Almost 970,000 Texans signed up for health plans through the Health Insurance Marketplace of the Affordable Care Act, and 86 percent of them received tax credits to reduce their monthly premiums, the U.S. Department of Health and Human Services said on Feb. 5, 2015.
Insurance policies purchased by people with lower incomes also have lower deductibles and lower caps on out-of-pocket spending.
Without insurance, a serious illness or accident can leave a person with a very large debt to pay back over many years or, even worse, bankruptcy.
I recently helped a middle-aged man enroll in the Marketplace. He then broke a leg in a skiing accident. He has scheduled a visit with an orthopedic physician for further treatment. His policy will limit the maximum that he will have to pay for treatment and rehabilitation to $500.
Another individual whose insurance became effective on Jan. 1, 2014 had a heart attack a month later. His total medical bill was $88,000 but he only had to pay $1,250.
Even those who choose a high deductible policy in order to significantly reduce their monthly premiums will have their maximum out-of-pocket liability capped at $6,600 or less.
A benefit of all policies, whether high deductible versions or more comprehensive ones, is the preventive care available as outlined in the Affordable Care Act.
Anyone with a policy can receive a yearly wellness check from a primary care physician for no charge. Other free preventive care available includes flu shots, shingles shots and colonoscopies for older adults, and periodic checks such as mammograms and cholesterol testing.
The Affordable Care Act requires individuals and families with incomes above a minimum level to purchase health insurance or pay a penalty for not doing so.
Requiring people to buy insurance creates a large pool of insured people with most of those healthy individuals along with a few very sick ones. That, in turn, enables insurance companies to set premiums at a reasonable level.
It is the same principle that insurers apply to corporate group insurance plans.
The income level above which health insurance is required is: individual - $16,104, family of 2 - $21,707, family of 4 - $32,913, family of 6 - $44118.
Hardship exemptions from the requirement to purchase insurance are also allowed for reasons such as recent death of a family member, recent bankruptcy, large, unpaid medical bills, and domestic violence.
The penalty for those who do not qualify for an exemption, for the calendar year 2015 is $325 per adult in the family and $162.50 for children or 2% of (family income less the minimum tax filing level), whichever is greater. The minimum tax filing level is approximately $10,000 for an individual and $20,000 for a family.
An individual living in Bexar County making $20,000 can pay a $325 penalty or, alternatively, purchase a high deductible policy for $516 per year ($43 monthly) or a very comprehensive policy for $900 per year ($75 monthly).
The difference between the insurance premium and the penalty is the cost of protection against a major medical expense and access to free preventive care as a minimum.
Go to www.healthcare.gov and click on ‘See Plans and Prices’ to find out the coverage and cost of the plans offered in any county in Texas. People can also enroll on the same website.
Those seeking help with enrollment can contact the Marketplace help line at 800-318-2596 or can call the MedTeam toll free at 844-660-9435 or at 220-3966 for assistance from a certified Navigator in Bexar and surrounding counties. The deadline for enrollment for 2015 is Feb. 15, only a few days from now.