Hi, everyone. Thanks for joining this week’s live chat on the Affordable Care Act. 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, just click the “comment” link below.
Let’s get started with a question from one of our readers. Patricia in TX wrote in: “I have exhausted my unemployment benefits,I haven't worked in the last 3 years. I am 56years old without any source of income. What should I do about medical insurance? How can I obtain medical insurance without any type of income?”
Unfortunately, Texas is not expanding its Medicaid program, which you would most likely would have qualified for. You may still be able to take advantage of financial assistance available through the marketplaces, which will make private insurance available at a very low cost. You need to check what’s available to you through Healthcare.gov, though I would suggest waiting a few weeks to do so. The website, as you may have heard, has not been working properly. The hope is that within the next few weeks it will be easier to navigate the site. You might also want pick up the phone to talk with a person who can help understand your options. To find someone in your area, check out: LocalHelp.HealthCare.gov
Also be aware that people with incomes too low to file income taxes are not required to carry health insurance. If that’s your situation, you won't be penalized for not buying a health plan.
Under the Affordable Care Act, beginning Jan., 2014 you cannot be denied coverage based on pre-existing conditions. In addition, health status cannot be used to set your premiums.
You can estimate your income based on your last years income and/or your current pay. You will need to keep the exchange informed if your income is significantly different than you estimated when you applied for coverage. If your income rises during the year your subsidy may change during the year. Any differences between subsidies paid and what you were actually eligible for will be resolved when you pay your income taxes.
If you have insurance through your employer you do not need to enroll in a state marketplace. Marketplaces are primarily for people who do not have insurance or are looking to replace their existing insurance. If you are happy with your employer sponsored insurance you can keep it.
Hi Kay, if you're applying for an individual policy, you shouldn't be seeing deductibles in the range of $10,000. The law limits out of pocket spending to $6,350 per year. Families can't spend more than $12,700. Still, you're correct in saying that many of us -- especially those who do not qualify for a subsidy -- may find insurance costs high. The law will make insurance very affordable for some people, less so for others. Generally, however, the benefits will be richer than plans you can buy on the private market today. If you don't qualify for a subsidy because your income is too high, I recommend you work with a licensed insurance agent and compare plans that are sold both through your state's marketplace and off the marketplace. You'll have wider choices and an agent will be able to help you find the most affordable plan that's best suited to your needs.
There are a couple things you need to think about. If your employer pays part of your premium you will lose that contribution if you buy a plan on the marketplace. In addition, if you are eligible for employer sponsored insurance and your plan does not cost more than 9.5% of your income, you will not be eligible for a federal subsidy to help you with your premium.
Every year there will be an open enrollment period in which you can opt for any of the plans offered in the exchange. The number and types of plans sold in the exchange may very over time so it will pay review your options every year.
It's your modified adjusted gross income (for most people that's the same as their adjusted gross income) that you'll need to use when applying for insurance.
Here's where you can find that information on your tax form:
If you use form 1040 EZ - Line 4
Form 1040 A - Line 22
Form 1040 - Line 37
Medicare enrollment is not changed by the Affordable Care Act. Medicare eligible individuals will not purchase coverage on the health insurance exchanges. You should review your options under Medicare, but they have not changed as a result of the implementation of the health insurance exchange.
I just went on to bewellNM.com and there is a link to find a Navigator or health insurance guide, as well as an agent or broker to help you enroll. In addition, you can call the toll free number 1-855-99-NMHIX to speak to someone.
Generally, if you have health insurance through your employer, the marketplaces are not for you. If the insurance you're offered at work costs no more than 9.5% of your annual income and covers on average 60% of medical costs, you won't qualify for a subsidy when buying insurance on the marketplaces, even if your income would otherwise qualify you. You should have received a letter from your employer explaining whether or not your plan meets the law's requirements. Likely your best bet is to stick with your employer's plan.
Great question, Linda.
The answer is quite possibly yes. Part of keeping insurance costs down depends on a good mix of both healthy and sick people in the insurance pool in order to spread the risk. If primarily sick people who use a lot of medical services are signing up for coverage and healthy people do not, that can cause insurance costs to rise.
If the bronze plan quoted to you by your current insurer has a premium greater than 9.5% of your family income you are likely eligible for a premium subsidy if you purchase coverage through your state’s health insurance exchange. You can estimate the amount of the subsidy using the link above. The subsidy is based on the premium of a silver plan, but you can use that subsidy to offset the cost of any plan sold in the exchange.
It depends on whether your disability payments are a part of your adjusted gross income on your tax filings. If you have other sources of income, SS disability payments can be taxed, otherwise they are generally non-taxable and would be excluded from the income used to calculate a premium subsidy.
Yes, LM, it's very possible you will qualify for a subsidy on the marketplace, as well as qualify for help to lower your out of pocket costs when you go for medical care. Contact Healthcare.gov to find out.
Kathleen, you cannot assume that the provider networks of any two plans are the same. If you have a doctor and/or hospital that you want to continue seeing, you must confirm that the providers are included in each plan's network. You may be able to check through the marketplace, but always double and triple check by also contacting the plan directly and then your doctor's office.
But if you're offered insurance at work, Kathleen, you likely won't qualify for a subsidy unless the premium costs you more than 9.5% of your annual income. Your best bet is likely to stick with your employer's plan.
You will want to enroll in a plan for the gap in coverage you will have from February to August. While the healthcare.gov website has been having problems with enrollment, you can shop for coverage without registering. You can now see what plans are available to you and get a general idea of premiums (over age 50 and under age 50). Go to healthcare.gov/families and click on “see plans now.” If you are having trouble registering through the website you can also call the toll free number and register that way (800-318-2596).
Subsidies are based on the second lowest cost silver plan in your area. If you decide to purchase a gold or platinum plan, you'll just have to pay the difference of the more expensive premium.
Regarding your second question about how soon you can go to the doctor, a plan you purchase between now and December 15th will take effect January 1, 2014. At that point your benefits will be in effect and you can use your plan.
You generally won’t be able to add your parents to your employer insurance. Employers have rules on who is considered a dependent and the Affordable Care Act does not change those rules. Your parents can apply for their own coverage through your state’s marketplace and may qualify for a premium subsidy based on their income.