Who needs health insurance? How does that work, anyway?

Do you have a friend who works at a small business that doesn’t offer health insurance and has a family history of heart disease? Or is your cousin a self-employed carpenter who can’t afford insurance who had leukemia as a kid? Bet they worry about an accident or illness and the bills that will bring.

Obamacare is coming but most people don’t know how the new system works.

You can make a difference by educating yourself and others.

Two elements are key for people buying insurance for themselves and their families.

First, cost will vary by income. Most working families without insurance will get financial aid.

CNN reports that nearly 26 million Americans qualify for a discount and “most of those who will be able to claim the subsidies are in working families with annual earnings between $47,100 and $94,200.”

Second, starting Oct. 1, every state will open a website listing insurance available to people who don’t have it through their employer, Medicaid, Medicare, or Tricare. Through this website for the insurance marketplace or exchange, people can pick the insurance they’ll have next year.

Each company will offer three levels of insurance — the gold, silver and bronze levels — with different degrees of coverage. People under 30 can get catastrophic coverage, which covers the least and costs the least. Everyone should get insurance. If not, there is a fine applied to one’s federal income tax (although people who truly cannot afford insurance are exempt).

To find out the cost, people enter information about the size of their family and their income. They also have to say how many adults and children are in the family and how many smoke. In Maine, due to a law passed when Republicans controlled the Legislature, those in rural areas are charged more. Pre-existing conditions don’t add to the cost.

You can get an idea of how much insurance will cost by using a calculator created by the Henry J. Kaiser Foundation.

Go ahead and Google “subsidy calculator.” When I did it, the Kaiser calculator was my top result. If that doesn’t work for you, Google something else like “Kaiser health insurance calculator.”

I tried it for a family of four with the median household income in Maine, $47,898. If this family buys the silver plan, they would pay $3,074 a year. The bronze plan would cost $1,385.

Another family, a single non-smoking mother or father with one child and a $25,000 annual income, could pay $1,729 annually for the silver health insurance. The bronze plan would cost this family just $284 a year.

Make sure you tell people that they can’t wait to buy insurance when they get sick. They can only buy insurance on the exchange during the open enrollment period (except for a special reason like having lost one’s job or moving to a new state). For 2014, open enrollment runs from October 2013 through March 2014. In the coming years, people will pick an insurance plan during two months in the fall.

Groups financed by billionaires David and Charles Koch plan to actively discourage young adults from getting insurance. But those young people are one accident or tragic illness away from financial disaster. And when that happens to some of them, the Kochs won’t step in to pay their medical bills and prevent them from going bankrupt.

Telling other people about their insurance options is critical. Because Gov. Paul LePage decided against Maine running its own exchange, the state has less money to explain the program. (Nor has LePage supported expanding Medicaid expansion, which would cover 70,000 low-income, working Mainers; many of them actually make too little to get subsidies.)

While research shows many don’t know about the financial aid for buying insurance, big majorities in every age group want health coverage. As the Kaiser Foundation reports, only 11 percent of the uninsured say they don’t have insurance because they don’t need it.  Eighty-eight percent agree that “insurance is something I need.” “Among those ages 30 and younger, roughly two-thirds say they are worried about ‘not being able to pay medical bills in the event of a serious illness or accident.’”

Check out the Health Care Reform website by WebMD and the AARP‘s Health Law Facts. They have clear explanations for many different kinds of families.

Who’s going to tell people about health insurance? You.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives.