Neither my husband nor I receive health insurance through an employer and have had an individual plan for years. His employer covers the cost of the plan. Will we still be eligible to buy our individual plan on the exchange? If we don't/can't buy on the exchange, will insurance companies still be allowed to deny coverage for pre-existing conditions or charge more for health reasons for individual plans not purchased on the exchange?
Hi there - I'll start with the last question, which is the easiest one to answer: No, insurance companies will not be allowed to deny coverage for a pre-existing condition, or charge more due to health conditions, beginning on Jan. 1, 2014.
As to your first question, yes, you should be eligible to buy health insurance on the new marketplace. Because its you and your husband buying health coverage - even though you're using money from an employer - that should still mean that you can use the new marketplaces, which open for enrollment on October 1.
If I lose my job (and with it my health plan) after the open enrollment period ends, will I be able to get a new plan right away in the exchanges? Or is there a coverage gap until the next open enrollment period begins?
Yes, if you lose your job outside of open enrollment, you will be able to get a plan right away in the exchanges. While there is indeed an open enrollment period (this year, from October 1 to March 31), the health care law allows people who have certain life-changing events to sign up outside of that period. Losing a job, along with moving to a new state or having a baby, count as those life-changing events.
Yesterday (September 24), Julie Appleby made the statement that people who are enrolled in Medicare don't have to do anything differently this year. Why the qualification "this year"? Does this mean that we will have to do something differently in the coming years?
No, there is nothing that Medicare enrollees will have to do differently in any years going forward, as a result of Obamacare. Julie, I think, was trying to clear up some confusion about how the health care law effects Medicare beneficiaries.
The bottom line: Medicare enrollment will work the same way as it did last year, in this upcoming year, and the years after that.
Can Americans living abroad participate and where can we find options?
Americans who live abroad are generally discouraged from purchasing a plan under Obamacare for two reasons. First, the health insurance you buy on the exchanges is unlikely to have coverage options outside the United States, so it won't help much with seeing a doctor. Second, the individual mandate does not apply to Americans living abroad. For more on this issue, check out this story I wrote about it.
Can I look at what's available on the exchanges by giving only my date of birth and state of residence, or do I have to give my full name and address?
Yes, the exchanges run by the state and federal government will allow people to shop for plans on the exchange without answering too many questions beyond, age and county of residence. But to determine whether you qualify for federal subsidies, you will have to include your income information or an estimate of your income in 2014. Here's a link to pricing information in about 26 states.
What if you are on Medicaid, in a state that did not expand Medicaid?
If you are in one of states not expanding Medicaid, you won't have the benefit of the law which expanded coverage of program to everyone under 138% of poverty rate or about $15,800 for an individual. States can still expand in future years. You are not eligible for subsidies in the exchange until your income is at the federal povery rate of $11,500
Is it true that the only way that the individual mandate penalty is collected is from any income tax refund the person otherwise would receive; i.e., no refund, no penalty? If so, why does all the commentary fail to point this out and instead claim everyone must be insured or pay a penalty?
I would say this is half-true: For people who do not buy health insurance coverage, the federal government will deduct the tax penalty from a refund. If you don't have a refund, the Internal Revenue Service will send you a bill for that same amount, much like they do for any other taxes you owe.
The thing that will be different about this fine, though, is there's not much the federal government can do after sending you this bill. They cannot garnish your wages for example, or put a lien on your house. The tax penalty will, however, remain on your IRS bill in subsequent years. You can read more about the issue here.
Why is there no discussion about improving health outcomes? Coverage without care is like having car insurance but no car. What will happen when people agree to pay for healthcare but do not get the medical, oral, rehab, or mental health services needed to be well?
Your're right. Having health insurance plays an important role in health but its only one factor. Nutrition, exercise, stress, access to doctors also play an important role. The Affordable Care Act is spending billions of dollars to try to find new ways to improve the delvery of health care so doctors and hospitals work better together. CMS has set up a innovation center.
The law requires all health plans to include 10 essential health benefits which does include medical care, rehab and mental health services and dental care to chlidren. But dental coverage for adults is not one of them.
My son is 26 and working in California, no employer health coverage. We are Canadian and were horrified he might not have insurance so we have been paying for catastrophic insurance only thru Blue cross/Blue shield. He has been told by them that his access to services will be limited if he buys into the exchanges but he currently has no well care and he would under the other plan. How does he find out exactly how limited is options will become? Can he switch back at anytime?
Hi there - the best place to research this will be California's insurance marketplace, Covered California. It has published information on the different health plans that will be available in different parts of the state, which you can see here.
There are options that tend to have wider coverage, but they also come with higher premiums, so there's a trade off you'll have to think about between price and access.
The only time your son will be able to switch plans will be during the open enrollment process, which runs this year from October 1 through March 31.
I've heard a rumor that even folks who work in DC and who currently have employer sponsored insurance will be required to participate in the exchange. Is this true? What will we have to do? (I am very happy with my insurance, have had it for a few years and don't want anything to change!)
For most people, this is not true: Residents of the District who get their insurance through a large employer right now, will continue to use that health insurance in 2014.
The one change that will happen next year effects small businesses. The District of Columbia has decided that beginning next year, all small businesses buying health insurance for the first time will need to use the health exchange. Companies that already have insurance can wait until 2015. You can read more about this issue in this article from my colleague, Lena Sun.
I made little this year as I just graduated. I am 26. Can I buy on the exchange even though my income is 100 percent poverty or am I required to get Medicaid? My income will be more than 100 percent poverty for 2014. I live in California.
If you fall under 138 percent federal poverty level (FPL) you will qualify for Medicaid..which generally is the best deal because has the least out of pocket costs. One caveat is you may have more trouble finding specialists compared to private coverage..
When you go to Covered Calif web site you will be directed to a plan based on the income you list.
I think I have needed to visit the doctor about five times in the past 10 years. With insurance premiums around $400/month or close to $5,000/year, I paid more than $50,000 in 10 years. That means each of those visits to the doctor cost $10,000. How is a 10 minute visit to the doctor to say, yes, you have a chest infection, bring this to the pharmacy possibly worth that much money? I can't help but think I could have spent the money better myself instead of paying so much for insurance that I didn't need or use.
My rabbi did his sermon this year with the theme of you never know when you are going to die and which day is your last. Same goes for your health. You can be totally healthy one day and sick with pneumonia the next. Health care is incredibly expensive in this country. A one hour trip to the ER can cost $5,000 if you need surgery it could be $30,000 or more. You buy health insurance so you don't go broke and bankrupt yourself and your family if that should occur. $50,000 over ten years is a lot of money--- but
if you need bypass surgery, cancer, MS or host of other diseases you would have needed much more than that. I would advise checking out the new insurance exchanges to see ifyou can find a better price.
If my employer doesn't offer affordable coverage - and I don't get insurance in my state's exchange - do I still have to pay the fine?
Generally the answer is yes: If you don't buy health insurance in 2014, you will likely face a tax penalty ($95 or 1 percent of your income, whichever is higher).
There is one exception to this: If you cannot find a health insurance plan that is affordable, the federal government will not require you to purchase a plan. The federal governmetn defines "affordable" as something that costs less than 9.5 percent of your income.
I currently have insurance through COBRA, which will expire on Jan. 31, 2014. How and when do I shop for insurance? I am single, living in Virginia, working as a contractor and not eligible for subsidy.
Am I better off in the marketplace or private insurance? How do I answer the standard question regarding my current insurance situation (I don't have private insurance and I don't have insurance through my employer)?
You could start shopping for health insurance right now, if you want, in the individual market. Beginning October 1 though, you'll also be able to shop for coverage on the new exchanges. You can access Virginia's health exchange at www.healthcare.gov.
