We'll help you wade through the uncharted waters to see if the Affordable Care Act applies to you — and, if it does, how to choose the best plan for your lifestyle.
Follow the flow
Here's a quick flow chart to see if the changes will affect you:
*If you are a senior citizen on Medicare, you can stop reading.
*If your employer provides affordable health insurance (your share of premiums is less than 9.5 percent of your paycheck), you can stop reading. Of course, you can still opt to compare costs; but if you buy your own policy and are covered by an employer, you won't be eligible for tax credits.
*If you earn less than 133 percent of the federal poverty level ($15,282 this year) and aren't already on Medicaid, you can enroll in the expanded Medicaid program and be eligible for health insurance after April 1.
*If you are uninsured or pay a heap of money for your insurance, climb aboard because there is a boatload to learn.
Navigating uncharted waters
If you're one of the 1.2 million Michiganders expected to shop the insurance marketplace, welcome aboard.
You can get a jumpstart now by gathering your Social Security number, and your health insurance policy numbers if you're currently insured. You shouldn't need your tax returns — the IRS will provide those.
Let's be clear, though: Just because the marketplace opens Tuesday doesn't mean you have to buy on the first day. You can purchase up to Dec. 15 and still have your insurance kick in on Jan. 1. If you miss the December deadline, your insurance won't start until February. If you like to procrastinate, your drop-dead deadline to enroll is March 31.
Miss the March 31 deadline and you'll have to wait until Oct. 1, 2014, when the next enrollment period begins.
But procrastinating could puncture your pocketbook. If you remain uninsured after enrollment closes, you'll likely have to pay an IRS fine of $95 or 1 percent of your income, whichever is greater.
Don't make this a habit — the fines gradually increase each year, to $695 or 2.5 percent of your income by 2016.
What's for sale?
Prices won't be available until Tuesday, but a report released by the federal government this week indicated Michigan will be in the middle of the pack on premium prices, before tax credits are factored in.
The marketplace offers four tiers of insurance coverage, named after metals. Consider the options and your financial and health situations.
A bronze plan will cost the least, but it covers only 60 percent of your expenses.
Comparatively, a silver plan covers 70 percent, gold plan 80 percent and platinum 90 percent. You are responsible for the remaining charges.
Obviously, the more a plan covers, the more it will cost in monthly premiums, but all plans will include a cap for your out-of-pocket expenses. Again, those figures will be released Tuesday.
If you have ongoing health problems, you may be better off with a higher-priced monthly premium with lower deductibles. If you're relatively healthy, a basic plan may do the trick.
According to state health insurance experts who held a conference call for reporters last week, the coverage will be better than most plans currently available on the market. They are required by law to cover emergency services; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services, and chronic disease management; and pediatric services, including oral and vision care.
How much will it cost?
Rates will vary based on income, family size, age, hometown and tobacco use, but experts estimate the majority of the 1 million-plus in Michigan who buy on the exchange will get some financial help.
Individuals who earn up to $45,960; couples who bring home no more than $62,040; and a family of four making up to $94,200 will be eligible for a tax credit.
Keep in mind that these numbers will change every year. They're based on a range of 133-400 percent of the federal poverty level.
Those earning up to 133 percent of the federal poverty level are eligible for the expanded Medicaid program approved by state legislators last week.
The amount of tax credit you'll receive is based on the purchase of a silver plan rate.
Want to save some bucks? Downgrade to a bronze plan to pay less out-of-pocket premium (with the caveat that, if you have a lot of medical bills, your overall cost could be more). You may also upgrade to a gold or platinum plan by paying the difference in premiums.
Again, actual prices won't be released until Tuesday, but estimates indicate a 27-year-old Grand Haven-area resident who is single and earns $20,000 a year will pay $85 a month after $1,633 in tax credits. A married couple earning $60,000 a year, both age 40 with two kids, will pay $409 a month after $4,786 in tax credits. A couple age 55 earning $50,000 a year will pay $396 a month after $6,557 in tax credits.
The government will pay the tax credit directly to the insurance company, with you picking up the difference.
You also have the option — which probably won't be a popular one — of paying the entire premium and getting your tax credit the following year as an income tax refund.
Younger adults can opt for a catastrophic plan. Premiums are lower, but no tax credits are available.
If you smoke, you'll pay about 50 percent more. Age will kick up the rate, too, but the law stipulates that a 64-year-old's premiums cannot be more than three times that of a 21-year-old.
Where's the life ring?
If you find yourself over your head with health insurance changes and need help wading through it all, here's a fleet of options for you:
*The marketplace will open on Tuesday at healthcare.gov. You'll find information on plan choices, rates and more.
*For a live chat, call the federal government hotline at 800-318-2596, or visit healthcare.gov/chat.
*Call the Michigan Health Insurance Consumer Assistance Program at 877-999-6442, or visit its website if you have questions or problems.
*To locate a navigator (a person trained in helping consumers select a new health care plan), visit enrollmichigan.com. No appointments will be set up until after enrollment opens.
*If you want to stay current on the new health care law, visit healthcare.gov/subscribe to sign up for e-mail and/or text updates.
*Regional experts will be at Spring Lake District Library on Oct. 25 to answer questions and assist people in signing up for health insurance on the marketplace.
*The Kaiser Family Foundation has a subsidy calculator on its website to help you determine estimated rates based on ZIP code and family size.