Mind, Body & Spirit

Affordable Care Act basics: enrollment, costs, penalties

People may enroll in the state-based insurance exchanges beginning Oct. 1, with coverage to start Jan. 1, 2014. See www.healthcare.gov/mar ketplace/individual/.

Who may enroll?

People who are uninsured or who have insurance they buy themselves (such as those who are self-employed or retired early). It is not open to those who have insurance through their employer, except if the premium through their employer is at least 9.5 percent of their income or covers less than 60 percent of costs. No one may be turned down or charged more for pre-existing conditions. To learn more, see www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf.

How much will it cost?

It varies with deductible choices, copays, and out-of-pocket maximums. It also varies depending on where you live. Figures have not yet been released for Arizona (they are expected to be available by mid-September). In other states, midlevel plans are averaging between $200-$400 per month. If you can’t afford insurance but don’t qualify for Medicaid, Medicare, or the Children’s Health Insurance Program, there are sliding scale tax credit subsidies for people making between 100 percent and 400 percent of the poverty level ($11,490 for an individual). In 2011, Arizona had frozen Medicaid enrollment of adults without children; with the implementation of the Affordable Care Act, Arizona’s Medicaid will be open to anyone who earns less than 133 percent of the federal poverty level ($15,282 for a single person this year). To learn more, see www.healthcare.gov/how-can-i-get-ready-to-enroll-in-the-marketplace/.

 What about a penalty?

Starting Jan. 1, nearly everyone is required to have minimum essential coverage. There are exceptions; if you would have to pay more than 8 percent of your income, it is considered unaffordable. There is also no penalty for a gap of less than three months. Enrolled members of Indian tribes are exempt, as are groups that do not pay into Social Security, such as the Amish. To learn about getting an exemption, see www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-06-26.html?DLPage=1&DLSort=0&DLSortDir=descending.