY State of Health

Obamacare is the shorthand name for the federal Affordable Care Act (ACA), which was signed into law by President Barack Obama in 2010.

This wide-reaching law does many things, but most significantly it:

• protects consumers -- for example, by requiring insurance companies to cover people with pre-existing conditions and preventing them from arbitrarily canceling your coverage
• requires most U.S. citizens and legal residents to have health insurance or, if they don't, to pay a tax penalty
• allows states to expand Medicaid coverage
• creates marketplaces (sometimes called "exchanges") for affordable health insurance plans, and
• establishes new funding for public health and prevention.

As a result of the law, new health plans will be available for individuals, families, and small businesses. You can compare plans and providers, and choose the coverage that’s best for you.

At ObamacareByZipCode, we focus on helping you understand how Obamacare works in New York, to help you get the coverage you need.

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Here are some topics that answer frequently asked questions about Obamacare.

Do I Have to Get Obamacare in New York?

How Much Does Obamacare Cost?

How Can I Save Money on Obamacare?

How Do I Sign Up for Obamacare in New York?

They are identical. Obamacare is just a nickname for the Affordable Care Act (ACA). 

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Here are some articles that answer frequently asked questions about Obamacare and the ACA.

What Is Obamacare and the Affordable Care Act?

Do I Have to Get Obamacare in New York?

How Much Does Obamacare Cost?

How Can I Save Money on Obamacare?

How Do I Sign Up for Obamacare in New York?

All health plans purchased through the NY State of Health, the health insurance marketplace for New York, must include the following benefits. These are known under Obamacare as “essential health benefits”:

1. Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)
2. Emergency services
3. Hospitalization (including surgery)
4. Maternity and newborn care
5. Mental health and substance use disorder services (including counseling and psychotherapy)
6. Prescription drugs
7. Rehabilitative and habilitative services and devices (for people with injuries, disabilities, or chronic conditions, to strengthen their mental and physical skills)
8. Lab services
9. Preventive and wellness services and chronic disease management
10. Pediatric services (including oral and vision care)

Companies that offer plans through a state exchange will compete on price and quality of service in delivering these benefits.

Under Obamacare, most people who don't have health insurance will be required to pay a tax penalty. But you may not have to pay if you qualify for one or more of the following exemptions:

• You are uninsured for fewer than three months of the year.
• You prove that you can’t afford coverage -- that is, premiums for the least-expensive policy cost more than 8% of your earnings.
• You don’t have to file a federal income tax return because your income is too low.
• You are a member of a federally recognized Indian tribe.
• You are a member of a health care sharing ministry.
• You are a member of a recognized religion that objects to health insurance.
• You are in the United States illegally.
• You are incarcerated.

You may be eligible for an exemption under other circumstances, as well -- for example, if you can show that obtaining coverage would subject you to serious financial hardship.

To learn more, see Do I Have to Get Obamacare in New York?

If you used the marketplace to purchase a plan last year. Most people who purchased their 2016 insurance plan from an online marketplace will be able to automatically renew their coverage for 2017. While automatic renewal sounds convenient, it has serious downsides:

• If your insurer decides to cancel your current plan, you could be switched to another plan without warning. The new plan may cost you more or change your eligibility for financial assistance.
• Automatic re-enrollment could mean you aren't getting the right subsidy package. That could leave you facing higher monthly premiums now or -- if you take more assistance than you're eligible for -- a big tax bill later.
• You may miss out on a better deal or better coverage if you don't compare all available plans to your current plan.

While allowing yourself to be automatically re-enrolled is better than going without insurance, it's best to take advantage of open enrollment and research your options. Shop around and evaluate new plans and costs. Even if you decide to stay with the plan you have, you can use open enrollment to confirm your personal information and ensure you're getting the right amount of financial aid.

If you purchased an individual or family insurance plan outside the online marketplace. As long as the plan meets Obamacare's coverage requirements, you can keep it. Or, you may use NY State of Health to compare plans and replace it. If you keep your current plan, you won't be eligible for the cost-saving subsidies available for plans purchased through the exchange.

Be sure to check with your current insurance provider before canceling a health insurance policy; you may have to wait until the end of your current policy year to make a change.

If you have insurance through an employer. As long as you're happy with your plan, you can keep it. You're considered covered under Obamacare. On the other hand, if you're not satisfied with the coverage you have, you may be able to switch to an individual plan through NY State of Health.

Keep in mind that if you buy a plan through the exchange:

• Your employer will not have to pay a portion of your monthly premiums.
• You may not qualify for cost-saving subsidies, even if your income falls within the eligible range. If your employer offers coverage that is considered affordable and sufficient under the law, you won't qualify to save on premiums or out-of-pocket costs for plans purchased through NY State of Health.

The health insurance marketplace (sometimes called an "exchange") is where to go to get health insurance under the Affordable Care Act. The marketplace for New York is NY State of Health. You can use the marketplace to compare plans, learn whether you qualify for cost-saving subsidies, and sign up for the plan that works best for you.

In New York, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from a navigator (often called an “in-person assistor" or IPA in New York) or from a licensed health insurance agent or broker.

Navigators can explain your options, answer your questions, and help you apply for the plan you choose -- but they can't legally recommend a specific plan for you. 

Private insurance agents or brokers can also help you understand your health care coverage options under Obamacare. Unlike government-trained navigators, they are allowed to suggest the best plan for you.

