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Let’s get started with a question from one of our readers. Joseph in NY asks: “My current insurance plan is being cancelled as of December 31. I read in the newspaper that the federal government has passed a law that requires health insurance companies to continue current health insurance plans. Is this true?”
Joseph, the president did address the issue of plan cancellations in November. Although many of the plans being cancelled would not be allowed under the Affordable Care Act because they do not meet all of the requirements such as including all the essential health benefits, the president said he would allow states to let insurers offer early renewals to people who currently held such policies. Therefore, instead of your policy expiring at the end of this year, your insurer could give you the opportunity to renew it before the end of the year thereby providing you insurance through 2014. The key word is “allow”. The president does not have the authority to require states to do this nor does he have the authority to require insurers to comply. In your state, New York, the insurance commissioner has decided not to allow early renewals so you will need to find a new policy for 2014.
And here's a question submitted over email from our reader, Betty: "I have been told my current health insurance carrier will not offer health insurance after 12/31/13 and I have applied over the phone and contacted them four more times as they keep telling me that they have a glitch in their system. The insurance company is MAhealthconnector and on the last call they told me not to call again, they would contact me. I am very concerned because this has been going on since October, and I can't get a response."
The MA HealthConnector is the MA insurance exchange -- an online tool where you can compare and shop for health plans. It is not an insurance company. Do you recall signing up for a plan through a particular health insurance company, such as Tufts or MA Blue Cross Blue Shield? If so, I suggest you call them directly to see if your application is in process.
Cobra coverage can be quite expensive because you are paying the full share of the premium – both the employer and the employee share of the premium plus a 2% administrative cost. The Affordable Care Act does not change the structure of Cobra, but you may be able to find a cheaper policy through your state Marketplace. Depending on your income, you may also qualify for a subsidy to help you pay your premium.
Documenting your income is important in determining your eligibility for a premium subsidy if you purchase coverage in the marketplaces. If your state has not expanded Medicaid you are eligible for a subsidy if your income is greater than $11,490. If you have pay stubs or other evidence of your current income that will work. On Healthcare.gov you can enter your predicted income for 2014, but you may be asked for further documentation to justify that prediction. If you can identify a navigator in your state they may help you through this process.
Clifton, if you use form 1040 to fill out taxes, line 37 is what you would use when applying for coverage.
The website now has a reset button where you can dismiss your old application and restart a new one. I would suggest trying that because you may be running into problems with the website trying to access information from your previous application. In general, the website is operating much better and people are having greater success. If the website gets too many users at a time, it will tell you to try back and will email you with a link putting you at the front of the queue when the website has fewer users.
Money drawn from retirement accounts do count toward your income and would need to be considered when applying for coverage. However, keep in mind that it's your 2014 income you'll be asked to report and that will be used to determine if and how much of a subsidy you qualify for. So, if you have no plans to withdraw the same level of income next year, you won't want to report that. Project as best as you can how much money you'll earn/withdraw in 2014.
If you have employer-based insurance now and will continue to do so until you retire, there is no need for you to take any immediate action. When you retire and lose your employer-based insurance, you will have a “qualifying event” which will allow you to shop for a Marketplace plan even though you are outside of the open enrollment period. You probably want to start your application and shop for plans at least two months before your employment-based plan ends.
You may have to call into the Healthcare.gov to complete your application.
You can compare plans on Healthcare.gov to see if there is a plan that fits your needs for a lower price or similar price. You need to make sure that you are comparing the details of each plan before deciding. Click on details for the plan and make sure they are actually similar in terms of out of pocket maximums, copays, and the physicians and hospitals included in the plans.
Also make sure you can stay on your existing plan through 2014.
If your clinic is no longer participating in Medicare, you can still get your care there, but you will need to submit your bills to Medicare on your own. In addition, the clinic can “balance bill” you which means they can bill you for their expenses beyond what Medicare would pay. You can try using your husband’s retirement insurance as your primary coverage, but most retirement policies act as a supplement to Medicare – meaning they pay after Medicare does. More than likely, you will need to submit your bills to Medicare and wait for payment. Your husband’s insurance may cover the portion of the bill that exceeds Medicare payment rates. I would get further clarification from your clinic that this is how it will work, however.
If you state allows you to continue your current plan that will count as coverage and you will not pay the penalty.
Clifton, if it is a nontaxable payment, my understanding is that it is not included in household income. But you should really consult with a tax expert for clarification.
Apart from premium subsidy, is there any help when paying for medications? If someone is not able to pay the deductible, what is the option? For individuals who earn less than about $28,000 per year, there are also subsidies that help to lower your costs each time you go to the doctor or fill a prescription.
In any event, make sure you carefully evaluate all of your plan options and take a close look at items beyond the premium, including co-pays, deductibles and co-insurance. For example, maybe it would pay for you to spend a little more each month for a plan that covers a higher percentage of your costs each time you go for care. You need to do the math. You might want to work with a navigator via Healthcare.gov who can help you walk through the various components of the plan to figure out which will be most cost effective for you.
Generally deductibles are the amount consumers have to pay for care before insurance begins to pay. However, different services such as drugs may have different deductibles. The Affordable Care act details a number of preventative care services that are provided free. So you would receive that care without paying anything.
When choosing an insurance plan you should look at the deductible, the coinsurance or copays that you have to pay after the deductible is met, and the out-of-pocket maximums which is the most you will have to pay in a year.
The premium subsidies are based on your estimated 2014 income.
It sounds like Massachusetts Health Connecter is telling you that you need to choose a new plan because your old plan is no longer offering insurance through their exchange. Go on the Massachusetts Health Connector website (https://www.mahealthconnector.org/) to find the available plans in your area; compare benefits and premiums; and select the plan that works best for you.
You very well might find a better plan for you outside the exchange. Healthcare.gov now allows you to view the plans sold on the exchange easily. You can then compare those plans to other plans sold in your state using a broker or a service like Einsurance and make your best choice.
No, once you've submitted the application you can't set reset to start over. You'll need to call the customer service line on Healthcare.gov to alter your income.