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Who will be affected by health reform enrollment in October?

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With less than 60 days before open enrollment begins Oct. 1 in the health plans in the Health Insurance Marketplace, there is still considerable confusion about who will and who will not be affected.

MORE LIKELY TO BE AFFECTED: The uninsured and those who are purchasing health insurance on their own or who have been denied coverage because of pre-existing conditions. In Georgia, there are about 350,000 purchasing health insurance on their own and many of them will be eligible for subsidies based on their income, which goes up to 400 percent of the federal poverty level or $94,000 a year for a family of four. There are an estimated 1.9 million uninsured in Georgia and many of those will also get help purchasing insurance. Advocacy groups have estimated that 800,000 will qualify for help. A prohibition against denying coverage because of pre-existing conditions also takes effect Jan. 1, which would make people in that category eligible for coverage.

LESS LIKELY TO BE DIRECTLY AFFECTED: Those who are currently getting health insurance through their employers. Those plans in existence when the law was passed in 2010 were grandfathered in, according to the Kaiser Family Foundation. They are still subject to some provisions of the law, such as extending coverage to dependents younger than 26 and eliminating lifetime limits on coverage or annual limits on coverage beginning in January, according to the foundation. They will not, however, have to provide the essential benefit package or cover preventive services for free that plans in the Marketplace will, provided the plans do not make substantial changes, such as eliminating benefits or changing insurers, according to the foundation.

Those with employer-based insurance could still look to the Marketplace for alternatives but would not qualify for premium help if their insurance plan is considered “affordable” and provides “minimum value,” according to, the Marketplace Web site where people will later be able to find plan information and enroll. Affordable is defined as a plan where the employee share of the annual premium for self-coverage is no more than 9.5 percent of annual household income, according to the Marketplace site. A plan would be deemed to provide “minimum value” if it is designed to pay at least 60 percent of the total cost of medical services for a standard population. An employer should be able to tell employees if their plan meets those standards.

The Affordable Care Act at one time included that Medicaid expansion would be a part of the coverage offered but when the U.S. Supreme Court upheld the law it made Medicaid expansion optional for states. Both Georgia and South Carolina have chosen not to expand Medicaid next year, which means adults who make less than the federal poverty level might not be able to find coverage because they are not eligible for subsidies under the law, according to the Kaiser foundation. However, they will also be exempt from the individual mandate so they will not be penalized if they do not have coverage.

If you are curious about whether you would qualify for subsidies or just want more information on how you would be affected by the Marketplace, you can go to and find out by inputting some of your information.

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whozit 08/03/13 - 08:19 pm

Our governor and legislature decided it was better for GA hospitals to continue to go broke rather than expand Medicaid. Now, the hospitals will continue to see indigent patients without reimbursement. If Medicaid were expanded, they would at least get paid that rate. As reported earlier in the Chronicle, they decided to forgo the $275 million in economic activity each year it would provide and the estimated 70,000 statewide jobs in the private sector. But, hey, they are Republican, so everybody loves them.

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