When that website goes live on October 1, you will be able to see what health insurance costs for you (the federal governmetn did give us a bit of a preview in a new report today). Then it'll be your decision whether you'd rather buy inside the marketplace or outside of it.
The fine / tax is MUCH less than the cost of minimal health insurance so why would I want to participate
Talk to a parent or a friend who has been sick or in an accident and asked them how much it cost to get health care. While on the surface it may appear paying a $95 fine in the first year is the better deal--- if you get hit by a car or develop a health problem, you'll be regretting your decicion. Check out some of the low prices on the exchange, particularly the catastrophic option which would be the lowest monthly premium--these are desigend for people who are in their 20s and don't expect any health issues but want to be covered in case the unexpected happens.
Just a note to say thank you for these various Q & As about the practical side of all this. There are many very common scenarios (eg, leaving a job, getting married, specifics about spouse's coverage) that don't seem to come up in general articles and even the websites. Bottom line: reducing uncertainty is helpful. Thank you.
I am a federal employee and my son is on my policy. He will turn 26 in May and be released from my policy, which is after the open enrollment season. Should he get his own policy during open season or can he wait until he goes off my policy?
Federal rules allow for certain people an exemption from the open enrollment period, if they have a life-changing event. Losing one's health insurance coverage counts as one of those special events, which means that your son would be able to enroll in coverage outside of the normal enrollment period.
Is HHS trying to stop state obstruction of navigators? I have an idea on how to stop it. Who should I contact?
Health and Human Services has taken some steps to protect the navigator program, which is currently under investigation in the House of Representatives. It sent a letter to House Republicans, on behalf of the navigator organizations, so they wouldn't have to each respond individually. Still, a few have decided to drop out of the program. You can read more on where things are on this issue here.
I know that there's no chance that you will bother to respond to this comment, but I would like to ask Phil Galewitz what the CHANCES are that young man whose five doctors' visits cost $10,000 each will get a terminal disease like cancer or MS or need emergency surgery that would possibly bankrupt him?
The fact is that they are quite low, and it DOES make sense to allow reasonably healthy young people to save their money rather than force them to buy policies that are very likely not to need. Any statistician will tell you have to have take into account the likelihood that a bad event will occur before you know its true cost. ACA simply ignores that reality.
The reality is no one is guaranteed health forever. And reality is most people need to see health providers to stay healthy or at least monitor their health. That's why we buy insurance. We all wish we could avoid buy property insurance until after the hurricane or storm hits but that's not how insurance works.
Can a U.S. citizen sign up his whole family (spouse and dependent children (citizens)) if one of those members (spouse) is here undocumented?
Undocumented citizens are barred from Medicaid and from buying coverage on the exchange. But that should not preclude the rest of the household from participating. The National Immigration Law Center is a great resource on immigration questions
My organization is working on "navigating" folks through the system. One thing we have been hearing is that it will be cheaper for businesses to just pay the penalty/fine and not insure folks...how can I address this notion? This seems unethical to me, but some insurance folks and others are advising the small businesses to do this.
This is generally true: Since the tax penalty for not purchasing coverage is $95, it will typically be chaper to pay the fine than purchase a health insurance policy. For this reason, some people are worried that the individual mandate is not strong enough to convince people to sign up.
On the flip side, if someone does not purchase health insurance during the open enrollment period, they will have to foot the bill for any health care costs, big or small, they incur in the next year. I think the decision that a lot of people will need to make is whether they see value in purchasing a health insurance policy. When they pay the individaul mandate fine, they don't get anything - but when they purchase coverage, they actually get something in return.
What is the role of the Equifax Workforce Solutions specialty consumer reporting agency in obtaining subsidized health insurance coverage from a federally-operated exchange?
Page 3 of the basic application released by HHS says "We need [your income] information to check your eligibility for help paying for health coverage if you choose to apply. We'll check your answers using information in our electronic databases and databases from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security, and/or a consumer reporting agency. If the information doesn't match, we may ask you to send us proof.
Should I request a copy of my Equifax Workforce Solutions report prior to applying for subsidized insurance coverage?
No need to get your credit report for obtaining coverage. But the federal government is paying Equifax to collect annual income information on consumers so they have another resource to check people's eligibility for subsidies. This may be helpful for people who don't pay taxes and thus the IRS does not have their most recent income information. The subsidies are based on your estimated income for 2014 not your current income but if your estimate if way off compared to your latest data the federal government databased, the exchange will likely ask you for more information to back up your claim. Remember, if your income estimate later turns out to be too low (and you get a bigger subsidy than you should have been entitled) you will have to pay money back.
Love your replies, but could you revisit as to what people on COBRA must or can do? Do they have to wait until the end of their COBRA or can they end it at any time and go to an exchange policy?
Sure thing - this article from Michelle Andrews at Kaiser Health News has a good take on the COBRA issue, as does this one from Jay Hancock. In general, people who don't have an affordable offer of health insurance (anything that costs more than 9.5 percent of their income) are welcome to shop on the exchange. So if COBRA premiums are above that price, then you would not need to wait until your COBRA runs out to shop on the marketplace.
If I drop my individual health plan and go barebacked for three months at end of year will this affect my choices in marketplace? I could save almost $3000!
No, dropping coverage will not effect your plan choice in future open enrollment periods. Insurance plans are only allowed to use a few factors to determine your premium, such as your age and where you live. Whether you've had continuous coverage is not among them.
I live in a state that is not expanding Medicaid. My sister who has no income helps take care of my mother. Knowing that she won't qualify for any subsidies, can she still purchase a plan from the exchanges or open market by paying the full premium? Family is willing to help with this cost.
Yes, as long as she is a legal resident of the United States, she should be able to purchase coverage on the marketplace. As you mention though, without the Medicaid expansion, she will need to pay the full price of the premium without any subsidy.
1. In the wake of the DC shootings, many have argued for better mental health care...doesn't the ACA provide for the largest expansion of mental health care that we have had in decades? 2. Many are complaining that the rates now revealed for ACA actually increase their rates. But, won't many qualify for subsidies?
Yes, the ACA requires individually sold policies to include mental health services including many services not covered today. Some mental health preventive services like depression screening now must be offered for free. Read more here from National Alliance on Mental Illness and The White House.
If my state decides to expand Medicaid later in 2014, and I qualify (eg, I earn less than 138 percent of the federal policy level (FPL)), will I have to give up the private, subsidized plan I enrolled in and switch to Medicaid?
If you have private coverage, you are never required to sign up for Medicaid. But you may find Medicaid a better deal, depending on how much your employer makes you pay for coverage at work.
My retiree contract has retiree heath insurance for my son who is 23 until he is 26. Both my husband and I are covered under this plan until I am Medicare age. Can my son stay on my retiree health plan as before? At 26, when he comes off my plan, what does he need to do? Is there a specific time of the year that he needs to get insurance at 26?
When your son ages off your plan, he will need to purchase health insurance coverage, either on his own or through an employer, or pay a tax penalty to the federal government.
He can do this whenever his coverage under your plan ends. While there are certain open enrollment periods, people who lose their insurance coverage get an exemption: They can purchase a new plan whenever their old insurance coverage expires.
Our small town Pennsylvania government is currently looking at health plans for our staff of less than 50 employees. Are the exchanges available for enrollment of our employees? If yes, is that a viable option that we should consider in addition to private insurers?
We want to maintain good insurance coverage for our staff, but increasing costs are eating away at available tax dollars. As I understand it, Pennsylvania has not set up its own exchanges.
Yes, the health law's small business marketplace is open to businesses businesses with 50 or fewer employees. So that would be one option that you could begin researching on October 1, when the new marketplaces open for enrollment.