Find a navigator. To find a New York certified IPA/Navigator, use the IPA/Navigator Directory at NY State of Health.

Talk to a licensed broker. To directly connect with a New York insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

For more information, see How To Sign Up for Obamacare in New York.

"Open enrollment" is the period of time, once a year, when you can choose or change your insurance provider or what kind of plan options you want -- for example, monthly premium and annual deductible amounts -- for the upcoming calendar year. For the dates of the next open enrollment period, see What New York Residents Need to Know About Obamacare.

Choose carefully, because after you make your choices, you must usually live with them until the next open enrollment period.

"Special enrollment" is an exception to the usual enrollment rules. If you qualify for special enrollment, you can sign up during a time period outside of the open enrollment period. The circumstances under which you may qualify for special enrollment include:

• moving to a new state
• having a baby or adopting a child
• getting married or divorced
• leaving a job and losing your insurance
• losing coverage under your parents’ plan
• losing other types of health insurance
• gaining status as a member of an Indian tribe
• becoming an American citizen, or
• getting out of prison.

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Traveling from state to state isn't complicated under Obamacare, but there are a few points to keep in mind.

What if I move to a new state?

If you enroll in a marketplace health insurance plan under the Affordable Care Act and later move to a new state, you’ll need to switch to a plan offered by the exchange in that state.

Your move is considered a qualifying life event, meaning that you can sign up for new coverage as soon as you move. You don’t have to wait for the next open enrollment period.

What if I live in more than one state?

You should purchase a plan from the marketplace in the state you consider your primary residence -- where you vote, pay taxes, and so on. But snowbirds need to be sure they choose an appropriate “multistate” plan.

Some multistate plans may be restricted to a certain region – for example, a metropolitan area that straddles state boundaries. Others will be more appropriate for someone who migrates longer distances, spending, say, summers in Alaska and winters in Arizona.

Ask the insurance provider for details, and don’t sign up for a plan until you’re sure it will cover you where and when you need it.

What if I travel frequently?

Traveling shouldn't present any problem under a marketplace insurance plan. Simply sign up for a plan in the state of your primary residence. The plan will cover you in case of emergencies that happen out of state.

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For more information about Obamacare in any state, including a link to the state’s health insurance exchange, choose the state from this list.

Here's a checklist of information to gather before you apply for health coverage at NY State of Health.

• Social Security numbers for you and other members of your household who will be covered by your insurance plan
• Policy numbers for any current health insurance plans
• Documents to help you calculate your annual income. Include all sources, such as employment, pensions, alimony, rental property, or other income. If you have a job, gather together pay stubs or W-2 forms. If you’re self-employed, have last year’s tax return handy, as well other records that can help you estimate your yearly income.
• If you or anyone in your household is eligible for job-based health insurance, a completed Employer Coverage Tool for each available plan
• A good idea of your budget for health insurance, so you know how much you can afford to spend each month. This will help you choose the best plan from among those offered to you.

HealthCare.gov offers an Application Checklist you can print to help you keep track of everything you'll need to sign up.

Finally, keep a list of any questions you want answered before you sign up for a health insurance plan. To get answers to your questions, or for information on signing up for a plan, see How Do I Sign Up for Obamacare in New York?

Press Release:
New Website Provides Local Obamacare Information

September 23, 2013

A new website, ObamacareByZipCode.com, gives people the answers they need about the Affordable Care Act (Obamacare). In plain English, it guides consumers to reliable, local information about their new health insurance options.

When users choose their state or enter their zip code, they will quickly find:

• whether or not they’re required to get health insurance

• what the available plans cover

• how much coverage will cost, and

• how to sign up in each state.

For consumers concerned about cost, the site shows how to determine whether they qualify for subsidies. It also explains the new rules about expanded Medicaid eligibility.

The new site was created by Albin Renauer, founder of LegalConsumer.com, and is coauthored by Renauer and legal editor and writer Shae Irving. LegalConsumer, which until now has concentrated on consumer bankruptcy, began in 2005, when Congress overhauled federal bankruptcy laws.

“When politicians tried to make it harder to file bankruptcy, I vowed to make it easier. When I read about politicians making it hard to get information about Obamacare, it got my blood boiling -- and I realized I could help folks find that information the same way I do with bankruptcy.”

Albin Renauer is an independent web and database developer and Webby Award judge. He created LegalConsumer.com as an online companion to his book, How to File for Chapter 7 Bankruptcy, to help people file for bankruptcy.

After receiving his J.D. from the University of Michigan Law School in 1985, Albin Renauer worked for various public-interest law firms in the Bay Area and as a staff attorney for Chief Justice Rose Bird of the California Supreme Court.  He spent 17 years as an editor at leading do-it-yourself legal publisher Nolo, where he helped create numerous books and software programs, including the bestselling Quicken WillMaker. He also edited Law on the Net, the first online directory of legal resources, and was the architect of Nolo's Webby Award winning website.

About Shae Irving

Shae Irving has been a legal editor and writer since 1994, when she joined Nolo, specializing in estate planning, health care, and family law issues. For almost a decade, she was the managing editor of Nolo’s bestselling Quicken WillMaker software. Her books include Living Wills and Powers of Attorney for California and Prenuptial Agreements: How to Write a Fair and Lasting Contract. Shae graduated from Berkeley Law and briefly practiced at a large San Francisco law firm before becoming an editor and author.

For More Information

Contact Albin Renauer.

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