Obamacare 101: What happens starting Oct. 1?

Next Tuesday, Oct. 1, is a red-letter day for President Obama’s signature policy, the Affordable Care Act. That’s the day the online marketplaces, or “exchanges,” open for business.

Most of the 48 million people in the United States who lack health insurance will be able to buy coverage through their state’s exchange or get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP), depending on household income. By law, Americans must have health insurance beginning Jan. 1, 2014, or pay a penalty.

Here are answers to some basic questions about the Oct. 1 rollout.

What exactly happens on Oct. 1?

Each state’s health insurance exchange goes “live” on the Web Oct. 1. That means people can start signing up for coverage by filling out a form that will ask questions about family size, age of family members, and household income.

What if the government shuts down on Oct. 1?

An impasse in Congress could lead to a lapse in federal government funding beginning Oct. 1, the first day of the 2014 fiscal year. But Mr. Obama said Sept. 27 that the exchanges will open on time, “no matter what.” The Affordable Care Act (ACA) is funded mostly through multiyear and mandatory spending, so it is largely shielded from the slings and arrows of the annual budget process.

“On Tuesday, about 40 million more Americans will be able to finally buy quality affordable health care, just like anybody else,” Obama said. “Those marketplaces will be open for business on Tuesday, no matter what, even if there's a government shutdown. That's a done deal.”

What can someone do in advance to get ready?

Healthcare.gov, a website run by the Department of Health and Human Services (HHS), is already up and running. Someone with access to the Web can visit that site and get information that will provide guidance about where to get coverage. Plan and cost information will be posted on Oct. 1.

The nonprofit Kaiser Family Foundation also has an interactive program, called the Health Insurance Subsidy Calculator, which can give someone an idea of what to expect on their state’s exchange. The program asks about state of residence, family size, household income, age, and tobacco use, and provides an estimated annual cost for the different levels of coverage.

What if someone doesn’t have access to the Web?

Anyone can call HHS’s toll-free number to reach a customer service representative 24/7. The number is 1-800-318-2596.

When does the coverage go into effect?

Coverage goes into effect Jan. 1, 2014. But the open enrollment period run for six months, Oct. 1, 2013, through March 31, 2014.

What if someone discovers now that they’re qualified for Medicaid?

Someone who learns that they or their family now qualify for coverage under government low-income programs – either Medicaid or CHIP – can enroll immediately.

The ACA provides for the expansion of Medicaid by raising the income limits for eligibility, but expansion does not go into effect until Jan. 1. The US Supreme Court ruled in June 2012 that states could opt out of Medicaid expansion if they want; so far, 26 states have decided to expand eligibility for Medicaid, owing to the generous federal subsidies.  

Could Oct. 1, the first day of enrollment on the health insurance exchanges, be chaotic?

There has been a lot of media coverage focused on problems and delays in implementing the law. In July, the Obama administration announced a one-year delay of the mandate for large employers to cover their workers. And on Sept. 26, the administration announced that online enrollment in the marketplace for small businesses (fewer than 50 employees) will be delayed until Nov. 1.

But Obama administration officials maintain that they’re ready for online enrollment for individuals and families to begin Oct. 1. Still, don’t expect a flood of enrollments right when the bell rings.

“October will be light for enrollment,” says David Simas, deputy senior adviser for communications at the White House. “November will be a little bit better. December, as people know [they] can now sign up and get coverage in a few weeks, will be better.”

Mr. Simas expects a dropoff in enrollment in January and February, with another increase in March right before the enrollment period ends.

What about immigrants?

People in the country illegally are not eligible to enroll in coverage via the exchanges. Legal immigrants, including people with green cards, are eligible. But they cannot enroll in Medicaid until they have been in the US for five years.

Also in the Obamacare 101 series:

• What to know if you already have health insurance

• How the federal subsidy works

• What to know if you opt out of buying health insurance

• What owners of small businesses need to know

• When will the enrollment glitches be fixed?

• What college students need to know

• Seven ways you can sign up, despite Web woes

• Enroll by March 31 to avoid penalty, White House clarifies