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Let’s get started with a question from one of our readers. Marie in NY asks: "How do I find a broker who handles individual insurance coverage? Would a health navigator provide the same function? I am currently on a direct pay plan for individual coverage and need to find a new plan for January. I'm confused by all the options and networks (none of which have all my doctors)."
To find a broker who can help you buy a plan through the Marketplace, check the National Association of Health Underwriters website at NAHU.org. You can search a listing of brokers operating in New York.
Our reader, Miranda asks, "I understand that I can get less expensive coverage than I now have, but doesn't that also mean the benefits won't be as good?"
Miranda, let me answer your question generally. And then let me suggest that you go on the website and really look at what your actual, factual options are so that you can determine what you have to pay and what coverage is available. First, in many states, consumers may find premiums that are lower than they would have paid before health care reform. This is particularly true for those with lower incomes who are eligible for subsidies, including tax credits. However, in some cases, the coverage available to you may be more expensive rather than less. As far as benefits go, as a general rule, they should be “better” than those in the individual insurance market before the law was enacted. For example, plans are now required to cover more preventive screenings and a list of government-guaranteed benefits including maternity coverage. However, you may face higher cost sharing than under a previous plan. So, again, let me emphasize the importance for all consumers of really getting on the website and checking out and comparing your options.
Tom, based on your income and family size you should qualify for a substantial subsidy with monthly payments well below $1,000 per month. In fact, your plan shouldn't cost no more than a few thousand per year.
As you likely know, there have been many different problems with the functionality of Healthcare.gov, and one of them is the accuracy with which it determines subsidy eligibility. I suggest you pick up the phone to speak with someone directly at Healthcare.gov to get personalized assistance walking through the process. You might also try working with an insurance agent certified to sell through Healthcare.gov. You can find one at NAHU.org by searching for an agent in your state.
Your Medicare benefits are not affected by the Affordable Care Act (ACA) generally. One way they are affected is that the ACA is beginning to close the coverage gap (sometimes called the ‘doughnut hole’) for prescription drugs so you will now have more comprehensive coverage than you previously had. Other than that, if you have Medicare, there is no need for you to shop on your state’s exchange/marketplace for a new plan. If you are looking for a new Medicare plan, open enrollment ends on Dec. 7th, and you can shop through www.medicare.gov.
Georgia is one of the states that has elected NOT to set up its own state marketplace, called an "exchange." So, to find out the options available to you, go to www.healthcare.gov and then select "Georgia." If the website is working, you should be able to check out plans available in your state.
Hi Mike, it's your household income that you'll need to report when applying for coverage. For most people that will be the same as what the IRS calls Adjusted Gross Income (AGI).
Regarding the issue of a marital status, in order to take advantage of subsidies you and your spouse do need to file taxes jointly, and both incomes will be counted when determining your eligibility for financial assistance.
If you have health insurance through your employer, you can still go online and check out the coverage options available through the exchange. Just be aware that most employer-offered coverage is subsidized pretty heavily by your employer. So, as a general rule, you will probably find that you have more comprehensive and more affordable coverage at work. But, certainly no harm in checking out the website and comparison shopping.
BLUEEDDOTR1 asks: "I'm just wondering...neither my husband nor myself drink or smoke, yet we have heard via the media, that our premiums are going to be higher, (to cover those who DO drink and smoke), simply because my husband and I both work. How is that fair? I realize it's called the "affordable health care act", but those who choose to make bad life style choices should have to pay more for their insurance, than those of us who make good health decisions."
Actually, people who smoke may be required to pay higher premiums than non-smokers. The Affordable Care Act allows premiums for smokers to be up to 50% higher than non-smokers so it can be a substantial penalty.
Your best bet is to call the 800 number on the exchange to discuss your case with a customer service representative. Make sure you have your reference # handy.
Once you're signed up, you should receive notice from your insurance company. You'll pay your premium directly to the health plan, and your first payment after the first of the year (2014).
You just want to make your best estimate as to your 2014 income. If you have a very low (or no) income now, but you get a job in 2014, you will want to let the exchange or marketplace know as soon as possible. Income changes during the year can affect the amount of your subsidy.
