Hi, everyone. Thanks for joining our weekly chat on Marketplace enrollment. I’m Kim Richardson, a member of WebMD’s Affordable Care Act team. We’re going to start answering your health insurance questions in just a few minutes, but if you’d like to go ahead and get your question in queue, just click the “comment” link below.
And as 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.
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Let’s start off with a question from one of our readers. Denise asks, “If a person has insurance through their employer, and the insurance doesn't meet the 10 requirements of the insurance offered on the Exchange, will the employee be required to purchase other insurance or will it be up to the employer to make changes?”
You will not be required to drop your employer’s insurance coverage to buy a plan on your own. Though you can buy a plan through the marketplace, it would likely be a mistake for you to do so.
And your company may not be required to make changes either. If your company’s health plan has grandfathered status it does not have to offer insurance covering the 10 essential health benefits. Companies that pay medical claims out of their own funds (called self-insured plans) do not have to comply with this part of the law either. Check with you HR department about these two details of your insurance.
One of our readers, Joyce, has already visited the Marketplace and has a question about what she found: "I have quotes for myself and my 2 children. One example of Marketplace costs is Blue Cross Premier Gold = monthly premium of $1,112.09. Figuring it with my actual income reduces it with tax credit subsidies to $614.01 per month. Does the government pay that difference to BCBS or does BCBS reduce the premium?"
Joyce, it looks like you’ve already done a lot of research on your options. If you do qualify for tax credit subsidies from the federal government, you can choose to pay the monthly premium in advance and then claim the credit later on your taxes, or to have the credit sent directly to the insurer. If you choose the second approach, you would pay the reduced premium amount. For consumers who qualify for additional assistance with reduced copayments and deductibles, those extra subsidies are sent directly to the insurer or health plan you choose so you do not have to pay those amounts out of pocket.
Go to Healthcare.gov. There you'll want to click on the "apply now" button, which will take you to a drop down menu where you can pick your state. You'll be led to a page with information about your state.
Our reader, Ruby, asks: "I cover my daughter thru my employment but will be retiring March 2014. My Daughter is 23 and will be dropped from my insurance. Should I have her apply for this now? or cover her until my retirement date, then have her purchase her own insurance?"
Your daughter has until March to purchase coverage on the exchange. So she can wait till Janurary or February to sign up for coverage that will take affect when she loses coverage under your plan. While she could purchase coverage on the exchange anytime, if she is your dependent she will not be elgibile for a tax subsidy on the exchange until she loses access to your coverage in March.
If your daughter is not a dependent for tax purposes you may want to begin exploring her options on the exchange now. She may be eligible for a subsidy that could make it less costly for her to enroll in a plan that begins in January.
John, while there are some differences among the states, generally, information about the law and its impact on people looking for insurance apply across the board.
You can purchase coverage for your son on the exchange that will take effect on January 1, 2014. You can access the exchange at Healthcare.gov. Your income will determine if he is eligible for a subsidy.
Will, small businesses will be impacted by the new health law. And, you're right, there is a lot of confusion. To briefly summarize, small businesses can get some help with coverage through tax credits, in some cases. These are generally available to employers with lower wage workers who have les than 25 FTE employees. Also, while larger employers have to meet more requirements under the law, small employers also have several reporting requirements. Here are just a few examples. (1) Small employers have to notify their workers about the new health insurance marketplaces-- called exchanges; (2) employers-- even small employers-- have to withhold additional Medicare taxes for higher income workers; and (3) small and large employers have to provide employees who have coverage with accurate summaries of the benefits they are eligible for. These are just a few examples. In addition to the tax credits, small employers may have some additional coverage options because they can enroll in so-called "SHOP" or small business exchanges in some states.
When you fill out an application for insurance you'll need to report both the wages you earn from your part-time job and your Social Security income. It's your total income (minus tax deductions) that count toward determining if and how much of a subsidy you qualify for.
Whether or not health plans available under the Affordable Care Act will cover second opinions will vary according to the individual insurance plan. There is no mandate under the law requiring insurers to cover second opinions. So, if that is important to you, be sure to check with the individual carrier before you sign up for a plan. And, because insurers may distinguish between the kinds of second opinions they cover (e.g., may cover a consultation with another doctor, but not necessarily a round of new expensive diagnostic tests), be sure to be specific.
In 2014 the maximum a single individual will pay out-of-pocket in 2014 will generally be $6,350 while a family could pay up to $12,700. These include deductibles and any copays or coinsurance payments. This is true for most consumers including those whose plans are purchased in the exchanges, but people covered by employer plans with pharmacy benefits administered by a different company than the primary insurer may face higher costs for drugs in 2014. This difference goes away in 2015.
The health plans sold through the marketplaces will cover many services required by people with critical illnesses, such as cancer or chronic diseases such as diabetes. It's important to carefully evaluate the specific services provided by each plan you're considering to make sure it will cover what you need. You can buy a separate critical illness plan, which is a supplemental insurance policy that can be added onto a major medical insurance policy. But these plans have not been impacted by the Affordable Care Act and they can't be purchased on the marketplaces. Long term care insurance is also a separate product, and something you'd need to apply for a purchase outside of the marketplaces.
Liv, your mother's situation with Medicare is becoming more frequent. As Medicare payments have not increased over recent years, more and more doctors are not seeing new Medicare patients. Unfortunately, the new health insurance exchanges under the health care law are not for Medicare patients. But, one option your mother may want to consider is looking at available private health plans that serve Medicare patients- so-called "Medicare Advantage" plans. The good news is that you can always stay with your traditional Medicare coverage. Or, go back to it, if the private Medicare advantage options don't work for you.
The fact that you have employment based coverage will affect your spouse’s eligibility for a tax subsidy in the exchange since she is eligible for coverage, but it will not limit her ability to purchase coverage on the exchange. Nor will her choice affect your coverage except that you may now opt for single coverage through your employer’s plan.
Hi Gloria, thanks for joining us today. Unfortunately, your daughter can only stay on your plan up until her 26th birthday -- really only through the end of her 25th year. If she has a job that offers insurance, she'll want to take a close look at that option. Otherwise, you'll want to shop the marketplace to get her a plan.
Angie, if your son is already on Medicaid, you do not need to make any changes or sign up for new coverage. It is important that you do recertify for Medicaid at the appropriate time, so make sure that coverage continues.
Generally for the Affordable Care Act your total income is simply your Adjusted Gross income your report on your income tax. Income from some investments may count as well, but the content of your portfolio will not be examined in determining income for subsidy eligibility.
Hi Lori, The good news for you is that you're now eligible to purchase a health plan through your state's marketplace. If you're not working, it's highly likely you'll pay significantly less for a plan than what your COBRA coverage currently costs. In addition, the health reform law now makes it illegal for insurers to deny anyone on the basis of their medical history. So, the concerns you've had in the past about being denied because of your health condition will go away.