Hi, everyone, and thanks for joining us. I’m Kim Richardson, a member of WebMD’s Affordable Care Act team. If you haven’t already heard, today is opening day for the state Exchanges established under Obamacare, where you can shop for health insurance. (You may have also heard them called Marketplaces). We know some of you have been preparing for weeks (or months!) while others of you are asking, “Wait, what is an Exchange?” So in the next hour or so we’ll be answering questions across that spectrum – from small details of the law to basic principles – all questions are welcomed.
We’ll get started in just a few minutes, but you can go ahead and submit your questions now by clicking the “comment” link.
Three WebMD health reform experts will be answering questions today – Sarah Goodell, Dean Rosen, and Lisa Zamosky. Sarah is an independent health policy consultant specializing in private insurance issues. Dean is president and CEO of Breakaway Policy Strategies in Washington, DC, a firm that provides health care providers and patients with in-depth analysis of the ACA and other government health programs. And Lisa is a healthcare journalist and longtime WebMD health insurance columnist and blogger.
One of the questions we get asked about a lot is exactly who can use the Marketplaces. We received this question from a reader: “If you already have a non- employer-based health plan, can you still go to the Exchange to see if you can get a better plan at a lower rate?”
You can go to your state’s Exchange or Marketplace to shop for a health plan even if you already have non-employer-based insurance. Exchanges are designed to make the insurance buying process easier. You can compare benefits and premiums across a range of health plans, each of which includes 10 categories of essential health benefits such as maternity care and prescription drugs. You can also find out if you qualify for financial assistance. If you are single and you make less than about $46,000 or if you are a family of four and you make less than about $94,000 you may receive help to pay your premium.
I agree with Sarah. This is a question on a lot of people's minds. If you purchase insurance on your own, you should definitely go online and look at what the marketplace in your state has available. Use these new marketplaces to compare the costs and benefits of the plans available through the exchanges-- marketplaces-- with the coverage you already purchase. If, however, you have coverage under Medicare, Medicaid or through an employer plan, you should stick with that. The new marketplaces/exchanges are primarily for people who buy insurance on their own or are uninsured
The income used is Modified Adjusted Gross Income so it is your income after deductions and other credits.
Jean, many many Americans agree with your perspective and oppose Obamacare. You raise a very good question about the individual penalties under the law. The answer is that you will not be penalized if you buy insurance outside the exchanges. As long as you have health insurance coverage, even if it is coverage you purchase outside an exchange, you should not have to pay a penalty.
Open enrollment starts today and runs through March 31, 2014. If you want insurance to begin January 1, 2014, however, you'll need sign up for coverage no later than December 15, 2013. If you have coverage through early next year, you can wait a few months to sign yourself up.
If you have insurance through your employer, you don’t have to do anything. The Marketplaces are generally for people who buy insurance on their own or are uninsured. That being said, if your insurance costs more than 9.5% of your income or doesn’t cover an average of 60% of your medical expenses, you can shop for insurance through your state’s Marketplace and may qualify for federal subsidies to pay your premium.
If you currently have COBRA coverage you can shop on the exchange in your state and drop COBRA if you find a better deal, which you're very likely to do.
If you dont have access to the internet, you should still be able to check out your health coverage options and get more information about the law. One place to start is to call: 1-800-318-2596. This is the main information line that appears on the federal government's main website: healthcare.gov. It says people are available there 24/7. Good luck!
Pediatric dental benefits are one of the 10 essential health benefits that all health plans sold on the Marketplaces must include, as do plans sold in the individual and small employer market. Marketplaces may contain stand-alone dental benefit plans for kids. Dental benefits for adults may be included in some health insurance policies, but they are not required and standalone dental plans for adults will not be offered through the Marketplace.
We had a question from a reader: "Will my premium be based on 2013 or 2014 where my income will be a lot lower in 2014 as I will be making $38,000 and she will be making $8,940 in Social Security which would be $46,940 for the 2 of us."
When you apply for an insurance policy through your state’s marketplace, you’ll be asked to project your income for 2014. If for any reason, your income changes throughout the year, you’ll want to contact the marketplace directly to report the change.
Bonnie has asked a good question about what happens to one's subsidies if their income and economic situation changes. If you are eligible for ACA subsidies now, but then your income increases, you may no longer be eligible for subsidies at that time. Or, the amount of your subsidy may decrease as your income rises. If you find yourself in this situation, you should contact your insurance company and let them know. And, again, depending on your circumstances, the amount of financial assistance you receive may be adjusted.
Prescription drugs are one of the 10 essential health benefits that all health plans sold on the Marketplace must include, as well as health plans sold on the individual market and through small employers. You cannot buy a stand-alone drug plan through the Marketplace, but the health plans sold there may have better drug coverage than what you currently have.
Tax credits can be taken in 3 ways. You can apply it entirely to your premium to pay the lowest possible cost for coverage. You can apply part of your tax credit during the year and take the rest at tax time or defer the credit, pay your full premium throughout the year and then get the deduction at tax time. If you have a change in income during the year that impacts how much credit you're eligible for, you’ll want to report that right away to your state marketplace to avoid having to repay the credit. Also, if your income drops, you’ll be able to take advantage of greater financial assistance.
First, I think it is very unlikely that the health law will be repealed. Even though Republicans in the House of Representatives want to repeal it, the Democratically controlled Senate and President Obama will never go for it. To be sure, there may be changes. But a complete repeal is unlikely under the current political climate. However, should the law be repealed down the road, you may experience some changes to your coverage. Given the fact that both political parties don't want people to lose coverage because of preexisting health conditions, I am sure that if repeal ever happened, there would be protections in place to make sure people did not lose their coverage.
Yes, mental health and substance abuse treatment must be covered in all new plans. You can read more detail about that here at WebMD’s Health Reform 101 blog.
Depending on the state you live in, you may qualify for Medicaid, which has very low cost-sharing and no premium. Go to www.healthcare.gov to see if you qualify. The web site is experiencing a flood of inquiries today, however, so you may want to wait a day or two to check it out.
Karen, if you recently began the process of applying for Medicaid in your state, you should definitely follow through with the process-- especially if you are out of work and have no income. You are likely to be able to get covered under Medicaid, rather than through the health exchanges.
If you're unemployed and can't find a health plan that you can afford (one that costs no more than 8% of your income) you will be exempt. However, the good news is that as someone without an income, you'll qualify for steep subsidies to dramatically lower the cost of insurance. And, if you live in a state expanding its Medicaid program, you may qualify for that as well, which will provide you with insurance at no cost.
Child-only plans will be available through your state Marketplace. Go to www.healthcare.gov to find out more information and fill out an application. You may want to wait a couple days to look into it, though, given the overwhelming number of users on the website today.