You're right that Pennsylvania has not set up its own exchanges. That means the federal government has stepped in, and will run the marketplace in your state. Beginning October 1, you'll be able to see the rates you would pay for insurance coverage at www.healthcare.gov.
Are there any resources out there that rate the quality of various health plans or can help me see differences and compare plans?
Good question. The non profit National Committee for Quality Assurance has ranked health plans for many years...so does Consumers Reports.
Your state insurance department web site may also publish information ranking health plans.
I am a retiree and eligible for social security retirement but I am not eligible to be covered by Medicare yet. I am currently covered under the retired employee healthcare coverage with my last employer and the premium is so expensive. Can I enroll the ACA health exchange on Oct 1st and be covered immediately for both me and my spouse?
This is an important question: While enrollment on the health law's marketplaces does begin on October 1, coverage will not start until January 1. This is true whether you buy a plan on October 1, November 1 or even December: None of the coverage starts until January. So no, the plan will not take effect immediately, but rather three months after you purchase coverage.
Yes, if you are under 65 and not on Medicare you can get coverage through the exchange. Word of caution: As you may expect, rates for people in their 50s and 60s are more expensive than younger adults but if your income is below 400 percent of poverty level. ( $62K for a couple) you will be eligible for a subsidy to lower the price.
Do you know how the premiums under the federal multi-state ACA exchange compare to the total premiums under the Federal Employee Health Benefits Plan? Shouldn't OPM be able to get about the same results for both the multi-state exchange and FEHB?
The best information we have on the premiums under the health care law is probably in a report that Health and Human Services put out today.
In general, it might be hard to draw a comparison between FEHB and ACA premiums. That's because you don't have OPM negotiating the rates for the ACA exchanges, as it does with FEHB. Instead, its state regulators who are overseeing and approving insurance rates in the case of ACA offerings.
My husband currently has health insurance coverage through his employer and I am covered as a family member. The price is affordable and the coverage is relatively good. Will I have to obtain my own policy or can I continue on under his plan?
If you are happy with your employer based coverage, you don't have to do anything. But be grateful.
My daughter is on Medicaid but my wife and myself pay for insurance. Will we have to purchase insurance for my daughter? Will she lose her medicaid beginning in October?
No. If you daughter is on Medicaid, nothing will change. The health law expanded Medicaid eligiblity because in most states only children, pregnant women and parents were eligible,--so called childless working adults were shut out. What's changing is now everyone under 138% of poverty level (about $15,800 for an individual) can qualify for Medicaid regardless of their age. But this part of the law was made optional by the Supreme Court so only about half the states are expanding in January.
I'm in sales and my annual income fluctuates do to variable compensation/commission. I do have a base income but in determining eligibility for subsidies I'm unsure of what amount to enter in the calculators. Do I use my guaranteed base income or make an educated guess that includes commission amounts?
That's a good question. The federal government generally will ask you to estimate what income you will make in the forthcoming year, which is tough for someone in a commission-driven industry.
One thing to know is that your initial estimate doesn't have to be the final say. The federal government actually asks that, if your income ends up being higher or lower than what you expected, that you go back and let them know, so they can adjust your premium subsidies appropriately. This is important because, if you don't do that, the federal government will likely recoup any excess subsidies in your tax return the next year.
I have an adult daughter who has been unemployed for in excess of a year. We do not desire for her to enroll in Medicaid, but rather we are willing to purchase a policy under Affordable Health Care Act. I have read if you are in this position you can acquire the Gold plan "deductibles, etc." for the Silver plan price. Can you explain how I might accomplish this?
You can cut the cost of your coverage through the federal subsidies that are based on your household income. But you get the most "bang for your buck" on the silver plans, I'm told, though silver may have a little higher deductible than gold. Its best to check ou the plans when they come out on tuesday at www.healthcare.gov..If you want to get an idea how much subsidy you will be entitled to, see here.
My sister lives in Michigan and is currently on Medicaid. She is also on SSI and has no other income. Will her Medicaid be impacted at all by Obamacare? (I see Michigan is currently one of the states expanding Medicaid).
Most likely not: People who currently have Medicaid shouldn't see much of a change to their coverage under Obamacare. The only possible change could be to access: With lots of people joining Michigan's Medicaid program, some people worry that it will become harder to see doctors next year.
This program doesn't look anything like the bill of goods we were sold at election time. Who has the time and the savvy to work through this bureaucratic labyrinth of plans graded as metals and prices that can change anytime? It is an unmitigated mess and the only people who will benefit are the insurers and their high priced executives and the lawyers who will have to be called in to make some sense of it.
Don't get scared off by all the naysayers. Seniors were frightened in 2005 when the Medicare prescription drug program launched and many were overwhelemed by their choices. Today, seniors are grateful for the coverage and a simple software program helps them figure out which plan is right for them....The same will likley be true with the new exchanges. There will be choices but you will be able to determine what price point you are shopping for. And as for prices changing anytime..that's inaccurate. Insurers can only change their prices once a year. That's why it pays to check your coverage each year to make sure you are in the best plan.
Is it true that the patient has a 90-day grace period to pay the monthly premium?
You should check with your state exchange on the rules they have set up. Generally to have coverage on Jan 1, 2014, you need to have paid your coverage by Dec. 15. States have set up rules so people aren't kicked off policies if they are a few days late paying premium.
Is Obamacare available for a senior citizen working via green card?
If you are in the country legally and don't have coverage, you are eligible to enroll in the exchange.
I am interested in knowing whether doctors and other health care providers will be required to accept Obamacare patients who sign up for, let's say, an Aetna plan if the doctors accept other Aetna plans? In other words, can doctors decline to accept Obama reimbursement, thus making doctor availability a continued problem for patients?
Doctors have no new oligations under Obamacare. They negotiate with private insurers on which plans they will participate in. As occurs today, not all doctors accept patients in all health plans. Doctor availability varies widely around the country and will continue to.
I become eligible for Medicare in April of 2014. Must I buy health insurance for the first quarter in order to escape paying a fine?
Yes, to avoid a fine you must buy coverage before the close of open enrollment on March 31 BUT millions are exempt from the mandate. The mandate’s exemptions cover a variety of people, including: members of certain religious groups and Native American tribes; undocumented immigrants (who are not eligible for health insurance subsidies under the law); incarcerated individuals; people whose incomes are so low they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples); and people for whom health insurance is considered unaffordable (where insurance premiums after employer contributions and federal subsidies exceed 8% of family income). More details here.
My 47-year-old son is in need of a surgery for his back. He is uninsured and plans to sign up on Oct. 1st for Obamacare in California. His doctor thinks he should have the surgery immediately, needs a fusion for ruptured disks. He has tried everything to find help, or to get insured. He earns too much for Medi-Cal or other programs. He cannot work, and he is very depressed about waiting until Jan. 1st to receive treatment. Will he be able to get access to care earlier than Jan 1st through his insurance after he signs up?
What a tough situation. Unfortunately, the Obamacare plans do not kick in until Jan. 1.
I did not earn the minimum amount to qualify for a subsidy in Virginia in 2012. If I earn the minimum amount, do I qualify? And if I earn less than the minimum to qualify for a subsidy, can I still purchase on the exchange without a subsidy?
Hi. In Virginia, if you earn less than the federal poverty level, which is about $11,500 for an individual, you will NOT be eligible for subsidies on the exchange. But if you earn more than $11,490 and up to about $46,000, you WILL be eligible for subsidies. (Yes, I know that doesn't make sense. It's because Virginia did not choose to expand Medicaid.) Use this calculator.
But you can still purchase on the exchange without a subsidy.
