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.
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Let’s get straight to some questions from our readers.
The best thing is for your boyfriend to contact the Connecticut marketplace, known as Access Health CT (https://www.accesshealthct.com). From here he can fill out an online application that will determine whether he is eligible for financial assistance to buy health insurance or qualify for Medicaid. Because he is not working right now and you indicate he does not have an income, it is quite likely that he will qualify for Medicaid.
If your plan isn’t scheduled to start until March, you are not covered for the months of January and February. What the letter you received from Covered California was likely informing you of is the need to submit proof of your income, and that you have 90 days from the start of your plan to do so.
That means your premiums will reflect the tax subsidies you’re eligible for during your plan’s first 90 days. However, if you fail to produce the necessary paper work showing proof of your income within that time period, your premium will revert to the full price.
You should go to www.healthcare.gov. This is the federal health care marketplace that will allow you to fill out an application to find out whether you qualify for a subsidy to purchase insurance or whether you qualify for your state’s Medicaid program. Some states have their own marketplace with a separate website, but healthcare.gov will direct you to their website if that’s the case.
Insurance companies tend to deny claims on the basis of whether the service or procedure you received is medically necessary, or if your benefits package doesn’t include the care. In many cases you can avoid denials by taking a few steps in advance of going for care: make sure you check your plan’s benefits summary to confirm the services you need are covered by your policy, get pre-authorization when needed before going for care, check your plan’s formulary to confirm the drugs you need are covered, and stick with in-network providers whenever possible.
If, however, you’ve followed all the guidelines and are still denied, the health reform law entitles you to at least two levels of appeals -- an internal appeal with your insurer and then an external review by an independent third party. The appeals process is often effective at getting denials overturned.
March 31st is the end of the open enrollment period. After that date, you will not be able to sign up for coverage through your state’s or the federal marketplace except under certain circumstances, such as you lose a job. The next open enrollment period will begin in October.
Worker’s compensation payments are not considered income for purposes of qualifying for a subsidy to purchase health insurance.
You’re eligible to buy coverage through the Marketplace, so contact Healthcare.gov to begin shopping. That’s definitely the best bet for your wife. But at 70, if you’ve been a legal immigrant and can demonstrate permanent, continual residency in the country for five years you are entitled to Medicare coverage. You can contact Medicare.gov for assistance.
If you are receiving unemployment compensation, you can use that as proof of unemployment. Otherwise you can show them a copy of you 2013 taxes showing your income. In general, subsidies are based on your estimate of your 2014 income. If you don’t have a job and don’t expect to get one this year, you can estimate your income reflecting that. If your situation changes during the course of the year, you will want to let the marketplace know because your subsidy may change as well.
When you file 2014 taxes next year, you'll need to state that you didn't have health insurance this year and you'll technically be assessed the penalty. If you are owed a refund, the IRS will deduct the penalty from that sum. However, in reality if you are not owed money the law provides no way for the government to collect those funds.
If your mother is considered a dependent on your income taxes, then you would have to include her income in your application for a health insurance. If she is not a dependent, than you do not have to include her income.
Becky, one of the benefits of buying insurance through the Marketplaces is that if during the year you experience a significant change in your income you can report that and have your premiums adjusted. So, if you lose your job, your premium will drop significantly. Just make sure to report that to Healthcare.gov (or your state's marketplace if you live in a state running it's own) once the change occurs.
Yes, generally an IRA withdrawal is counted as income.
Reports are consistent with your experience – the wait time to get in touch with Covered California is very long. The exchange has recently hired additional staff to handle the high call volume, but it’s going to take some time to get them up to speed and to see a real impact in the call center.
The phone number for the exchange is (800) 300-1506 – that’s listed on website, and it is an active number. Unfortunately, I don’t have another phone number to offer you. But folks I’ve spoken to who work with the call center frequently suggest not calling on Mondays because that’s when things are busiest and it’s hardest to get through. Instead, try calling on Thursdays when the call volume is a little lighter.
