Hi, everyone. So happy to have you with us for this week’s chat. I’m Kim Richardson, a member of WebMD’s Affordable Care Act team. We’ll be getting started in just a few minutes, please feel free to go ahead and submit your health insurance questions.
Let’s kick things off with a question from one of our readers. Helen from PA asks, “In the past (prior to ACA), I have been told that is often less expensive for husband and wife to have their own individual plans rather than a family plan. Is this advisable for the ACA as well? Are there specific instances where it is or isn't?”
Family coverage has historically been more expensive than two individual plans. But some of the reasons for that are changing with the law. If you buy your own coverage now, for example, (prior to ACA taking effect) insurers can charge more for pre-existing conditions, charge women more than men and increase your rates by a lot because of age. While insurers can still charge more for age in 2014, they are limited to a maximum of three times what they would charge a younger person. Women can no longer be charged higher rates, nor can people with pre-existing conditions.
That’s all to say I’m not certain you would save much by getting a separate plan from your husband. You can do it, of course, but if you qualify for a subsidy, you’ll probably want to get some help figuring out the best way to split that between the plans. I would suggest you go online to your state’s Marketplace and test out a few options. See what a joint plan would cost and then the cost for two plans if you buy separately. Check out Healthcare.gov to find information for your state.
Dinubhai, you will need to call an insurer and speak with them directly.
Mary, you need to confirm whether your husband's employer sponsored plan meets the law's affordability requirements. If the cost for just your husband's policy is less than 9.5% of his income and the plan covers on average 60% of medical costs, he won't be eligible for a subsidy, even if your household income otherwise qualifies you. However, if you're willing to pay the full cost of a health plan and wish to shop around for better coverage, there's nothing stopping your husband from buying a plan on Marketplace.
Christina, you can have the credit sent to the insurer directly or you can elect to pay the premium in-full and then receive the tax credit at the end of the year.
Hi Dennis, to qualify for Medicaid you can earn no more than about $15, 856 per year. But with an income of $21,000 annually you will qualify for tax credits that should substantially lower costs. You'll also get some financial help paying for out-of-pocket costs associated with doctor visits and filling prescriptions.
De Ann, employers with more than 50 employees who do not offer coverage to dependent children under the age of 26 will have to pay a penalty.
It's your 2014 income that the subsidies are based on, though you will be asked for income information for previous years when applying for coverage. Social Security income does count toward your annual income. So too will IRA distributions.
Mary P, Delaware opted not to run a state exchange (instead, they are using a “partnership model”). You will need to go through the federal exchange (healthcare.gov), which, as you probably know, is not running smoothly.
Syd, a lot of people are upset about the cost of health care under the law. The fact is the price of health plans are going up for several reasons, including the fact that insurers are now required to offer richer benefits and because many of the underwriting practices insurers used to limit their risk (like denying coverage to people with pre-existing conditions) are now illegal.
For lower income people who qualify for a subsidy, the cost of insurance may be quite affordable, actually. Many will have access to very low or in some cases no-cost coverage. But if your income is above the threshold to qualify you for financial help, you'll likely find your costs going up. Those optimistic about the long-term effects of the law believe that with millions more Americans insured in time health care costs will slow. But that remains to be seen.
Tina, it has been awhile since my wife gave birth, but the costs of even a routine childbirth can be substantial, like $15,000 (this includes the insurers’ cost). It depends on the tradeoff between premiums and your expected out-of-pocket cost, but I would strongly consider paying more for a “Gold” or “Platinum” plan if you know you are going to give birth next year.
Sharon, I recommend you call the 800 number on the website or go to LocalHelp.HealthCare.gov to find a navigator or other type of helper who can assist you by phone or in person.
Steve S, you can switch if you have a “life changing event”, but otherwise no, you cannot switch. You have to wait until the open enrollment period.
Steve, you can no longer buy an underwritten health plan -- the ACA has now made medical underwriting an illegal practice. You have no option but to buy a plan that is compliant with the new law.
Bob, everyone who has qualifies for care through the Veterans Health Administration has coverage. If this applies to you, you do not need to buy a private policy
Eleanor, I would call the disability office in your state to see if you can get some guidance as to what he might expect the payments will be. But regardless, he's unemployed right now and it could be quite some time until those payments kick in. I would suggest he report his current household income and when he begins receiving payments, contact the Marketplace to report the income change.
Mush, you will not need to pay the penalty. Unfortunately, your options are limited to buying a private plan. You will not be eligible for subsidies to buy insurance under the Affordable Care Act.
Steve, in most cases insurers that are doing this are offering people already insured with them the chance to sign up again for another year, generally at a lower price. You can keep a non-ACA compliant plan through 2014. But that option goes away in 2014 -- and it's not an option for consumers living in some states because the Marketplaces have not allowed it. If you've been given the chance to buy or renew a non-ACA plan for another year, then I'm guessing you already know the difference in price -- likely the companies are offering a less expensive option with a plan non-compliant with the law. The plans also typically offer benefits that are not as rich. As I first stated, however, this option for most people goes away.
Linda, no. As long as you have Medicare, you do not need to take any additional steps.
LJ, unfortunately, you can be charged 50% more for smoking. Although people who get coverage through work do have the option to participate in a smoking cessation program and get a break on their coverage as a result, it's not an option for people buying coverage on their own. If you are successful in quitting you can report this to your state's Marketplace and ask that your premiums be re-calculated based on the change. Best of luck to you!
Virginia, this is a tough situation. If he has no income, he will not qualify for subsidies under the ACA Exchanges. You might file an appeal for SSI/SSDI so he eventually gains Medicare coverage.
Julie, you will need to make your best guess about what your income will be next year. If it differs substantially from your income this year, you may have to provide some documentation.