I’m putting this in GQ because I want factual answers and not political opinions of any stripe. If it should be moved, I won’t be offended.
But as many of you know, the wife and I plan to move back to the US in a few months after 22 years living in and around Bangkok. I’ve been exempt from the Patient Protection and Affordable Care Act due to my overseas status. While I have carried health insurance over here, having left my office this week I am now without that, and the wife having retired from her government job I’m now off her policy too. (Spouses can be included under their other halves’ government plans only while the other half is actively employed by the government.) I am still covered by Thailand’s meager Social Security system and can fall back on that in case of emergency, and that will have to do until I get to the US.
So what do I need to know as a complete newbie? I already know I will be required to carry health insurance. I think there’s some sort of website I need to sign up on. Assuming I have to pay for my own policy once I get to the US and won’t have an employee plan, at least not for a while, what would I need to do after I step off the plane?
First, so long as your residence is overseas you continue to be exempt from the mandatory coverage requirements of the PPACA. You can claim that exemption on a month-by-month basis, and is sorted out on your tax form 8965.
Assuming you are under age 65 you probably will not be eligible for Medicare yet. You will then need to obtain qualifying coverage through an employer or self-purchased plan or else pay a tax penalty. Sounds like you will need to self pay, at least for a little while, assuming you want to avoid the penalty.
Once you establish a US residence, your next step depends a bit on which state you move to. Assuming you want to take advantage of any subsidy you are eligible for you will either use the Federal Exchange website or the website for the individual state exchange to shop for an insurance plan. Enter your details, see what comes up and what subsidy you are eligible for. Make arrangements to start paying your premiums and you are set.
Moving from overseas back to the US is a qualifying factor that earns you a special enrollment period. So even though there is no open enrollment for everyone, you can still choose a plan.
Nitpick: The ACA is not Obamacare. Obamacare included a public option, an insurance system run by the government, which would compete against the private insurance companies on the marketplace. The ACA as passed did not include that.
[Aside] Once y’all get back and get settled, I think I speak for many Dopers when I say WELCOME!! and also, would you start a thread on changes you’ve observed for good and ill, your expectations (met and not met), just in general, what the resettling process is like…I’d really like to hear all about that. And you are such a damned articulate devil, I know it will be interesting. Geez, maybe you need your own forum.
It’s going to vary depending on the state you reside in. The ACA sets the requirements. The states have say in how it’s implemented. Most states have a website aggregate individuals can buy health insurance through. If you are eligible for any type of subsidy going through one of those portals may be preferred. I’m not and have not found MA’s ‘Health Connector’ to provide better pricing than I can get buying direct.
I was unaware that ACA and Obamacare were not synonymous. Thought the latter was just slang for the former. So do both exist?
We don’t expect to suffer much culture shock. I find that overrated. I suffered none the first time I moved back to the US in 1990. And we’ve spent weeks at a time in the US over these past couple of decades and really didn’t feel anything like Culture Shock. The longest period was by the wife, who spent the summer of 1996 attending a workshop at the U of Michigan. The last time we were stateside was April 2012, visiting the East Coast.
I should have emphasized one more point. You MUST use the official exchange website in order to get a subsidy on a self-purchased plan. If you buy outside of that exchange then no subsidy for you.
If you find that you do not qualify for a subsidy (too high income) then you can still shop through the exchange website or buy a policy outside of the exchange. So long as it meets the requirements for qualifying coverage then you will not have to pay the tax penalty.