This KHN story was produced in partnership with Cosmopolian.
As you probably know from all of the talking (and screaming) heads on TV, the Affordable Care Act (ACA) stumbled out of the gate with a glitch-ridden enrollment site, cancellation of some insurance policies and other technical glitches that have made Steve Jobs roll over in his grave.
But if recent headlines and late-night jokes have left you confused, let us straighten it all out for you and tell you what you need to know.
First of all, what the heck went wrong?
The online health insurance exchange was intended to be a one-stop shop where Americans in 36 states could compare plans offered in their area, determine if they were eligible for federal subsidies to lower their costs, and enroll. The site was meant to help millions of uninsured Americans who don't get health coverage through work or government programs like Medicare.
Unfortunately, healthcare.gov has been plagued with technical problems since its October 1 launch. In addition, several states running their own marketplaces also hit technical snags. Oregon is probably the worst case—the state has yet to sign anyone up online. Officials there are urging consumers to use paper applications, which they can mail or fax. (Yes, you read that correctly: fax. We know that may sound ridiculous, but in Oregon, a fax machine—unlike the website—does work).
So what should you do now?
The Obama administration says "the vast majority of users" will be able to shop and buy coverage on the site by Saturday, November 30, so if you haven't been able to sign up yet, give healthcare.gov another try. You have until December 23 to buy coverage that will take effect January 1, 2014. Even after that, you can continue to sign up until the end of March 2014. Past that date, if you don't sign up and remain uncovered, you'll face the penalty.
Are there any states whose marketplaces are working well?
Yes—those in California, New York, Connecticut, Colorado, Kentucky and Washington state. To find out which website handles your state, go to healthcare.gov and click "buy online.
Can I buy directly from an insurer's website?
You can. But you may not be able to tap into new federal subsidies that help people with incomes below $45,960 a year. In addition, you may miss out on a better plan from a competing insurer.
How can the government force me to buy insurance if I can't afford it?
The individual mandate under the ACA requires most Americans to have health insurance by March 31. But if your income is so low that you don't have to file federal income taxes, or you can claim hardship or if you're a member of a federally recognized Indian tribe, you are exempt from the penalty. If you don't fall into any of the above categories, then you must buy insurance. But keep in mind that almost half of enrollees in the new insurance market are expected to be eligible for federal subsidies to lower their costs, so before you balk, do your comparison shopping, because there should be an affordable plan that works for you—that's what this law is all about.
Can I get my insurance through Medicaid?
If your income is below $16,000 a year, you may qualify for Medicaid next year, and you can enroll for that directly through your state Medicaid office. About half the states are expanding eligibility for that program to every individual who makes up to that figure. But note that income eligibility amounts change based on the size of your household.
So how much exactly is the penalty?
In 2014, the penalty for not signing up for insurance by March 31 will be either $95 or 1 percent of your household income, whichever is greater. Even if you must pay the penalty, the Internal Revenue Service won't send anyone to your house. You would simply owe that sum to the federal government when you pay your taxes in 2015, or the IRS will deduct it from any refund you're entitled to.
Obama said if you like your insurance, you could keep it. So why are insurers canceling millions of existing individual policies?
Insurers say they canceled the policies to meet new requirements of the law that take effect in January–requirements such as enrolling applicants without regard to their health status, capping out-of-pocket spending and covering services such as maternity care. The cancellations affected some of those who buy their coverage directly from an insurer–a subset of the 14 million Americans who buy such policies. To counter the criticism that the President broke his pledge to Americans, the administration recently urged insurers to extend the recently canceled policies until October 2014. But several states, including California, Connecticut, New York, Massachusetts, Minnesota, Vermont and Indiana, are not going along, for fear the change will lead to increased costs. If your insurance was canceled, you should call up your insurance company to ask if they are granting policy extensions or not.
Is it true there have been security lapses with healthcare.gov? How secure is the information I enter?
Despite assurance from Health and Human Services Secretary Kathleen Sebelius, there was a security risk on the site that took a month to fix. The good news is there has been only one report of a user obtaining someone else's account information, and that case was an accident, according to testimony before a U.S. House committee. Federal Health Officials say the site is now secure.
If I'm having trouble on the website, where can I go for help?
You can apply by telephone (800-318-2596) or by mail, though both methods can be cumbersome. Your best bet is contacting a so-called "navigator," paid for by your state or federal government to guide you, or to call a licensed insurance agent trained in the law who can help you compare plans offered by multiple insurers. You'll want to compare plans not just on premiums, but look at copays, deductibles and whether your drugs, hospital and doctor are in the network.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.