F

acts & figures: ObamaCare, also known as the Affordable Care Act
OVERVIEW

The cost to individuals, like you and me, as healthcare consumers and as shoppers seeking good, affordable insurance coverage to pay for that healthcare: ObamaCarealso known as the Affordable Care Act or ACA health insurancewill cost most of us (the average American) between 3% and 9.5% of our income after cost assistance that some of us may be eligible for. Insurance costing 8% of your income is considered affordable insurance for individuals; 9.5% is considered affordable for job-based insurance. "Affordable insurance" is capped at a percentage of your taxable income (the less you make, the lower the cap). Currently, the average American family pays up to 20% of their income for health insurance. Insurance pricing: ObamaCare spokespersons say health-insurance companies can price your insurance based on smoking status, location, income, family size, and age but not on health status or gender. Cost Differentiationthe sliding scale of payments: As a rule of thumb, the less you make (the less you report as income earnings) the less you pay or can be charged for insurance, assuming you will be using the Health Insurance Marketplace to shop for health coverage. Estimating your own personal price / premium: You can get an estimate of what your health insurance will cost on the marketplace by going to the health insurance premium estimate tool from healthcaregov. Cost assistance may be available for low-to-middle income Americans who shop on the socalled Health Insurance Marketplace. ObamaCare representatives estimates the average insurancemarketplace subsidy per subsidized enrollee will be $5,290 in 2014. Most young people and low-income Americans may be eligible for free (subsidized) or low-cost health insurance through the marketplace. ObamaCare's cost to the national economy in terms of tax requirements and or government budgeting: An estimate of ObamaCare's net cost can be averaged as at $1.8 trillion dollars by 2023. (Cost estimates are changed on a regular basis but are often quoted, from media and Congressional sources, as being between $1 trillion and $2.6 trillion.) ObamaCare, how paid for on a national basis: ACA is being paid for through collected taxes, penalties, spending cuts and reformations to the health care industry. ObamaCares fiscal savings: Although Obamacare's net costs are in the trillions, that law (ACA) actuallysupposedlyreduces the growth in health care spending by tens of billions each year, and is estimated to result in an overall net decrease of the deficit. Page 1 of 5

Specifically in terms of national cost reductions, Obamacare is projected to cut the national deficit by over $200 billion during its first 10 years and over $1 trillion over the next two decades. The scope of insurance coverage for individuals, like you and me, as distinct from the scope of healthcare coverage: As insurance-policy buyers, we are only marginally interested in claims that Obamacare will help to insure tens of millions of citizens. The lawthe Affordable Care Act or ACAdoesn't set up or sell health insurance; it does create incentives to spur a marketplace for Americans who want to buy regulated, subsidized private insurance. Age: Your age does affect the cost of your premium before subsidies are applied. Gender: ObamaCare does away with sex discrimination so you can no longer be charged more or denied coverage due to your male/female status. Pre-existing conditions: ObamaCare does away with pre-existing conditions as a disqualifying factor or as discrimination, so you can no longer be charged more or denied coverage due to your medical history. Smoking (tobacco smoker checkbox): Expect a "tobacco surcharge." Come 2015, smokers can expect to pay up to 50% more than non-smokers for the same health plans. Subsidies are calculated before the "tobacco surcharge," meaning smokers could find their affordable insurance unaffordable. Who has to buy in to this health-insurance mandate: On paper, everyone has had to obtain health insurance by January 1st, 2014 or pay a Shared Responsibility Fee. That tax penalty (the Shared Responsibility Fee)for not having insuranceis paid on your federal income taxes at the end of the year. Individuals making between $50k and $75k annual gross income (9% of Americans) who don't want insurance and will have to pay the 2.5% penalty (by 2016). Annually, that figures out to... 2014 = $95 per person per year or 1% of your Income 2015 = $325 per person per year or 2% of your Income 2016 = $695 per person per year or 2.5% of your Income 2017 = Tax Penalty will increase by the rate of inflation going forward, or 2.5% of your Income Whos exempt from that tax penalty: If your taxable income is below 133% of the federal poverty level, you are exempt from this tax. If you enroll in a health insurance plan through the Health Insurance Marketplace by March 31, 2014, you wont have to make the payment for going without coverage for any month before your coverage began. For example, if you enroll in a Marketplace plan on March 31st, 2014 your coverage begins on May 1, 2014. If you didnt have coverage earlier in the year, you wont have to pay a penalty for any of the previous months of 2014. The scope of healthcare coverage for individuals, like you and me, as distinct from the scope of insurance coverage: As healthcare consumers, here again we are (frankly) only marginally interested in claims that Obamacare will provide health care for many more Americans. Page 2 of 5