I don't have insurance right now. I would like to look at the alternatives starting October 1. Do I have to give out personally identifiable information - like full name, street address, social security number- to see the details and costs of plans?
Yes, you will be required to give basic bio and identifying information because the online systems are going to try to give you a real-time determination to see what you qualify for.
What constitutes income for purposes of the subsidies? Does interest, dividends, capital gains, tax-free interest and other such items count? Do people deduct standard deductions, capital losses and similar items from the calculation in a state that has its own exchange?
Hi there - Here is an explainer from the UC Berkeley Labor Center (PDF) on how income will be calculated on the exchanges.
I'm a freelancer and all of my income comes from different clients (magazines, museums, etc.) who hire me to write for them. However, I currently pay for my own health insurance and am allowed to deduct that from my income on my taxes. Same thing for my retirement (SEP-IRA) contributions. If I just look at my gross total income with no subtractions, I can't get subsidies on the exchange. But if I subtract my typical health insurance cost, I can.
Is there an easy way to tell what my "income" is for Obamacare purposes? I was hoping it might be a specific line on my 1040, for example.
These are all good and fairly complicated questions. The exchanges are using something called modified adjusted gross income, which is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have. There may be more info on the federal website, at www.healthcare.gov.
I live abroad and receive coverage through the national system of my son's second nationality. What are our Obamacare obligations as Americans living overseas?
My colleague Sarah Kliff got a question about this yesterday and here's her answer: Americans who live abroad are generally discouraged from purchasing a plan under Obamacare for two reasons. First, the health insurance you buy on the exchanges is unlikely to have coverage options outside the United States, so it won't help much with seeing a doctor. Second, the individual mandate does not apply to Americans living abroad.
Is there a common definition of state residency, or is it up to each state to define who is and is not a resident for purposes of using the state exchanges?
What is the phone number for the Virginia exchange? I want to enroll first thing on October 1st.
Virginia is not one of the states that chose to run its own exchange. If you recall, state officials were among the first to challenge the constitutionality of the law. So the federal government is running Virginia's exchange. The toll free number for the federal government call center is 1-800-318-2596, and it's open seven days a week, 24 hours a day. The federal government website is www.healthcare.gov
I have spent the last 2 days reading your answers and visiting various sites you linked and I really feel I get it now. I have been through big changes in providers in my business and it was chaotic. So who wouldn't expect ACA to be the same, when it's a whole country? Bottom line, I am so grateful that I don't have to worry about getting sick and I actually get to have a check up that is partially covered!!!! So happy.
Do you have to be a U.S. Citizen to get Obamacare? My husband has been a legal resident for 21 years. If he lost his current coverage, could he use the exchange?
People who are U.S. citizens and legal residents can use the exchange, so yes, he can use the exchange.
Is the income that determines if I get a subsidy my 2013 or 2014 projected income? If I am at or below the 100 percent poverty level (I just graduated and have had very little income this year) and it is recommending I get Medicaid, can I buy on the exchange at the silver level anyway? Would it just mean I don't get a subsidy?
The income they will use is your 2014 projected. And you'd better project pretty accurately; if you undershoot it, you will have to send any extra subsidy you received back to Uncle Sam!
If you qualify for but decline Medicaid, then you will not get a subsidy, but you can buy whatever plan you want at the regular sticker price.
Lower income individuals who apply for health insurance can easily become disqualified for subsidies if they have any savings in the bank, despite the fact that their current income may be very small. I have heard that the Affordable Care Act will not have such a disqualification for saving in the bank. Is that true? If not, what are the financial thresholds for subsidies?
They will be using your income, something called modified adjusted gross income, which is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have.
I know, for example, that workers compensation pay will count as income, even though people who get that as their only income don't pay taxes on it or file income tax returns.
I'm single, self-employed, live in Virginia, and have been buying my own insurance for years. It's a high deductible plan that I gather wouldn't qualify under the new rules, but I've been told by BCBS that because I've been on it for so long it will be grandfathered in, and remain valid. My guess is that my existing plan is cheaper than what I would get on the exchange.
Will my plan be permitted under grandfather rules indefinitely, or will there come a time when I have to switch?
You will only be able to keep your grandfathered plan for a year. Some insurers are letting people renew at the last minute this year so that they can hold onto it for the entire 2014 calendar year. Some states are not permitting that, however.
I've been getting emails for quite some time telling me that I can go online now and set up my account on the MD exchange so I will be ready when Oct. 1 comes. I cannot get on the exchange to do so. It seems that function is not yet available.
Is there a problem rolling this out? What other features might be delayed?
Hi. I just spoke with someone from the Maryland exchange. You will be able to set up your account in Maryland on Oct. 1, but not before. I know people living in states where the federal government is running their exchanges are being encouraged to set up accounts ahead of time.
Just read the entire thread and this has been extremely helpful. Please keep answering questions, we need more accurate and non-partisan expert help like this.
I'm aware that people whose employers offer health coverage are not eligible to participate in their state exchanges. But what about retirees? I am nearing age 55 at which point I will be eligible for my company's retiree group plan and am thinking about leaving. If I wait until age 55, am I ineligible to participate in the DC exchange?
No, you shouldn't be ineligible to participate just because you are 55. What you can do when the exchange opens is to do some window-shopping and compare what kind of plans are out there for your age and income. If you create an online application, you can also find out if you're eligible for a tax subsidy, which is based on your income. Generally speaking, in D.C., an individual earning more than $22,980 but under about $46,000 is eligible for a subsidy.
Yesterday, the DC exchange said they were having problems with the part of their system that could immediately make these eligibility determinations. But if you create an application, they will get back to you via email in November to let you know what your subsidy might be. That would still give you time to sign up for a plan because coverage won't go into effect until Jan. 1. Here is a story I wrote about it today.
I have two sons, ages 28 and 30, both employed full-time at companies that do not offer health insurance. Both sons currently have individual health care coverages with CareFirst. Can they remain with CareFirst or should they look into the health exchange in Maryland?
You might want to log on to the Maryland exchange Oct. 1 and see what is being offered on the exchange. Under the law, all plans will be required to offer many more "essential benefits" than what many individual plans offer today. The cheapest plans on the exchanges will be the ones known as the "bronze" plans, because they typically have the lowest premiums. But they will tend to have higher out-of-pocket costs. All depends on what their individual health needs are going to be. the site is www.marylandhealthconnection.gov. Or you can go to our calculator, type in their ages, and zip codes, and get a rough sense of what they might pay for the moderately priced plan, and the cheapest plan.
I keep hearing that rates on the exchanges will be "lower than expected." But isn't the relevant question whether the rates will be lower than what roughly comparable plans are already offering? And how do we know that people will be willing to pay these rates?
I agree that it's not very helpful to an individual person to compare the prices of the plans they can buy to previous projections.
The problem is that it's hard to figure out "comparable rates." The new plans will cover a lot more things than some of the cheaper private plans do currently. So it would follow that they might be more expensive.
The conservative Manhattan Institute took a crack at answering your question. Here is a link.
My stepson (single) works at Wal-Mart and makes about $18,000 per year. His current insurance is fairly cheap, but it has a $5,000 deductible. So, it really hasn't done him any good. Will the ACA offer him any better options or is he stuck with the Wal-Mart plan?
Hi. It will depend on where your stepson lives. I know from talking to many young people that they do have these high deductibles. Depending on what state your stepson lives in, he (maybe with you sitting beside him) can certainly go online and check out what is available on the exchange. If he lived in the District, for example, he would be eligible for the expanded Medicaid coverage because the District chose to broaden coverage to include individuals earning up to $22,980. You can also go our calculator and get a rough idea of what some of the plans might cost.
