Hi, everyone. Thanks for joining 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 a few minutes, but you can go ahead and submit your health insurance questions.
Let’s get to our first question. One of readers asked, “Exactly what does it mean when states are not expanding Medicaid?”
As originally drafted the Affordable Care Act required every state to expand its Medicaid program for all adults up to 138% percent of the poverty level (roughly $15,900 in annual income for a single person household). Prior to the Affordable Care Act, many states’ Medicaid programs covered only the poorest of the poor adults. Complementing the Medicaid expansion, the Affordable Care Act made federal subsidies available to people who made too much to qualify for Medicaid, but still had income low enough that insurance premiums were unaffordable. The Supreme Court struck down the requirement for states to expand Medicaid and instead made it optional. There is still a significant incentive for states to expand – the federal government will pay all the costs of the expansion for the first 3 years – but a number of states have decided against the Medicaid expansion. In those states, people who are between 100% and 400% of the federal poverty level can still get a premium subsidy to buy a private policy, but people below 100% and do not qualify for Medicaid will not receive any assistance.
If you have no income you are likely eligible for Medicaid. Eligibility for Medicaid will depend upon your state, but is free. The cost of private health insurance will depend upon your age, location and whether you smoke. If your income is below the Federal Poverty level ($11, 490) you are not eligible for a subsidy in the exchange
Yes, the tax penalty is small in 2014, but it will increase in subsequent years. One reason to have insurance is to protect you against a catastrophic event, such as a car accident or a cancer diagnosis. Without insurance, something like that could push you into bankruptcy. In addition, there are other benefits of insurance such as access to free preventive care, coverage for prescription drugs, and coverage for doctor’s visits. If your income is low, you should check with your state’s marketplace/exchange because you may qualify for federal assistance to help you pay the premium.
Diane from TN asks, “When can I use the ACA? I was told by one person it would be Jan 1, another right now. Just like to know the truth.”
Hi Diane, you can enroll right now, although as you've probably heard the website has been having troubles. Those problems are supposed to be fixed by the end of this month. If you want coverage for Jan. 1, you need to enroll by Dec. 15.
You can include them in your plan if you desire regardless of their tax status. If you have declared them as dependents and your employer offers family coverage that is deemed affordable they may not be eligible for a subsidy on the exchange.
You would need to check with your former employer’s human resources office. If you were a federal employee, this would be the Office of Personnel Management. Generally if you give up retiree health care you cannot go back on it at a later date. You can still go on your state’s exchange/marketplace to see how much coverage is through an individual policy and may find something cheaper, but you may put your retiree insurance at risk.
Mary, a reader from NJ, had a question: “Eligible for insurance in March 2014. Must I get insurance before that?”
Mary, the Affordable Care Act does not require you to get coverage before March. However, the law does require you to sign up for coverage by March 31, 2014 or face a penalty.
Whether you have to include Social Security disability as income depends on whether or not it is your sole source of income. If you have other income in addition to your disability benefits, they may be taxed, otherwise they generally won't be.. A good answer is to see whether you included disability income as adjusted gross income when you filed your taxes last year.
Medicaid costs currently are split between the Federal Government and each state. If a state expands Medicaid in 2014 the Federal Government pays the entire costs of Medicaid expansion for the first three years. After that state’s share increases by 2.5 percentage points every year until 2021. For every year after that the Federal Government pays 90% of the costs and the state 10%.
Brenda asks, “Who are the 3 insurance companies for Illinois?”
You can always purchase insurance on your own – either through your state’s exchange/marketplace or on the individual market. Whether or not you qualify for a federal subsidy depends on whether your insurance was considered “affordable.” Affordable insurance is defined as insurance that costs no more than 9.5% of your income and covers at least 60% of your medical expenses. If your employer insurance meets those standards, even though it may seem expensive to you, you would not qualify for federal assistance. Again, though, this does not prevent you from buying insurance and paying for the full cost yourself.
You can switch from COBRA coverage to coverage on the exchange at any time during open enrollment (its open through March of 2014). The earliest your coverage under the exchange would begin is Jan. 1, 2014
I’m not sure exactly what you mean by “dropped” but if you lose your existing coverage for any reason (other than a failure to pay your premiums) you have experienced a “qualifying event” which allows you to shop for insurance and enroll in a plan outside the open enrollment period.
Martha wrote in from Maryland with a question: "I am very happy with my health insurance plan. I have the GEHA - Government Employee Health Association and I really don't want to sign up for this Obamacare. Will I still be able to keep mine?"
Hi Martha, unless you've been told that your current insurance plan will no longer be available to you, you can keep it.
There are a lot of factors that go into the price of insurance – how much competition there is in the area, how many hospitals and physicians are in a given area and how strong their bargaining power is, how sick the people are that the insurance company to enroll, etc. However, many of the policies offered through the marketplaces/exchange actually have lower premiums than many experts expected. You should try shopping on your state’s marketplace to see what the premiums are. If you have low income you also may qualify for a subsidy.
One of the key features of any health insurance plan is the network of hospitals, physicians, and other care givers available under the plan. In choosing a plan you need to understand where you need to go to get care covered under the plan. A general rule of thumb is that the less expensive the plan the more restrictions there will be on your choice of providers. In most of the exchanges you will be able to find an option for coverage that includes the hospital of your choice, but you have to be look that each plan’s network to ensure your provider is included.
You can provide your estimated income for 2013 and use that to see if you qualify for a federal subsidy. If there are any discrepancies between your estimate and your actual income once you file your taxes, you will want to let your state marketplace/exchange now so they can adjust any subsidy you are receiving.
Hi ZKreider, unfortunately there is no easy, consistent way to determine the overall quality of care of a given clinic or emergency room. There is no site or other place to go to get objective ratings. Your best bet is try talk to family and friends. Find health care providers that they like and that they feel offer them the attention their medical needs deserve. There are some rating sites but just be cautious with those as you're getting the opinions of relatively few people. Plus, people may be more likely to complain than rave about the wonders of their medical care. They can be a decent place to reference but don't rely solely on those. Best to talk to people who you trust.
Here's a question from Albert in NJ: "I am 63 years old and collect social security. 1/3 of my income goes to health care. What plan is right for me? I need a plan to help with my 6 medications. My income is $26,000 a year – do I qualify for a tax credit?"
Based on your income you should qualify for a tax credit. $26,000 in yearly income for a household of 1 is about 226% of the federal poverty level. Subsidies are calculated based on a maximum percent of your income that you would need to spend for the second lowest cost silver plan in your area. At your income, you should qualify for a subsidy that would require you to spend no more than about 7% of your adjusted gross income in order to purchase the second lowest cost silver plan. You can use that subsidy to purchase a more expensive plan – such as a gold or platinum plan – which will have a higher premium, but cover more of your out-of-pocket costs. Because you take a number of medications, you will want to check with a plan’s formulary to make sure they are covered before enrolling. A Navigator can help you if you need assistance. You can also use the WebMD Coverage Advisor tool which can help show you how your total out-of-pocket costs will vary based on the type of plan you choose.
You will be able to purchase an individual plan just for you, but your eligibility for a subsidy in the exchange will depend on your family income. So to determine your costs of coverage you need to include both your and your husband’s incomes. Once you have determined if you are eligible for a subsidy you will just purchase a single plan.
If you have employer sponsored insurance, you do not have to enroll in another plan. Likewise, your husband would not need to enroll in a plan just for his U.S. visits.