© 2017 Kaiser Permanente of Georgia
Health Care Reform


1. What is Health Care Reform?
Health Care Reform refers to the Affordable Care Act (ACA). This is the federal law that was passed in March 2010, as well as any state laws passed to put it in place. These laws were put in place to help more people get affordable health care coverage and receive better medical care.

2. Who has to buy health insurance?
The Affordable Care Act requires most U.S. citizens and legal residents to have a basic level of health coverage starting January 1, 2014. Some people will not have to buy insurance. This includes people with certain religious beliefs, members of Native American tribes, undocumented immigrants, and people who are in prison. People who have income below the threshold for filing income tax ($10,000 for individual or $20,000 for family in 2013) or where the cost of insurance exceeds a certain percentage of their income also wonít have to buy insurance.

3. What is the Health Insurance Marketplace?
In Georgia, the Marketplace, sometimes called "Exchange", is an internet website run by the federal government where U.S. citizens and people lawfully present in the U.S. can buy health care coverage. You can compare and choose health plans, get answers to questions, and find out if you are eligible for Federal financial assistance or special programs. The Marketplace will re-open November 1, 2017.

4. What if I donít buy health care coverage?
If you are required to buy coverage and donít or if you go without it for three months or longer, youíll have to pay a tax penalty. If you lack coverage for a period of fewer than three months, you will not incur a penalty for that period of time.

5. Can anyone get health care coverage?
Yes, because insurance companies can no longer deny coverage to anyone who has a medical condition and you donít have to pass a medical exam to qualify for coverage. Some people (undocumented) may not be able to buy insurance in the Marketplace. However, they will be able to purchase directly from Kaiser Permanente.

6. What if I can't afford to pay for health care and don't qualify for an exemption from the requirement to buy insurance?
The federal government may provide financial assistance in the form of reduced premiums and reduced out-of-pocket expenses also known as subsidies to help some people pay for health coverage or care if they can't afford it themselves. This is usually determined by a person's income level and family size. You will be able to find out if you qualify for reduced premiums and reduced cost-sharing when the Georgia Marketplace opens in November. But here are some general income guidelines that might be used by the government to see if you qualify and how much help you would receive.

  • If youíre single, the range of income qualifying for assistance could be $11,880 and $47,520.
  • For couples, the range of combined income qualifying for assistance could be between $16,020 and $64,080.
  • For a family of four, the range of combined income qualifying for assistance could be between $24,300 and $97,200.

7. When is the next open enrollment period?
Under the ACA, you can select your new health plan during the open enrollment period beginning November 1, 2016, through January 31, 2017. If you do not select a new health plan during this time, you will have to wait until the next annual enrollment period, unless you qualify for a special enrollment period or a limited open enrollment period in 2017.