Hello and welcome! Great to have you with us today. We’ll be starting the chat in just a few minutes, but if you have a question for our health insurance experts, you can go ahead and get it in queue.
To start us off, here’s a question from Mary in NE: “I was unable to get insurance, due to a preexisting condition. As a result, I don't have a primary care physician. Will I have trouble finding a physician because of the influx of new patients from the Affordable Care Act? How do I go about it?”
There may be a number of people looking for new primary care physicians, but you should still be able to find one, particularly if you are open to using a nurse practitioner as your primary care provider. Some plans do have narrow provider networks, however. The best way to find a provider is to look at the network of the plan you are choosing – and you may want to do this before you select a plan. Unfortunately, most of the marketplace websites do not allow you to do this so you will have to go to the insurance company’s website.
The penalty for not purchasing insurance is $95 per person or 1% of your income, whichever is greater. The penalty is collected when you file your taxes and will be assessed against any tax refund you are due.
First, make 100% certain that you’re getting the full subsidy for which you’re eligible. You also need to make sure that the cost of the least expensive plan available to you is not more than 8% of your annual income. If it is, you’re not required to carry insurance and you won’t face a penalty for not having coverage. If the insurance is truly too expensive for you, you may wish to not purchase a plan and instead pay the penalty, which will no doubt be less expensive than the cost of insurance. You can seek low cost care at a federally qualified health clinic. That would be unfortunately, but you can find a clinic by searching the U.S. Health Resources and Services Administration website: www.findahealthcenter.hrsa.gov/Search_HCC.aspx.
Your best course of action is to contact Kaiser directly to make sure they have your information and have you enrolled in their plan. Many of the marketplace websites are having trouble getting all of the information to insurance companies.
No, only children are guaranteed dental insurance under the law. You would have to purchase a separate dental plan to have that kind of coverage. In some cases medical insurers allow for a pair of glasses, but you would have to check plan details to see if that’s an offered benefit. It’s certainly not a requirement. However, prescription coverage is required. You can see a list of the 10 essential health benefits all plans are required to cover at Health.gov.
You are most likely better off purchasing a Medigap policy than purchasing a full medical policy through the marketplace. Medigap policies are designed to wrap around Medicare coverage and fill in the gaps in coverage. To get help finding a Medigap policy you can contact your local State Health Insurance Assistance Program (http://www.hapnetwork.org/ship-locator/). There is nothing to prevent you from purchasing a policy on the marketplace, but you would not qualify for a premium subsidy because you already have Medicare, and it may not be the best policy for you given you have other coverage.
David, when you're self-employed and your income fluctuates determining how much you'll earn for 2014 is a bit more art than science. If you think your income will be in the ball park of your past years' income, that's a reasonable amount to report. What will be important for someone in your situation is to then be vigilant about reporting any significant changes in income to your state's marketplace during the year. If your income drops dramatically, you'll be able to get a higher subsidy. If, conversely, it jumps by a lot, reporting that mid-year will allow you to avoid a tax bill.
You may want to check with the health insurance plan because some plans have clauses in their provider contracts that require providers to participate in all of the plans they offer. If it is true, however, that your provider is not participating in that plan and you want to stay with that provider, you may have to choose another plan. Ask your provider what plans he/she is participating in.
If you qualify for Medicaid and wish to receive financial help from the government to cover the cost of your health plan, you must take Medicaid. You don't have the option of instead selecting a private, subsidized plan. However, if you do not wish to have Medicaid and can afford to pay the full cost of a private plan with no subsidies, you are free to do so.
Dental benefits are an essential health benefit for kids ages 19 and younger.
About half the states have expanded Medicaid for individuals up to about $15,900 in income. If you live in one of those states, you can enroll in Medicaid. Unfortunately, if you live in one of the states that has not expanded Medicaid, you will not qualify for assistance.
Ralph, in response to your question, if you're applying for coverage through Healthcare.gov the amount of financial assistance for which you're eligible will be determined during the enrollment process. But perhaps you're referring to some other type of assistance -- it's not clear from your question. In order to buy a subsidized plan through your state's insurance exchange, you must enroll by no later than March 31, 2014. Any plan you buy today that is outside of the exchange will be your responsibility to pay for and you will not receive a refund once you sign up for a plan through Healthcare.gov.
Hi 2222, sorry if I wasn't clear. You can buy a silver or gold plan through the NY state exchange as long as you pay for it in full with no subsidy. If you apply for financial help, and your current income qualifies you for Medicaid, you're going to be required to take Medicaid. So, the only way to avoid Medicaid in your case is to pay for the private plan 100% on your own. Please follow up with another question if that isn't clear.
Most plans offered through the marketplace are unlikely to provide health benefits when you are overseas. You should check with your school to see what they suggest to students who are studying abroad. You can also work with an insurance broker to buy a policy that will cover you while you are traveling.
Hi Denise, the best way to determine whether the marketplace plans will be a better deal is to go onto Healthcare.gov and start shopping the options. In addition to the monthly premium it will be very important for you to closely evaluate the details of the plan benefits -- often employer coverage is more robust. Be sure to watch for how much you'll be required to pay in deductibles, copays and coinsurance for your care. Then evaluate which plan will be the better deal for you. Keep in mind that if you're not working right now (sounds like you're currently on a COBRA plan) you'll likely qualify for a substantial subsidy for a plan purchased through the exchange that could lower both your premium and your out of pocket costs.
You can buy a policy on the marketplace and use it as secondary coverage, although it may be more coverage than you need. You probably will not qualify for a subsidy, especially if the other coverage you have is Medicare, as you mentioned in your previous question. You should check with the marketplace in your state to verify.
You should visit the Covered California website (www.coveredca.org). Without knowing your income, I don’t know whether or not you would qualify for a subsidy to help you with your premiums. Covered CA is a good place to start, however, to see what your options are. You can shop and choose a plan through Covered California even if your income is too high to qualify for a subsidy.
Chris, those numbers sound awfully high for someone without an income. Perhaps it's your previous income that's being taken into consideration. In any event, I suggest you call the 800 number on your state's exchange to get help walking through the process. Without an income you should qualify for a plan with much lower monthly costs and/or Medicaid.