Will an 81-year-old visiting the U.S. on a tourist visa be eligible for ACA? What if he or she obtains a green card (he/she is not yet eligible for Medicare)?
You need to be a U.S. citizen or a legal resident of the United States. So until that person got their green card, no, they wouldn't be eligible.
Please clarify this question: "What if you are on Medicaid, in a state that did not expand Medicaid?" If you are in one of the states not expanding Medicaid, you won't have the benefit of the law which expanded coverage of the program to everyone under 138 percent of poverty rate. If you are currently on Medicaid, you will be able to stay on Medicaid regardless of whether or not your state is expanding Medicaid under the ACA.
Hi. Not sure what you want clarified. If you are already on Medicaid now, you won't be affected. You get to stay on Medicaid. But about half the states are expanding Medicaid to allow it to cover more people. That means people earning under 138 percent of poverty--this comes out to about $15,856 for an individual, $21,404 for a couple, or about $32,500 for a family of four--will be eligible for coverage.
I live in NC and I am currently unemployed. NC will not set up an exchange. My income for 2014 will be approximately $14,000 assuming I do not find a job. I do not have COBRA. Where do I need to go to find a health care policy I can afford?
You should be able to go the federal website because the federal government will be running the exchange in NC. And as a single person with income of about $14,000, it sounds like you should be eligible for a tax subsidy from the federal government. You won't qualify for Medicaid because NC is not expanding that program. But an individual earning up to about $45,960 is eligible for a subsidy. The website is www.healthcare.gov
I live in Virginia. I do not have a job and made $0 this year. I am living off my savings, which is about to run out. I am not eligible for Virginia Medicaid. Will I get any kind of subsidy? Or is that only for people eligible for Medicaid in states that are not accepting the extra federal money for the Medicaid expansion?
See an earlier answer to a similar question. You need to earn MORE than $11,490 in 2014 to be eligible for a subsidy. You can still shop on the exchange to look for coverage if you earn less than that. But because Virginia did not expand Medicaid, you fall in that group of people who are not getting help from Medicaid, and earn too little to be eligible for a subsidy. It's very hard for people to understand, but it's because many folks assumed that states would be expanding Medicaid.
Did Virginia finally decide to expand Medicaid, or not?
I know that the quality of coverage on the exchange varies from state to state and through the various plans, but how much different is the exchange plans from Medicaid and private insurance through an employer, in terms of choice of doctors and quality of care?
That's an excellent question and unfortunately, we won't really know until Oct. 1 when consumers can see the plans and everything they offer. They are supposed to be displayed very much like what you see when you buy an airplane ticket online. We have heard that in some places, to keep the premiums low, that the network of doctors and hospitals may be more limited. But we'll know much more in a few days.
Can you explain the difference between purchasing insurance via a state exchange versus the open market? Will there be major differences in costs/coverage option between the two markets?
Starting in January, individual and small group plans sold both on the exchanges and through the private market will be more alike than different. No one can be turned down for medical conditions or charged a higher rate for them. All plans must cover 10 "essential health benefits. People will choose from among four different plan types--the proportion of costs that consumers pay will vary. But there will be some crucial differences. Consumers can only get subsidies to reduce the cost of coverage if they buy a plan on the exchange. That's important, since an estimated 80 percent of people who buy on the exchange will be eligible for subsidies. On the other hand, if you want to buy a plan from a particular insurer you might have to buy on the private market because not all insurers will be selling plans on the exchanges.
Under the ACA, the premiums are supposed to be based on the numbers of enrollees to the program. How are the initial premiums set and what are they based on? When will the accurate premiums start?
Premiums for individual and small group plans sold on the exchanges, or marketplaces, can only vary based on a few things, and the number of enrollees in the program isn't one of them. Premiums can vary based on family size, where you live, the type of plan you buy, whether you smoke and your age.
Will plans that have various administrators (pharmacy, etc) be able to utilize separate out-of-pocket maximums for each administrator?
In 2014 only, plans that use separate administrators for different services, such as medical benefits and pharmacy benefits, can permit separate annual out-of-pocket maximums for each type of service. If a pharmacy plan has no limit on out-of-pocket spending, that will also be permitted next year. But in subsequent years, there will be single out-of-pocket maximum for all services. The amount will change, but next year it's $6,350 for individuals and $12,700 for families.
My husband and I are nearing 60 and expect that we may lose our jobs and our job-related insurance in the next year or so. If that happens, we will start drawing our 401K and our income will drop by about half. Would the income that qualifies us for a subsidy be based on the last tax year, or on the income we expect in the upcoming year?
When you sign up for a plan on the exchange, you'll be asked to estimate your income for the following year to determine your eligibility for subsidies. At the end of the year the IRS will reconcile your estimate with your actual income. If you received a premium tax credit amount that was too high based on your income, you may have to pay it back. So if your income changes during the year or is higher or lower than you estimated it's important to contact the exchange to let them know promptly so they can adjust your credit.
Do the Obamacare insurance plans cover medications?
Yes, all plans sold on the health insurance marketplaces must cover prescription drugs. It's one of the 10 "essential health benefits," along with emergency care and doctor visits, hospitalization, maternity care, rehab and lab services, among others.
Besides the initial open enrollment dates, what will be the annual open enrollment dates going forward? Currently I am on COBRA, which ends in Oct 2014. Will I be able to enroll at that time?
This first year, annual enrollment will run from Oct. 1 through March 31 of next year. In 2014, annual enrollment will run from Oct. 15 to Dec. 7.
We have a daughter who will turn 26 this coming year and who lives at home. She has medical complications (epilepsy). When she applies for insurance, will she be regarded as an unemployed adult with no income? Will she therefore be eligible for premium subsidy, or will she have to include our household income since she lives in our house? My wife and I are both employed, though I am 69 and she is 61.
In general, if you claim your daughter as a dependent on your income taxes, her eligibility for subsidies will be based on your household income. If your household income is less than 400 percent of the federal poverty level, she may be eligible. If, however, you have access to health insurance through your jobs that's considered affordable and adequate under the health law, she may not be eligible for subsidies regardless of your household income.
Our daughter is currently a student and is enrolled in a Virginia University. We have health care through my employer, but it does not offer dependent (non-spousal) coverage. So we previously purchased an individual policy for her that we will need to change to get one that is ACA compliant. As an unemployed adult, but also under 26 and a student, does she qualify to apply for a policy through the exchange?
Almost anyone can shop for a plan on the exchange. The question is whether she'd be eligible for subsidies. If you claim her as a dependent on your taxes and your employer plan doesn't offer dependent coverage, she may be eligible for subsidies if your household income is less than 400 percent of the federal poverty level. If she's not a tax dependent, then her eligibility for subsidies would generally be based on her own income.
We have insurance through my husband's employer, who pays a small portion of it. However, we do not like the plan and the premiums just went up. Can we shop on the exchange for better options?
Almost anyone can shop on the exchanges for coverage, and you can too even though your husband's employer offers coverage. But you'll only be eligible for subsidies on the exchanges if the employer coverage is considered unaffordable--meaning it costs more than 9.5 percent of your income for self-only coverage--or inadequate--meaning it doesn't pay for at least 60 percent of allowed medical costs.
Hi! I am 61 and retired. My husband an I live on investment money. I currently buy individual insurance, a high deductible. I take no medications. Clearly, I am lucky in several respects. I live in Pennsylvania. Am I eligible for an exchange?
Almost anyone can shop for a policy on the exchanges, but you may not be eligible for subsidies if your income exceeds 400 percent of the federal poverty level or you have access to other forms of coverage, such as through an employer plan or Medicare.