A core issue is...Will it enhance health care, particularly our own health care? SPECIFIC INSURANCE / HEALTH -CARE PLAN CATEGORIES The category (quality) of the plan, that you choose to purchase, determines the cost of your ObamaCare plans. The least expensive plan, the Bronze Plan, covers 60% of out-of-pocket health care costs and offers basic coverage (or in technical terms, it has a 60% actuarial value). Plans range from the basic "Bronze" (60%) to "Silver" (70%) to "Gold" (80%) and "Platinum" (90%) level plans. Each plan has progressively better benefits and networks and is also progressively more expensive. High-end plans carry a 40% excise tax which helps pay for the program. Bronze Plan as a comparative frame of reference: The average nationwide price of a Bronze Plan is $249 a month ($3000 annually) before cost-assistance. The total annual fee for not buying insurance can't be more than the average price of a Bronze plan. "Bronze" Plans for individuals are expected to go up to between $4,500 and $5,800 a year in 2016. But if you make less than 4 times the Federal Poverty Line (FPL or about $45,000 for an individual in 2012), youll pay less by virtue of receiving tax credits. Someone making up to 133% of the FPL will get credits so that his net payment will be only 2% of income, while those making 300% to 400% of FPL will pay 9.5% of FPL. Obamacare (ACA) as an employment-benefit package component: Obamacare will cost employers (with over 50 full-time employees) a penalty if they do not choose to provide their workers with affordable, quality health care. The tax, to employers, is $2000 per worker or $3000 if the workers must opt to buy insurance through the insurance exchange. Cost assistance: About one-fifth of federal spending for the major health care programs (i.e. Medicare, Medicaid, CHIP, and marketplace subsidies for individuals, families, and small businesses) will finance care for able-bodied non-elderly people; about one-fifth will go toward care for blind and disabled people; and about three-fifths will go to care for other people who are age 65 or older. There are three types of cost assistance offered through the Health Insurance Marketplace for those who make under a certain income, and who don't have access to employer-based insurance: Medicaid / CHIP for those making less than 138% of the Federal Poverty Level (FPL). If your state decides to offer it, theres Medicaid for those with income up to $15,302 for an individual and up to $31,155 for a family of 4. If your income is below the poverty line you will most likely save on health insurance costs. Help with out-of-pocket costs for those making up to 250% of the FPL. Premium tax credits for those making up to 400% of the FPL. If you are making over 400% of the poverty line, you can expect to pay just about what you do now, but receive better coverage. There are, also, three ways to save money on your health insurance through ObamaCare's marketplaces: Advanced premium tax credits which lower your monthly premium costs, cost sharing subsidies which lower your out-of-pocket costs for copays, coinsurance and deductibles, and Medicaid which does both. Page 3 of 5

Tax credits in general: When you (and your family) apply for health insurance through the Health Insurance Marketplace, you're supposed to be made aware if you are eligible for premium tax credits. Tax credits help to subsidize your premium costs resulting in lower monthly premiums for you and your family. The amount you receive in tax credits is based off of your previous years Federal tax return. Tax credits are automatically paid to your insurance provider and are adjusted on your year end taxes based off of change in income for that year. If your income increases, you will be responsible for a larger share of your premium and that will be reflected on your year-end Federal tax returns. You may qualify for both premium and cost-sharing subsidies as they are not mutually exclusive. Cost assistancehelp to pay your premiumis available only through your State's health insurance marketplace. Its available... T if you buy in to your state's online marketplace, for individuals earning between $11,505-$46,021, and a family of 4 earning between $23,425-$93,700; T as subsidies for out-of-pocket costs, if you buy in your state's online marketplace and earn up to $28,763 for an individual and for a family of 4, up to $58,564; T The less money you and your family make, the smaller the percentage of your income you will have to pay due to subsidies offered through the Health Insurance Marketplace. Cost-sharing reductions lower the amount you have to pay for out-of-pocket costs like deductibles, coinsurance, and copayments. These are costs you have to pay when you get care. The average family's costs are projected to decrease between 7% and 9% due to ObamaCare. We have seen costs range from free to an excess of $30,000 for an older, high-risk, high-income family of 5 in a state with high regional costs. When to enroll: Private insurance outside of the marketplace, Medicaid, and CHIP don't have open enrollment periods. The health insurance marketplaces, Medicare and employer based insurance all have open enrollment periods. ObamaCare's Health Insurance Marketplace is open until March 31st, 2014. You won't be able to purchase marketplace insurance again until November 15th, 2014 without qualifying for a special enrollment period. Hardship Exemption Update December 20th, 2013: If you had your plan canceled in 2014 due to the Affordable Care Act, you now qualify for a hardship exemption in 2014. That means you won't have to pay the fee if you decide to go without insurance and will qualify for a low premium, high out-of-pocket catastrophic plan on your State's health insurance marketplace. This change does not affect your ability to get subsidies or purchase other marketplace plans. If you like your plan, you can keep it: Aside from reports to the contrary affecting a relatively small number of health-care consumers...Americans who like their health insurance can keep it until 2015 at which point all non-grandfathered health plans must meet the requirements of the ACA or be switched to a new plan. On November 14th, 2013 the President announced a "fix" that lets insurance companies renew plans and extend coverage of existing plans, that don't comply Page 4 of 5

with the ACA, until the start of 2015. Some States have rejected the fix due to it creating two risk pools which could potentially drive up the cost of new plans. Learn more about keeping your insurance, under ObamaCare, by looking at healthcaregov or contacting the The National Chamber of Commerce for Women in ElderCare. Eligibility in general or for specific categories of coverage, credits or subsidies: ObamaCare creates State specific health insurance marketplaces (also known as exchanges) where individuals, families and small businesses can shop for subsidized health insurance and find out if they qualify for Medicaid, CHIP or Medicare. NOTE: If you have coverage through work, you can't get subsidies on the marketplace. _________________________________ Learn more about how you personally, NCCW in Elder Care, Holly Gemme, Director or as a business, can take advantage 10 Waterside Plaza, Suite 6 H / NY NY 10010 Phone 212-889-3806 of ObamaCare by contacting us, the The National E mail : nccw@aol.com / nccw eldercare.com Chamber of Commerce for Women in ElderCare ______________________________

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