Hi, everyone, and welcome to the weekly chat. I’m Kim Richardson, a member of WebMD’s Affordable Care Act team.
We’ll get started in just a few minutes, but if you’d like to go ahead and submit your health insurance question, you can click the “comment” link to get your question in queue.
And just a reminder: WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD.
WebMD does not endorse any specific product, service or treatment. If you think you have a medical emergency, call your doctor or dial 911 immediately.
Three WebMD health reform experts will be answering questions today –William S. Custer, PhD, Sarah Goodell, and Lisa Zamosky. William is the director for the Center for Health Services Research at Georgia State University, Sarah is an independent health policy consultant specializing in private insurance issues. And Lisa is a healthcare journalist and longtime WebMD health insurance columnist and blogger.
Let’s start off with a question from one of our readers. Diane asks: “My husband and I split our time between residences in two states, SC and NJ. Will there be any exchanges that will be country wide?”
The law requires that marketplaces sell what are called multistate health plans. These plans are offered by Blue Cross Blue Shield, and are available now in 30 states. They will be offered in all 50 states over the next four years. Multipstate plans in some cases will offer national provider networks that may allow you the flexibility of buying a policy that provides coverage in multiple states across the country. However, not all multistate plans will give you access to cross-border benefits.
I would suggest you call the customer service line of your marketplace to discuss your various options with one of the staff there trained to help and to find a plan that best meets your specific needs.
People living outside the country are not affected by the law. Only residents will be able to buy insurance through the new health insurance marketplaces. If you return to the states and need health insurance, you would then be able to shop for insurance through the marketplaces in the state you live in.
One of our readers asked what to do if the insurance offered in the Marketplace doesn't include their doctors or hospitals. Bill, can you answer that one?
Many if not most of a state’s physicians and hospitals will be participating at least one of the plans offered in an exchange. However, most plans offered in state’s marketplaces will have a limited choice of physicians and hospitals. You can check the providers available in each network before you choose a plan. The information on the providers in each plan is linked on Healthcare.gov. You may also check the websites of the insurers in your state who are offering plans on the exchange to see what providers are included in each plan.
If you are happy with your employer-sponsored insurance, you likely will not have to do anything. While the media has picked up some stories about a few employers dropping insurance for their employees, the vast majority are not. Coverage under insurance purchased now through the marketplace does not begin until Jan. of 2014, so even if your employer does drop insurance, you will still have time to look at your options.
One of our readers asks: "I completed my application for Covered California's Affordable Care Act, and one of the requirements I need to do is submit a verification that I am a Californian resident. To whom do I send this information to and would a driver's license suffice?"
It’s your U.S. residency (not state residency) that the marketplaces need to confirm, and here’s the information you’ll need to do that:
• Social Security numbers for U.S. citizens, or document information for immigrants with legal status. Families that include immigrants can apply, and you can apply for your child even if you aren’t eligible for coverage.
• Employer and income information for everyone in your family.
• Federal tax information. If you don’t file taxes, you can still qualify for free or low-cost insurance through Medi-Cal.
Your residency and other information must be verified by a number of federal databases, so your driver’s licence will not suffice in this case.
There should be an option to submit this information in an online application. If that’s not available at this time, there is an address where you can send your information. You can call Covered California to find out where to mail the needed documents.
If you currently have COBRA coverage you can shop for alternative coverage in your state’s marketplace. Depending upon where you live you may have a wider choice of plans and premiums.
You can shop on your state’s marketplace when your insurance is about to end. Although open enrollment will be from Oct. 1-Dec. 15th next year, if your current policy is ending, you can shop and purchase coverage outside the open enrollment period.
Your ability to qualify for federal subsidies is based on your household income. So even if your spouse qualifies for Medicare, both your incomes will be considered when applying for a subsidy for yourself.
Your income would qualify your family for Medicaid coverage. You should begin the application process to get yourself started. If, however, you live in a state not expanding Medicaid, this won't be an option for you. If the monthly cost of your current plan exceeds 8% of your family's annual income, you won't be penalized if you don't have health insurance. If only your husband's portion of his employer's insurance also costs more than 9.5% of your family's income you could look to the marketplace for a plan and qualify for subsidized coverage. There are details about family coverage that you'll need explained to you in greater detail. Contact your marketplace to speak with someone about your options.
If you have specific prescription drugs that you take you do want to check with the individual health plan to see if it’s covered on the plan’s formulary. Prescription drugs are one of the 10 categories of essential health benefits so all plans will cover drugs, but plans can have their own formularies. There is a maximum out-of-pocket cost for prescription drugs of $6,350 so any drug costs after that will be covered.
If your child is already on Medicaid, that won't change. If your income is very low you should also check to see if you can qualify for Medicaid. You'll at least likely qualify for a health plan that is heavily subsidized and hopefully affordable for you. Check with your state's marketplace to learn about your options.
Premiums for individual and small group coverage are reviewed each year by the state Insurance Commissioners and/or the state marketplaces. Premiums are based on the entire marketplace’s experience, not on an individual’s health status. As a result premiums may rise in the future, but will rise at the same rate for everybody.
The essential health benefit provision applies to all plans sold on the marketplace or in the small employer and individual market. Plans that are considered “grandfathered” – meaning they have not made substantial changes since the ACA was passed – do not have to cover the essential health benefits. The majority of plans are not considered grandfathered, however.
If you qualify for a tax credit you'll be able to take it right away in the form of lower monthly premiums. If you prefer you can also pay the full premium throughout the year and take the credit at tax time, meaning the premiums are paid with after-tax dollars. Generally, you pay with after-tax dollars when you buy insurance on your own, unlike employer sponsored plans, which you do pay for with pre-tax dollars.
All insurance plans must cover the essential health benefits as described in the law. Many plans currently available for individuals do not cover those benefits. Your plan may be one of those plans. You can purchase a plan for next year on your state’s marketplace or on your own that will meet those requirements. Your costs will depend on the plan you choose and your income. Healthcare.gov will have a description of the plans and their premiums available to you.
Here's a question from our reader, Clement: "What if you're a veteran and have veteran health care. Do you still need to get insurance?"
If you have VA coverage nothing changes for you as a result of the Affordable Care Act. You do not need to concern yourself with the new marketplaces or the search for another plan. You'll stay with your current coverage.
You should look to your state’s marketplace to begin the application process. If your spouse’s plan costs more than 9.5% of your family income, it is considered unaffordable and you may qualify for subsidies to buy insurance on the marketplace. There are other specific rules about spouse and dependent coverage that should be answered by your state's marketplace.
If your daughter is under the age of 26 and your insurance plan covers dependents you can cover your daughter under your plan. She does not need to be a dependent for tax purposes to be covered.
I would suggest you contact your State Health Insurance Assistance Program for free, unbiased help selecting a plan. Find your local program by visiting the Medicare.gov Medicare Helpful Contacts page or by calling 1-800-MEDICARE (1-800-633-4227).
Audience member, Evelyn, asks: "If your employer offers health insurance to you have to take it or can you choose ins under the ACA?"
You are welcome to shop for insurance coverage in your state’s marketplace, but if your employer insurance is considered affordable – meaning it costs less than 9.5% of your income and covers at least 60% of your medical expenses – you will not qualify for federal subsidies.