My daughter got married and kept her individual policy. Her husband kept the individual policy he had as well. She is now pregnant and her carrier has informed her that she must get new insurance by January 1 as it will no longer be providing individual policies in Maryland. Can they just drop her? Can she simply pick up a new family policy under the new insurance system? Will she be penalized in pricing because she is pregnant?
Generally, individual insurers have a transition plan in place for members to move them into plans that are compliant with the requirements of the Affordable Care Act. But in any case, starting in January, your daughter will be able to sign up with a plan on the individual market. In the past, insurers typically turned women down and wouldn't insure them if they were pregnant because it was considered a pre-existing condition. Under the ACA, they will no longer be able to turn her down because she's pregnant nor charge her a higher premium.
I am a very low income person with no insurance. How do I get insurance when I can't afford it? How do I try to qualify for Medicaid?
Go to healthcare.gov and search for information about the Medicaid expansion. If yours is one of the roughly half of states that are expanding Medicaid eligibility to individuals with incomes up to 138 percent of the federal poverty level you may qualify.
If you lose job-based insurance in 2014 after the marketplace open enrollment period (for example, if a worker didn't maintain enough hours to continue to quality for their company plan), will you still be able to buy insurance on the marketplace after open enrollment?
Losing job-based insurance is one of the life events that may qualify someone for a special enrollment period lasting 60 days during which he or she could shop for coverage on the health insurance marketplace outside the regular open enrollment period.
I live in Texas. Our state is not participating in the exchanges. My disabled son has been on Medicaid and Medicare for years. Will he have access to the increased mental health coverage under Obamacare?
Medicaid and Medicare already cover essentially unlimited mental health coverage. People in your son's situation will continue to have that same coverage. They will stay on Medicaid and will not go onto the exchange. In a state like Texas the federal exchange is available for others, but unnecessary to your son.
One issue I haven't seen addressed is whether these plans will provide reimbursement for doctors who don't accept health insurance -- that is, they only take out-of-pocket payment and leave it up to the patient to deal with making insurance claims.
Like current plans, the relative generosity of coverage when you use doctors who are "out-of-network" will vary from plan to plan. Some may cover some percentage of their "usual and customary" charge for a service and others may not cover out-of-network service at all. Read the plan's benefits description to find out.
Thanks for the chats. Can you set up a deduction plan with your employer and the exchange to pay your premiums from your paycheck?
Employers normally only pay for a few things directly from your paycheck, like IRS and OASDI witholding. Rarely would they pay bills for things like rent or private insurance. You can ask your employer. But you can simply pay by check, just as for most other bills, for an exchange insurance plan.
My spouse and I are small business owners whose insurance comes from a small group policy that covers only our family (we currently have no other employees.) The rate is outrageous and the coverage isn't good. We would love to shop for coverage on the exchanges, especially because we believe our income would result in us qualifying for a subsidy. Can we simply end/stop offering the group policy through our business and switch over to Obamacare?
Yes. Go on the website serving your state starting Oct. 1, or contact the help resources your Exchange is providing (you can find these resources for your state through www.healthcare.gov). Compare the premium, benefits, and available providers offered on the Exchange with what you have now. You might find that is available for your family on the Exchange is a better option for you than what you have now.
Is there an out-of-pocket limit to what you pay for deductible and co-insurance costs on each tier of insurance? For instance, on the level where you pay 60 percent of your costs - it's 60 percent of how much? Unlimited or capped amount? Thanks. We have a small business and our rates are astronomical so hope to get good coverage cheaper in the exchange.
Each plan has a maximum out-of-pocket limit for individuals and families. There are also likely deductibles, copays, coinsurances, etc. Some plans count certain costs towards the deductible and others do not. I assume the tiers you are referring to are the various Metal levels of Bronze, Silver, Gold, and Platinum. These tiers are designed to reflect certain average out-of-pocket cost coverage percentages (60 percent, 70 percent, etc) for the entire population, not a consumer just like you (same age, family size, health status, etc.). So the best value for you has to be a consideration of both the premium fro the plan and the estimated out-of-pocket costs fro someone like you. This may require comparing plans accross the Metal levels.
If I am eligible for a subsidy, will I be able to apply it to my existing individual health insurance or do subsidies apply only to plans purchased through the exchange?
Subsidy eligibility determination is for plans purchased through the Exchange.
If an employee leaves a group and enrolls through an exchange, does his coverage count as a "legitimate" waiver for the employer group participation requirement?
The employer rules are not yet final, and the "employer mandate" has been delayed for a year. What counts against the employer will also depend on precise details of his plan, so there is no way to answer now.
I was startled to get a note from Blue Cross / Blue Shield in the mail on Friday (four pages, single spaced) telling me that my policy doesn't fit the ACA, and will therefore have to end on its normal renewal in February -- but they have a whole slew of different policies that they'll sell in the exchange that I could look at instead, after Tuesday. (Alternatively, they said I could cancel and renew early as a way to extend my current policy -- which I dislike -- for almost a year). This came as complete news at the very very last minute, and I don't know why it was sent so late... and yet there's not a darn thing I can do about it, in terms of checking those prices, until Tuesday. What a silly letter -- urgent but nonactionable. Can you explain what's up? And since it's BC/BS, do you think these are the "multi-state policies" we've just learned about?
It sound like your existing plan would only be compliant under ACA when viewed as meeting "grandfathered plan" criteria and if you wished to stay in that plan, they are offering a mechanism to meet those grandfather criteria. Otherwise, there will be new plans available to you that meet ACA requirements.
The main difference, I'm told, between health plans sold on and off the ACA marketplace will be the provider networks. Will any non-HMO plans be offered among the marketplace plans? If not, does this create a two-tier system?
Besides provider networks, how will plans sold off of the marketplace be different? And what wiggle room in the ACA are they leveraging to make them that way?
There will be many PPO plans on the exchanges, not just HMOs. We have seen the details of all plans in several states and in general they look a lot like existing insurance plans as to type of plan and benefit structure. As you know, there will be a lot of variation in provider networks and that will be an important way users should compare plans. Details on plan structure for most states will be available on healthcare.gov, but you will probably have to contact plans directly about network details.
How is Mental Health Parity designed to work in the exchanges? Will patients have copays for mental health visits?
The exchange plans are all subject to "minimum essential benefits" rules and these rules require parity for physical and mental health services. Most exchange plans will have deductibles, copays, or both for both physical and mental health services. There will be no discrimination between physical and mental health services for these payments.
For the past year or two, my doctor's office has been pushing an advanced level of service/care for the practice. Most of it is preference for appointment times, free referrals, faster meds, that type of thing, for a certain fee each month. I've resisted on principle. But now that the doctor's offices are going to be filling up with new patients and the level of care will be decreased, should I go ahead and kick in and "reserve/save my spot" with my doctor?
These "boutique medicine" practices are becoming more common. Their extra fees are rarely covered by group or individual insurance. You shouldn't worry about doctor's offices overflowing with patients until or unless it happens. Don't worry about it for now.
Both navigators and federally qualified health centers (FQHCs) received HHS grants. What will be the difference in their roles and functions, and how will they avoid overlapping one another? I'm told that the ACA requires that the health centers be included in provider networks, and that they may reach beyond their neighborhoods to bring new clients into their health plans.
Since they work with insurers, is it possible for them to use the funds to garnish their customer base?
Exactly how these centers will change under the ACA will be a "work in progress" for several years. Very importantly, they will continue to serve patients who have no insurance for whatever reason. They will also serve more people through insurance under the ACA, which will give them more flexibility. What geographic restrictions may apply may evolve over time.
Will supplemental plans meet the requiremenst for Obamacare? Plans like the duck offers?
