What You Need to Know About the New Health Law: Questions for the Uninsured

We know the federal health law is big and confusing. Some parts of the new law started immediately. Others will roll out over the next 10 years. Texas physicians have carefully studied the Affordable Care Act so we can help you understand what the changes mean to you.

On a regular basis we will answer questions Texas patients have asked or provide information you need to know. Please feel free to submit your questions about the new law at Me&MyDoctor.

If You Are Uninsured

Q. Is it true that every Texan must now have health insurance?

A. Yes, the new law requires almost all Texans and legal immigrants to have health coverage by 2014. People eligible for coverage through their employer can enroll in their employer’s plan. Employer plans need to meet certain standards. Unless the government says so, they cannot set lifetime dollar limits and must gradually eliminate annual limits. Some must cover preventive care with no deductible or copay.

Q. Where am I supposed to buy insurance?

Starting in 2014, Medicaid will expand to cover people who make up to $14,483 for individuals and up to $29,725 for a family of four. People without insurance through their employer can buy plans through new insurance marketplaces called “exchanges.” Many people who buy insurance through the exchanges can get tax credits to help them pay for it. The lowest-price insurance plan for sale on the exchanges must cover 60 percent of costs. Deductibles for these plans will be no more than $2,000 per year for individuals and $4,000 for families.

Q. When will the new law help people who do not have insurance?

A. If you haven’t had insurance for six months, and you can’t afford or don’t qualify for insurance because of a preexisting medical problem, you may be eligible to buy insurance through a new federal “high-risk” pool. Information and prices are available here: https://www.pcip.gov/

Q. What will happen if I don’t get health insurance?

A. You will pay a tax penalty if you don’t have insurance by 2014. For adults, the penalties will be:

• $95 or 1 percent of income (whichever is greater) in 2014
• $325 or 2 percent of income (whichever is greater) in 2015
• $695 or 2.5 percent of income (whichever is greater) in 2016. After 2016, the dollar amount increases with inflation.

For children, the dollar amount of the penalty is half the numbers above. For a family, the penalty will be no more than 2.5 percent of income or three times the penalty for one adult ($2,085 in 2016).