Questions and answers on the mandate

Who is affected by the mandate and will have to get health insurance?

Anyone not insured through an employer, Medicare, Medicaid or the Children's Health Insurance Program, TRICARE (for service members, retirees, and their families), the veterans health program, privately purchased insurance or a health plan grandfathered before the law was enacted.

Are any other people exempted?

Anyone in a religion opposed to benefits from a health insurance policy; undocumented immigrants; prisoners, Indian tribe members; those with incomes below the tax-filing threshold ($9,350 for individuals, $18,700 for families in 2010); if you would have to pay more than 8 percent of your income for health insurance after taking into account any employer contributions or tax credits.

How many uninsured people might now get insurance?

In New York, 2.7 million -- 275,000 of them on Long Island -- are uninsured. The state expects about 1 million people, 600,000 as individuals and 400,000 through small-business owners, to enroll in the soon-to-be established insurance exchange.

What are the penalties if I choose not to get insurance?

In 2014, when insurance exchanges are set to begin, the penalty is $95 per adult and $47.50 per child, up to $285 for a family, or 1 percent of family income, whichever is greater. In 2015, the penalty rises to $325 per adult and $162.50 per child, up to $975 for a family, or 2 percent of family income, whichever is greater. By 2016 and after, the penalty is $695 per adult and $347.50 per child, up to $2,085 for a family, or 2.5 percent of family income, whichever is greater.

How will I get insurance if I don't already have it?

On April 12, Gov. Andrew M. Cuomo issued an executive order to establish a statewide health insurance exchange. The exchange will let individuals and small businesses comparison shop. By 2014, if your employer doesn't offer insurance or you don't already have it, you will be able to buy it from the insurance exchange.

How will the exchange work?

The exchange will offer four levels of insurance at prices below those available on the open market. Consumers will be able to choose from plans that will cover as little as 60 percent and as much as 90 percent of their medical costs. People who use the exchange can go to a website, use a toll-free number or go to designated offices to choose their insurance options.

Will I save money?

The average premium for an individual who gets coverage directly from the exchange, not through an employer, is expected to drop by about 70 percent. For example, a family of three earning $24,352 to $27,465 annually will have a maximum annual premium cost of $730 to $1,098 and a maximum annual co-pay/deductible of $3,867. Those making from $54,930 to $73,240 will pay premiums of $4,421 to $6,957 a year, with a $7,733 deductible.

What if I can't afford a health plan?

Medicaid, the government health insurance for those with low income and the disabled, is being expanded beginning in 2014. Adults will be eligible if their annual incomes don't exceed about $14,000 for individuals and $29,000 for a family of four.

What if I don't qualify for Medicaid but still can't afford a plan?

You could be eligible for a government subsidy in 2014. Subsidies would be available for individuals with incomes up to about $43,000 and $88,000 for a family of four.

I have a small business. Do I have to offer insurance?

If you have fewer than 50 employees, you face no penalties if you do not offer insurance. Until 2013, employers with fewer than 25 employees and average annual wages of less than $50,000 who offer health insurance coverage to their workers can get a tax credit up to 35 percent of the cost of the premiums. That will reach 50 percent by 2014. The average single premium for small businesses purchasing through the exchange is expected to be about 21 percent lower than the average single premium in the current small-employer market, excluding Healthy New York.

What about businesses with 50 or more employees?

By 2014, those businesses that don't offer coverage to their employees will have to pay an assessment for employees who get their insurance through an exchange.

Sources: healthcare.gov; healthcare-

reform.ny.gov; New York State Department of Health; New York State Department of Financial Services; Kaiser Family Foundation