En español | The Supreme Court on June 28 gave the Affordable Care Act a mostly clean bill of health. The court upheld the law's constitutionality, keeping provisions already in effect and allowing other measures to phase in as scheduled.
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On a major new expansion of Medicaid, however, the court gave states the right to opt out without jeopardizing their existing Medicaid programs.
Illustration by R. O. Blechman
It wouldn't be easy, but Congress, under prodding from a future president, could change or repeal the law. However, is where things stand now:
How does the law affect my Medicare?
Your guaranteed Medicare benefits are safe, and you can keep your own doctor. Many preventive screenings, including colonoscopies and mammograms, are free. Prescription drugs will cost less as the "doughnut hole," the gap in Medicare Part D coverage, shrinks until it is eliminated in 2020.
Taken together, various measures in the law will save the average Medicare beneficiary $4,181 over 10 years. A beneficiary with high drug costs will save about $16,000.
Some Medicare patients may receive more intensive follow-up care after hospitalization to keep them from being readmitted.
The law changes some payments to doctors, hospitals and other providers. It reduces payments to Medicare Advantage, and some companies offering these plans may charge higher premiums or cut benefits.
High-income beneficiaries will continue to see higher premiums for Medicare Part B and Part D prescription plans.
My employer provides my health coverage. How does the ruling affect me?
If you like your employer's coverage, keep it and do nothing. If you find you can't afford it or you don't like the benefits, in 2014 you'll be able to buy coverage through your state's health insurance exchange, an online marketplace where companies compete for consumers. If you have a low to middle income, you may be eligible for a subsidy to help with the cost. For example, an individual with income of $44,680 now would qualify for a refundable tax credit to purchase insurance on the exchange.
What happens if I don't buy health insurance? Could I go to jail?
Most taxpayers who do not have health insurance by Jan. 1, 2014, will be required to pay a special tax on their returns. If you have Medicare, Medicaid or insurance through your job, you have insurance. Exempt from the tax are people for whom insurance would cost more than 8 percent of their 2014 income and a few other groups. The annual tax in 2014 is the greater of either 1 percent of income or $95. The amount will increase annually in later years. Jail? No, there is no criminal enforcement. But you could lose all or part of a tax refund.
Next: Will you be able to get health care through Medicaid?
Will I be able to get health care through Medicaid?
It depends. The nation's health program for low-income people is a joint federal-state program, with states setting the eligibility rules. The Affordable Care Act called for every state to expand Medicaid to low-income adults under 65 starting in 2014. An individual with income up to $15,415 and a family of three with $26,344 in 2012 would meet income guidelines. The law was expected to bring 16 million uninsured into Medicaid. But the Supreme Court ruled that states may opt out of the expansion. About a dozen governors have said they won't expand Medicaid or are weighing that course of action. Check with your state Medicaid office.
I'm uninsured and don't qualify for Medicare or Medicaid. How can I get health insurance?
Starting in 2014, you'll be able to shop for insurance on your state's health insurance exchange. Even if your income is too high for Medicaid, you may be eligible for a refundable tax credit to help pay the premiums.
How will provisions coming in the next few years affect me?
In 2014, you'll be able to find insurance through a health insurance exchange in your state. Even members of Congress will get their health insurance on the exchanges. If states fail to set up exchanges, the federal government will step in.
If you're one of the 129 million Americans with a preexisting condition, you no longer will be charged more, be denied benefits or be denied coverage. Insurance companies won't be able to charge women higher premiums than men.
Starting in 2013, Medicare payments will be reduced to hospitals that have too many patient readmissions within 30 days. Patients may get more home attention, including visits from a social worker or coach, telephone calls or electronic monitoring devices to check their progress.
You or your employer may get an insurance rebate. The law requires insurance companies to devote more of the money they receive for premiums to patient care — or send consumers rebates. About $1.1 billion in refunds is expected to be returned to millions of consumers this year. Rebates will average $151 per eligible family.
If you're a high-wage taxpayer who makes over $200,000 as an individual, or $250,000 for a couple, you'll have to pay higher Medicare hospital insurance taxes on income and earnings.
Marsha Mercer is an independent journalist.
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