We assume you are referring to the AFLAC ads. Supplemental insurance will NOT meet ACA standards, by definition. The plans that meet ACA standards must be plans that cover all essential benefits (not just hospitalization, for example), and that do not impose "maximums" on these services. Of course, any company that meets state licensing standards can offer ACA-compliant insurance if it chooses.
What are the employer's responsibilities regarding the reporting aspect of the new health care law? Are we required to report the health insurance premium on the employee's W2? I do feel that this new law does weigh heavily on the employers shoulder especially for the small businesses with about 100 employees.
Employers in general will have to inform their employees, on their W-2, the cost of the employer share of insurance provided. This will be pretty easy to comply with. There are indeed a number of other reporting requirements that the Administration is still trying to design in a minimally burdensome way. That is one reason the employer mandate enforcement was deferred for a year. But there is no question that there will be additional burdens on employers, large ones especially.
I intend to gain coverage on CA marketplace; my current Blue Shield of CA plan enables me to receive care in VA. Will ACA balkanize plans between states even more or does it depend on the plan? I do not want to become a VA resident again.
Eligibility for VA services is independent of private insurance. In general, private plans don't pay for residential services other than hospital stays.
Will owing and paying monthly back taxes to the IRS affect my eligibility for a subsity? (Couldn't pay taxes because my health insurance premiums are 37 percent of my income!)
This is the kind of problem you should discuss with the IRS to reach a payment plan. In general, taxes you owe the IRS are irrelevant to enrolling in an exchange plan. You will probably find that you are eligible for a premium subsidy and this will greatly reduce your future insurance premiums.
I made the mistake of joining a Medicare HMO instead of buying supplemental insurance and using regular Medicare. Will supplemental insurance still be able to turn me down based on preexisting conditions (controlled diabetes)? Does the No Preexisting Condition Clause extend to supplementary insurance?
The ACA does not substantially change either Medicare or the role of Medicare supplemental (Medigap) plans. You should talk to one or more of them about your situation. In general, you pay more for delayed enrollment. You should also consider staying in Medicare Advantage but changing plans in the Open Season this fall in order to deal with the problem you face. Your total premiums will be considerably lower if you don't enroll in a Medigap plan.
Our 29-year-old worked full time in 2012 but only part-time in 2013 and moved in with us. Is the modified adjusted gross income (MAGI) figured from her latest tax return or what she estimates it is for 2013? Does "income" from free rent factor into the calculation for the subsidy cutoff?
The MAGI calculations are complicated and she may benefit from counseling with a Navigator. The actual application form on healthcare.gov or your state exchange answers most questions. Free rent will not count as income or otherwise affect the subsiby cutoff.
What do you see as the changes, if any, brought about by Obamacare with respect to alternative healthcare providers? For example, are we going to see more consistent/expanded coverage of preventative care services such as massage, chiropractic, coaching, nutrition, or more common access to integrative providers such as naturopaths and osteopaths?
The law requires all plans to offer a broad range of preventive services. You can find information on what these are on healthcare.gov. In general, services that are accepted as medically proven are covered, but "alternative medicine" services are not. That said, many plans will cover some services you mention, such as nutrition counseling and chiropractic.
My husband is self-employed and has no employees. Will his business qualify as a small business in order for him to get health insurance through Obamacare?
A person who is self-employed with no other employees can use the marketplace for individual insurance, but not the SHOP exchange that is reserved for small businesses.
Please explain why Congress and the executive branch (President Obama, et al) were exempted from joining the plan.
The Federal Employees Health Benefits Program already meets all substantive ACA requirements that apply to large employers. The requirements that apply to exchanges are separate and distinct from those that apply to large employers. That said, there is a provision in the ACA that requires Congressmen and Senators and their personal staffs to get their insurance through exchanges.
I am considering moving to another state in mid-2014 where I will be resigning from my job and likely will not have a job when I arrive. When applying for health care, how will my income be determined? Will my income from the first half of 2014 be included, even though I will no longer be working? Also, is interest income included when determining one's income?
Your expected 2014 income will not be considered by an Exchange now. It will be considered in the future. Your interest income will be considered in determining your eligibility for a subsidy.
If insurers can't deny preexisting conditions, what prevents an individual from waiting until they need care to buy insurance during the yearly open enrollment? Wouldn't that only be out-of-pocket $95/year. In the worst case scenario, you'd have to wait at most a year to receive access to a plan. I understand this approach wouldn't address out-of-pocket expenses for any immediate care needs, but I think many will consider it's worth the risk since they could eventually be covered if anything "bad" happens short of an emergency.
If you don't enroll before you need and use care, you will have to pay for the care you use before enrollment and you might might have to wait until the next open enrollment period under ACA to get any coverage for health care services you use. And you might have to pay the $95 penalty (higher in future years) unless you qualify for an exemption. Those are the main risks. Could be minor or could be catastrophic.
If I have Medicare and a Medicare supplement, am I able to shop for better coverage? It costs me almost $300 a month for both and they continue to rise in price and I am in the gap.
You are an obvious candidate for considering joining a Medicare Advantage plan and paying one premium instead of two. We suggest you go to www.medicare.gov and use the planfinder tool there to compare all types of plans you can join. Over one fourth of all Medicare enrollees have elected this option rather than pay for a Medigap plan.
IRS, Social Security, Homeland Security and other unnamed agencies are networked for Obamacare...will the NSA have access to these health care records?
We have no expertise as to what information the National Security Information may obtain in particular circumstances. But in general it will NOT have access to individual health records. Furthermore, the IRS, Social Security, and Homeland Security will not have such access. The Medicare program, of course, has access to billing records for its enrollees.
I am currently offered "affordable"Â insurance for myself through my employer; however, they do not subsidize family coverage for my wife and child, making my family coverage astronomically expensive. My wife is a stay at home mom, so from what I have read, I don't qualify for subsidies since my employer offers "affordable" coverage, thus, disqualifying my wife. My question is: Can I move my wife and child on to the public marketplace through ACA, even without subsidies? Seems like I just fell into the Obamacare donut hole!
Yes, exchange insurance will be available for them. Because your situation is complicated, you may wish to use a Navigator service for counseling. But start with healthcare.gov or your state exchange. There are also some books online (or on paper) that cover situations like yours in depth. Time for homework!
My husband is 54 and has had early onset Parkinsons for a number of years. We have insurance through his company and I own my own business. We make about $300,000 a year and have two daughters. At some point in the near future, he will have to retire early due to the disease. Our income will go to about $150,000 and we will lose our family's health insurance.
I have been worried for years about his forced early retirement because when I look at the current privately offered insurance on the open market, not only is it twice as expensive, it has sky-high copays, out-of-pocket costs, very poor prescription drug coverage (he takes four different meds just to function) and very high annual limits that we must meet before the coverage fully takes effect.
I calculated that if we have to buy insurance from a private source, we will spend about 1/4 of our pre-tax income on it. Also, he will likely need brain surgery at some point to continue daily life functions. Will Obamacare change that picture for our family, and if so, how?
You are precisely the kind of family that will benefit under the ACA. You will be able to join a plan that gives you the coverage you need without regard to the preexisting condition, at a reasonable and affordable premium. Your income is probably too high to qualify for a premium subsidy, but there will be plans with affordable family premiums for people your age and income. There may also be even better options for your family if you and he approach this as individuals. He may be eligible for Medicare Disability, and thereafter Medicare, for example.
My friend is a foreign national, presently working in this country on an H1B visa. Her visa expires in about 18 months. Her employer does not provide her with health insurance. Can she purchase insurance via the exchange? And, if her income is low enough to qualify for a subsidy will she, as a foreign national working legally in this country, be eligible for the subsidy?
