Hi, everyone! Welcome to this week’s live chat. We’ll get started in just a few minutes, but you can go ahead and get your health insurance question in queue if you’d like.
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Let’s get started! First, we have a question from Maxine in CT: “If my current doctors are stating that as of now they are not going to participate in the insurance exchanges, how will I be able to continue to use the same doctors?”
You should look carefully at the provider networks in each of the plans you are considering. Some plans may include some of your doctors because they are using the same provider contracts they have for other insurance products they offer. You can also see what type of coverage the plan has for going out of network. But it may be the case that you have to change providers in order to use a policy through the exchange.
Go to Healthcare.gov. In the middle of the page is button that says “See Plans Now” Click on that button. On the page that button takes you to is a statement “How to view health plans and prices” Click on the link in the first sentence (where is says “plans and sample prices” Remember the premiums are not the actual costs you will face. Your actual costs will vary by your age and whether you are eligible for a tax subsidy. But you will see the plans available in your area.
Hi Marie, you should always double check directly with your doctor to confirm that he/she is in a health plan's network because mistakes on those lists are common. In addition, doctors come in and out of networks all the time so you can't assume that because your doctor participates today that will always be the case.
One of our readers, lkamala, had a question: "LPR above 65 years presently living in Connecticut --reen card ot in 2011-- annual income less than 100%-- wish to know whether eligible for government susidies for health care though health market place of CT."
You should check with the exchange in Connecticut (http://www.ct.gov/hix/). You may qualify for Medicaid depending on how long you have been in the country (there is generally a 5 year ban on Medicaid eligibility for legal immigrants). If you do not qualify for Medicaid because you have been in the country fewer than 5 years, you should qualify for a federal subsidy to purchase a private plan on the exchange.
If you don't qualify for a subsidy, you can shop outside of the exchange. And, it would be a good idea for you to do so because you'll have a wider selection of plans from which to choose. You can buy insurance directly through an insurer or work with an insurance agent to consider a wider range of options.
Your eligibility for a subsidy is based on your family income, so yes you need to include your husband’s income in your application. You can estimate what subsidy you would be eligible for using WebMD’s calculator.
If you qualify for Medicaid those are the plans you’ll be offered. If you decide instead to buy a different type of plan you’ll be required to pay its full cost. Consumers don’t have the opportunity to choose the type of financial assistance they accept.
The income you use is your Modified Adjusted Gross Income, which in most cases is the same as your Adjusted Gross Income on your tax form. So it is not your total income, but the income adjusted for your deductions and credits.
If you’re a company with employees in more than one state you have the option to either establish one SHOP account that serves all of your locations, which you could do in the state in which your company is headquartered, or you can set up accounts in each state where your employees are based.
Steve in OK has a question: "Once I enroll in a plan, do I have to stay enrolled for the whole year or can I change plans if I decide to do so within a shorter time-frame?"
Generally, if you are purchasing individual health insurance coverage you can change plans only during open enrollment periods. You can move across plan types (individual, employment-based, etc) during the year if your status changes. For example if you lose a job where you had health insurance, or if your birthday means you can’t stay on your parents plan, or if you move to a new area.
Karen in NY writes, "Will I get coverage for dental if I qualify for the new Medicaid on Jan. 1,2014? I was also wondering if I have to report my widow veterans benefit along with survivor benefits from Social Security as income?"
New York's Medicaid program does include dental coverage for adults. Social Security benefits do count toward income. Widow Veteran benefits do not.
You and your husband can purchase separate policies if you prefer. Your eligibility for a tax subsidy to help you purchase your policy if you qualify, would be based on your household income. So if you are purchasing two policies you would each be able to use half of the credit. Whether you should purchase an individual or a family policy based on you and your husband’s health circumstances will depend on the policies available to you. You should look at whether the deductible applies to each of you individually or whether there is a family deductible. In the case of the family deductible, your husband’s health expenses may satisfy the deductible for both of you and it could be advantageous to purchase a family policy vs. two individual policies.
Kaylo, If you are offered affordable coverage by an employer, you can buy insurance through the new Marketplaces but you won't be eligible for tax credits. Affordable employer health insurance is defined under the law as that which costs no more than 9.5% of your income and covers at least 60% of covered medical costs.
That will depend upon the plan you purchase. Some plans have no out-of-network benefits. That means if you do not go to a provider listed as in network you have to pay the entire costs and those costs are not counted toward your out of pocket maximums. Not all plans have that feature. You need to check with the insurer offering the plan. While if varies depending on the state you are in, most plans that are labeled HMO plans have no out-of- network benefits.
The situation is very frustrating, and you’re certainly not alone in facing obstacles. One other option you might want to try is to speak with folks in your area trained to help consumers through the process. You can find someone local here: LocalHelp.HealthCare.gov.
You can shop for a policy on the exchange/marketplace for just your wife. Even though you are only purchasing a policy for her, they will look at your total household income in order to see if you qualify for a subsidy. Based on your income and a household of 2, it looks like your wife will qualify for a subsidy to help pay her premium.
If you lose health insurance coverage outside the open enrollment period you can sign up for a plan at that time.
Yes, New York Medicaid does cover some vision care including eyeglasses.
Only pediatric dental coverage is included as an essential health benefit. Some plans may offer limited dental coverage for adults, but it is not required and probably not very common. It is probably most common in an HMO type plan.
Louis, projecting your income for 2014 when your work situation is in flux is a bit more art than science. Make your best estimate as to what you expect you'll earn for next year. If your income rises mid-year you just have to report that to the Marketplace (you can call the 800 number). Adjustments will then be made to the amount of subsidy you receive and that will prevent you from having to repay at tax time.
Judy in FL asks: "I am on SSD for RA and Neuropathy and am not covered by SS insurance until May or June of 2014. What do I do?"
You can buy a policy on the Florida marketplace, run by healthcare.gov, and drop it once you qualify for other insurance.