There are a couple things. States have Navigators to help you with your health insurance options, including guiding you through the application and enrollment process. You can go to (https://localhelp.healthcare.gov/) to find a Navigator in your area. Secondly, if you are disabled, you may qualify for Medicare. Contact the Social Security Administration to see if you qualify (www.ssa.gov).
Alice, when you sign up for coverage between the 1st and the 15th of the month, your coverage takes effect on the 1st of the following month. If you sign up between the 16th and last day of the month, your coverage starts the first day of the second following month. That means if you sign up on March 16th your coverage kicks in on May 1st.
If you have insurance you should be using it whenever you go to the doctor, even if the bill is below your deductible. You will never meet your deductible if you are not counting all of your bills. In addition, you may be eligible to pay the lower prices the insurance company has negotiated with the doctor. Finally, if you cannot afford to pay for the services below your deductible, you may be able to work out a payment plan with your doctor.
David, you can wait until you lose your work-based coverage. Though open enrollment ends March 31st if you have a qualifying event -- the loss of a job, getting married, having a baby, for example -- you can sign up for coverage outside of open enrollment.
It is really hard to predict what will happen with insurance costs in the future. Premiums for employer sponsored insurance have been rising around 5-10% per year over the last decade – well before Obamacare was passed. Employers may be pointing their finger at Obamacare as the source of rising premiums, but that can only be a part of the story based on experience over the last decade.
I would try to contact the carrier directly to see if you can get through and make arrangements to pay. Do understand that insurance companies remain highly backlogged in many cases. The volume of paper work to process is high. So there will likely be a delay in getting your paper work, and you may have to settle in for a long wait time to get through to the company by phone. But I would try to make sure you don't miss your payment date, so go ahead and give them a call.
You have until March 31st, the end of open enrollment period, to make a change in your health plan. Find out from your doctor which insurance plans he/she participates in and then contact your Marketplace to make the switch.
Melissa, does your mother claim you and your children as dependents on her taxes? If not, then just because you live in the same house doesn't mean your "household incomes" are one and the same, and you shouldn't be reporting her income as part of yours. If, however, she does claim you on her taxes then you must report her income. In Florida, your Marketplace is run by the federal government, so go to Healthcare.gov to begin the shopping process.
An EOB is an Explanation of Benefits. It shows what services you received at your doctor’s visits, including any tests that were performed, and usually includes a procedure code that providers use to bill insurance companies. It will show the amount the insurance company paid – often very different than what was billed by the doctor - and anything that you may be responsible for. This is different from a bill, however. If the EOB shows that you are responsible for an amount, you will be billed separately for that, usually by the provider directly.
Once your adult child turns 26 he can no longer stay on your plan. That's only allowed through the end of his 25th year. He can shop for coverage on his own (if he doesn't have an offer of insurance coverage through a job) at Healthcare.gov. Many young people are eligible for a tax subsidy that may lower the cost of his coverage.
Pregnancy benefits are much better under Obamacare than what was previously available in the individual market. Before Obamacare, most policies excluded maternity care or covered it only if you purchased a ‘rider’ – an addition to your policy that was often very expensive. Under Obamacare, maternity benefits are one of 10 essential health benefits that all non-grandfathered plans in the individual and small employer market must cover.
Yes, for the purposes of reporting income to determine your eligibility for tax credits under the ACA, Social Security benefits must be reported.
You should definitely contact Covered California to find out if you qualify for a subsidy. The plan you currently have may not be available through Covered California so you may have to switch plans, but there are a number of plans that are available through this exchange.
This can be tricky. You can call your doctor and ask, though sometimes they can't give you a firm price. Your insurer may have a cost calculator on its website to help you plan in advance for costs and select the most cost-effective provider in your area for your medical need. And, there are cost calculators available to help you project what your costs might be. Healthcarebluebook.com and Fairhealth.org are two to try.