This is a legal question and we can't provide a definitive answer. In general, we understand that legally resident aliens are eligible for insurance, and illegally resident aliens are not. Check with a Navigator or www.healthcare.gov.
My COBRA coverage ends on January 31st, 2014. I'm currently unemployed. My spouse (under 60 years old) is 100 percent disabled and is currently covered under Medicare (A&B) and my soon-to-expire COBRA plan, which has prescription drug coverage and nearly unlimited provider choices. Would we be able to enroll in a family plan in order to obtain prescription coverage for my spouse and more provider choices? Any advice would be greatly appreciated. Many thanks, Uneasy in Arlington
It is almost certain that your best arrangement is to handle your insurance as separate individuals. Your spouse should be able to enroll for the Medicare Part D drug benefit. You will be able to enroll on an exchange. Your spouse should go to www.medicare.gov or call 1-800-medicare for help on the drug question. For yourself, you should explore options on the exchange that serves your state (find it with www.healthcare.gov).
I'm concerned about deductibles under the ACA. I'm currently on COBRA and I have a $500 deductible; I've heard the lowest deductible will be $2,000 with the higher premium platinum plan. If true, I may 'rush' to have certain tests and specialist visits before the end of the year. As you know premiums are only part of the story. I've heard 25 percent of insured Americans use no services during any given year, in part due to their deductibles and copays. Besides the 'no-cost' preventative services that have been described, will I have to pay the total cost of routine visits and tests until I've met my deductible under ACA?
Different Exchange plans will have different medical and drug deductibles. In some plans certain services may or may not count towards the deductibles. You'll need to compare plans on both premium and benefits offered. Ideally the Exchanges will compare plans on a single dollar amount combining premium and estimated-out-of-pocket costs for someone like you. Unfortunately, only a few states will provide such information initially. Many states will, however, be offering plans with deductibles below $2,000.
My wife and I are federal employees and we are in the process of adopting an infant child. Our health insurance coverage would only be extended to our child until the adoption is finalized. This could take anywhere between three weeks and two months once the child is places with us. Meanwhile, we are expected to provide health insurance for the child between the placement and finalization phases. Can we purchase an insurance plan from the exchange that would provide gap coverage for our child between the placement and finalization period?
The question as written is confusing. In the federal employee program any child, biological or adopted, is covered by any family plan. This certainly takes effect when the adoption takes effect, and generally when you take custody. You should make sure that one of you enrolls in a family plan in this fall's Open Season. Self-only plans will not work. Coverage in that plan will begin January 1. If there is some additional complication we don't understand, please talk to the Office of Personnel Managment about your situation. You are probably able to cover the child even sooner but we can't tell your precise situation from the question as written. This is a good source of information.
I am employed and currently contribute out-of-pocket to the employer mandated plan. If I retire in one year, will it be more advantageous to buy retiree coverage and/or will I be eligible for less expensive coverage under the ACA?
Hard to answer without details on your retiree plan and which plans you will be eligible for on the Exchange. You'll need to compare coverages and premiums for our retiree coverage and for plans on your Exchange including any subsidy you might be eligible for on the Exchange.
Will I still be able to purchase a non-ACA plan that starts coverage prior to Jan 1st 2014 after tomorrow?
Certain provisions of the ACA became the law of the land, affecting all commercial health insurance. There will still be plans offered both inside and outside the Exchange however, and there are some plans that will be "grandfathered" relative to certain aspects of the law. A navigator or broker can advise you on this.
If you're receiving VA disability health care, are you exempted from buying Obamacare? If on Medicare, are there NY wrap-around plans?
VA services, as such, do not exempt someone from requirements for obtaining insurance. But it sounds like you are on Medicare as well. Medicare recipients are not subject to those requirements. Wraparound plans are not part of the ACA. To check on Medicare wraparound ("Medigap") plans, go to www.medicare.gov and use the planfinder program.
How do I comply when I have no job, no money, and receive no assistance? I live off the good will of my parents.
If you are under 26 you could be covered under your parents' insurance. If you are on your own and impoverished, you may qualify for Medicaid or a substantial subsidy to purchase health insurance.
My income is hard to predict and varies year by year. Every year, I pay my quarterly estimated income taxes, and the next spring, when I do my final taxes, I either get a refund or I have to pay a little more. That's why they are called "estimated" taxes. Shouldn't I think about the ACA subsidies the same way? I have no problem making my best guess, getting (or not getting) the subsidy if there is one, and then either getting additional subsidies or paying back a little at tax time, just as with my estimated taxes. Some people suggest that paying back some of the subsidy (for the happy reason that I made more money than expected) would be the ultimate nightmare -- it seems normal to me.
Yes. You are under no obligation to apply your full Advance Premium Tax Credit to your premium. You May wish to leave some buffer against unexpected increases in your income or you can accept the full amount and be prepared to pay back some portion if necessary.
I was fired from my last job and have to wait for a decision for my unemployment benefits. I have no income at all and am living on loans from family and gifts from friends. How does this affect my ability to qualify for the ACA?
If you are unemployed, you may be eligible for a subsidy to assist with purchase of insurance through your State's Exchange (Marketplace). Did you discuss the option of continuing your coverage under COBRA with your employer? You would be responsible for the full premium if you proceed under COBRA provisions. You might also want to find out if and when you might be eligible for Medicaid in your state.
I get social security but I am not old enough for Medicare. My husband is on social security and Medicare. I have been buying insurance on my own for the past several years after becoming unemployed. We manage on our social security and dividends and by selling investments. How do I calculate my income for possible subsidy?
Each state marketplace can make the eligibility calculation for you after answering a few questions.
I don't receive health care from my employer but my wife does. However, my wife is pregnant and will be leaving her job before Christmas to take care of our first child, which means she will lose the coverage by Jan. 1. Are we eligible to sign up now for a new plan that will cover all three of us now, or how would that work? And secondly, for a family of three with one working person (me), what is threshold for receiving a subsidized plan?
Coverage does not begin until January 1, so an Open Season starting October 1 seems like it will provide the perfect window for you to sign up for new insurance for your family.
I live and work in PA and make below $11,000 which may mean I'm not eligible for the marketplace but PA is not expanding Medicaid. Or are they? They say on Jan. 1, 2014 they are going to use a modified adjustable income to decide who gets Medicaid--what does that mean? What happens if I don't qualify for Medicaid and can't purchase a plan in the marketplace?
You will have to check with PA and www.healthcare.gov as to the PA Medicaid situation. There are some people who will fall between the cracks if they have income below the Federal poverty level (around $12,000) and are not covered by a Medicaid expansion in their state. Is there any way you can work more hours to make sure you qualify?
I've heard that the penalties associated with Obamacare will be automatically deducted from my checking account. Is this true?
The penalty will be paid as a federal tax liability on income tax returns and is enforced by the Treasury.
Does the law apply to residents of Puerto Rico?
I am a permanent resident but I'm unemployed and have no medical insurance. Am I eligible to enroll in the individual plan and how do I pay for coverage if I can enroll?
If you apply for individual coverage through the Exchange, you may find that you are eligible for Medicaid or a subsidy to help you purchase insurance.
If you live in a state that is not expanding Medicaid and do not qualify for subsidies, are you still expected to pay the fine for not buying insurance which you can not afford (because you presumably live at the poverty level)?
People who don’t qualify for their state’s Medicaid program but earn too little to qualify for subsidies on the exchange will have to pay full price for the coverage offered on the exchanges. So if you can’t get Medicaid and don't qualify for a subsidy, you will not be eligible for subsidized coverage on the exchange.
Will I be able to get a federal subsidy if I'm unemployed and on unemployment?