Theoretically, your insurer should be getting the information about your switch and contact you with information about your new plan. However, if you're signing up through Healthcare.gov, we know there are difficulties with the transfer of information. It certainly can't hurt to call your insurer directly.
I am so sorry to hear of your difficulty getting enrolled. I am sure this has been very frustrating for you. My recommendation is to go to www.healthcare.gov again. Just this weekend, the Administration made some upgrades to the website that are supposed to allow it to handle more traffic. You may also try to log on earlier in the morning or later at night when there may be less traffic on the site. If you are able to at least look at your options, you can then try to call the insurance carriers in your state directly, or go to their website. Many insurers have set up ACA enrollment websites where consumers can sign up directly, especially if they are having problems with the government website. Again, i know this is not a perfect answer. And I am sorry this has been so frustrating.
I wouldn’t describe the ACA as a one-size fits all, but it does create a minimum set of benefits that all plans in the individual and small employer market must cover (note: nearly all large employer plans already cover these benefits). Previously, most plans in the individual market did not offer very comprehensive coverage and had a number of exclusions (e.g., maternity, mental health coverage, even cancer treatments). The idea behind insurance is that it is spreading risk across a large group of people. At any point in time, many people will be healthy and won’t need to go to the doctor.
Your best bet is to work with an experienced insurance agent in your area who can walk you through your various options. It sounds like you have a very small company, so you might qualify for tax credits if you buy insurance through the ACA SHOP exchange (SHOP stands for Small Business Health Options Program). This would lower your costs.
You can find someone in your area by searching NAHU.org. You'll be able to plug in your state and look for an agent who can help you.
Mike, your experience is not unique. Some people are finding that premiums, as well as out of pocket costs, are higher in the new coverage. The reasons really have to do with the fact that insurers are faced with several new requirements. They have to enroll anyone who wants coverage. There are limits on how much they can charge, even for people with preexisting illnesses. They have to cover a series of mandated benefits. What this means is that many people who may not have been able to get coverage before, or who had to pay very high premiums for less-than-comprehensive coverage, are being helped. For some who had coverage before, they may find they are faced with higher costs-- either premiums or out of pocket costs, or both. I hope this provides at least some of the factual reasons for what you are experiencing.
If you don’t sign up for a plan by Dec. 23rd, you will not have coverage beginning Jan. 1, 2014. You can still sign up after that point, but your coverage will not begin until the following month. For example, you must sign up for a plan before Jan. 15th for coverage to begin Feb. 1st. If you sign up in late Jan., your coverage will not begin until March 1st. If you do not have coverage by March 31, 2014, you may be subject to a tax penalty.
If you're living outside the country for the majority of the year you are not required to buy health insurance under the Affordable Care Act. If you visit a physician while here for a visit, without health insurance you'll need to pay out-of-pocket for the services you receive.
Cynd - In several of the plans available through healthcare.gov, consumers will have to meet a deductible (pay that amount out of pocket) before the insurance plan begins to cover most benefits and services. Based on your question, you are also finding some plans that then require you to pay a percentage of the costs (so-called "coinsurance") for benefits or services after meeting that deductible. So, for example, you may have to pay 15% of the cost of a physician office visit after the deductible, or 25% of the cost of a hospital stay.
If you file taxes independently from your parents (i.e., they do not claim you as a dependent on their tax form), you would not have to include their income in your application.
Ben, plans vary from state to state and even from one health plan to another. You really need to take a number of factors into consideration beyond the premium, such as how often you go to the doctor and how much you'll pay in co-pays and co-insurance for your visits. What doctors are in the network and are your prescriptions on the plan's formulary? These are all important factors for you to evaluate among the various plans being sold in your state.
I suggest you work with someone to help walk you through the insurance options. You can find help in your area by searching on Healthcare.gov. You can also look for an insurance agent certified to sell insurance through Healthcare.gov at NAHU.org.
Individuals who earn up to 250% of the federal poverty level are eligible for additional subsidies to help pay their cost-sharing (e.g. deductibles, co-payments, co-insurance). The cost-sharing subsidies are only available for the silver plan and vary by income.