Next year will see some of the biggest changes to the health-care system brought about by the Affordable Care Act, passed in 2010. Other reforms have already rolled out, but nothing like what will happen in 2014.

Starting Tuesday, you can start shopping for health coverage on new insurance "marketplaces." Some people will be able to qualify for tax credits to help afford a policy, which must follow a new set of standards. No one can be turned away because they're sick, and insurers can't cap the amount they will pay out. You will be penalized if you don't have insurance.

John Ueland

What will the new health-care exchanges cost you? In many cases, more than you think. WSJ health policy reporter Louise Radnofsky explains. Photo: Getty.

Even for Americans with stable coverage, the law boosts benefits so everyone gets things like free preventive coverage.

"People don't always understand how the law can protect them in good ways," says Rebecca Burkholder, vice president of health policy at the National Consumers League, a consumer-advocacy organization. "It's not just for the underinsured—there are a lot of great opportunities for everyone."

Here's our brief rundown—what you need to know about the new health-care law:

If You Need Insurance

First, determine whether you need to buy a new policy.

The federal government website,, is the best place to start. Spanish-language information is available at If you have coverage through your job that you are happy with, or coverage you bought on your own before the law passed on March 23, 2010, you don't need to worry about a lot of this.

The marketplaces sell plans through March 31. Loss of minimum essential coverage qualifies as an event that would allow you to enroll outside of this window.

If you want your insurance to start by Jan. 1, 2014, you need to buy it by Dec. 15, 2013, says Karen Pollitz, senior fellow at the Kaiser Family Foundation, a health-care policy organization.

The Health Law Rollout

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Insurance sold on the marketplaces comes in four levels: platinum, gold, silver and bronze.

What differs among them is largely the premium, or the cost per month, and the cost-sharing—or how much you will pay in things like deductibles and copays. On average, bronze plans will pay about 60% of medical costs, silver covers 70%, gold covers 80% and platinum covers 90%.

What doesn't differ are the basics that a plan must cover. Even the bronze options have to cover "essential benefits" including hospitalization, labs, prevention and maternity.

Call your providers to make sure they are in the network of the plan you are considering. Also look into whether the medicines you take are on the plan's drug formulary.

Tax Credits

You might qualify for help with your health-insurance payments through the marketplace, in the form of a "tax credit" paid out in advance to help with premium costs.

In general, for a family of four, you will likely qualify if you earn between $23,550 and $94,200 a year. The lower your income on this range, the more you will likely save in insurance costs.

Folks on the lower side of that income spread might be able to get help with costs such as deductibles. This affects families of four earning up to $58,875.

When you apply, you may need to have your Social Security number, W-2 forms, policy numbers for current health insurance and information about job-related coverage.

You can get help paying your premium only if you purchase coverage on the marketplace.

If You Need Help has a live-chat feature. There is a call center open 24 hours a day at 1-800-318-2596. The service offers personalized assistance with things like plan selection in more than 150 languages.

You can also get in-person assistance. "Navigators" can help you prepare your application and determine your eligibility for tax credits.

Insurance agents are another resource. You or the insurer might have to pay the agent, who is allowed to steer you toward particular products, says Ms. Pollitz.

Another option is to go to a local health center—they've received $150 million in grants to help enroll people.

The Fine

If you don't have insurance by Jan. 1, you might face a fine. In 2014, it's 1% of annual income, or $95, whichever is higher. The fine goes up each year.

You might be exempt if you've been uninsured for less than three months of the year, have an income too low to file a tax return or are a member of an Indian tribe.


Private insurance isn't your only option. You can also look into whether you qualify for Medicaid, the health-care program for low-income Americans, which has been broadened in many states.

The law expanded Medicaid eligibility to Americans below 133% of the federal poverty level, which is about $31,000 for a family of four in 2013. To see where your family might fall on this scale, look at and

If you are in a state that didn't expand Medicaid, but your income would have qualified you for coverage under the new rules, you are exempt from the fine. Also, regardless of where you live, families with children will no longer face an asset test, and income requirements are now simpler, so look into it even if your state didn't expand, suggests Cheryl Fish-Parcham, director of health policy at Families USA, a health-care policy group.


Insurers can no longer rescind, or take away, your coverage for arbitrary reasons. They cannot deny you coverage if you have a medical condition that predated your application.

Insurers can't place yearly or lifetime limits on what they will spend paying for your essential health benefits.

Kids and Women

Some new protections apply specifically to women and children.

Dental and vision coverage for kids are required in the marketplaces.

Insurers can no longer charge higher prices for women. All marketplace plans cover pregnancy and childbirth. Breast-feeding support is also covered, including breast pumps and counseling for new moms.

Even if you don't qualify for Medicaid, investigate public programs on behalf of your kids, says Ms. Fish-Parcham. Look at


Small businesses with fewer than 50 full-time equivalent employees don't have to do anything differently in 2014. If they offer coverage, they can continue doing so. If they don't offer coverage, they don't have to.

They will have the opportunity to purchase insurance through new marketplaces designed for them, known as the SHOP system. All of the policies sold there need to cover the essential benefits. Insurers can't charge a small business more if it employs women or if its workers have high medical bills.

Small businesses with fewer than 25 employees could qualify for a tax credit to help pay for insurance. Large employers, on the other hand, might have to pay a fee if they don't offer coverage, but not until 2015.


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