Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and enforcement officially began in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare's Effect on Hawaii Health Insurance
In Hawaii specifically, Obamacare has not had a huge impact on the uninsured rate, most likely because the state has taken a progressive stance on healthcare reform since the 1970s. Because of this, the uninsured population only decreased by a few percentage points after the Affordable Care Act was passed. An additional 18% of low-income families have received access to affordable coverage in Hawaii due to the passage of the ACA.
What Hawaii Residents Should Know About Obamacare in Hawaii
The Pros and Cons of Hawaii Obamacare
Hawaii was a quick supporter of the Affordable Care Act and immediately went to work on expanding Medicaid and developing their exchange. Obamacare has made health insurance coverage available to many that could not previously afford care due to Medicaid expansion and has increased educational opportunities about available benefits to those that previously qualified. It has also been successful in stressing the importance of individuals taking ownership of their care by participating wellness programs and early screenings. Finally, Obamacare in Hawaii has successfully eliminated denial of care based on pre-existing conditions and has disabled Hawaii companies from charging a higher premium based on race or gender.
There have been criticisms of Obamacare in Hawaii about the exchange. There were many technical problems and logistic issues. One example was not having hours of operation that matched Hawaii’s local time. After a few years of financial difficulties, the state marketplace opted to utilize the Federal exchange, Healthcare.gov. There have been additional criticisms that the federal requirements are actually a step back for Hawaii who has always operated on the leading edge of healthcare reform. Because of this, the Governor is working towards approval for waivers that would allow Hawaii to continue operating in their current manner.
Obamacare Health Plan Categories and How Much You Will Pay
When shopping in the Hawaii Obamacare Marketplace, there are four primary health plan categories you can choose from: bronze, silver, gold, and platinum. The categories determine the percentage of healthcare costs that the plan will pay for over a course of a year. The remaining percentage is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. Think about it this way: If the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay the remaining 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount of healthcare services each plan pays for:
- Bronze plan - 60%]
- Silver plan - 70%
- Gold plan - 80%
- Platinum plan - 90%
How do I sign up for Obamacare in Hawaii?
The Hawaii Obamacare Marketplace and exchange can be accessed through the federal government website or by calling (800) 318-2596.
What are the Obamacare Marketplace and exchange?
The Marketplace is a central location to shop for insurance options and enroll for selected coverage. In the case of Obamacare, Hawaii will begin utilizing the Federally-Facilitated Marketplace (FFM), which means that the U.S. Department of Health and Human Services operates and manages the Marketplace where health insurance plans are offered. Hawaii plays an active role in qualifying plans and the benefits that they are offering.
Do I need to use an exchange?
To access public health insurance, you will need to go through the government exchange. The only exception to personally using the exchange to sign up for Obamacare in Hawaii is if you are able to seek help from a Hawaii certified counselor or a private insurance agent who can discuss your options and select a plan, on your behalf, through the exchange.
How do I use an exchange?
You can use the exchange one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling (800) 318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing health insurance coverage from the Obamacare Hawaii Marketplace while off-exchange normally refers to purchasing health insurance coverage from a private company.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in Hawaii is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short term individual private insurance to avoid a penalty.
What is the Obamacare penalty if I don't buy health insurance?
If you do not buy Obamacare or other qualifying health coverage (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 years of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What if I cannot afford Obamacare?
If you cannot afford to pay for Obamacare coverage, you may be able to qualify for a government subsidy. For more information on government subsidies visit the HealthCare.gov website.
What are the alternatives to Obamacare in Hawaii?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange.
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