Andi, if you have no income or very low income, you may not have to pay the penalty under the ACA. The law includes a so-called "hardship exemption" for people who cannot afford the coverage available to them. But, be sure to check the specific rules at www.healthcare.gov. And, remember, if you do get a new job or your income rises during the year for another reason, you may no longer be exempt from the penalty. If you do have no income now, or very low income, you should also check out your state's Medicaid coverage option. You may be eligible for coverage there with little or no cost.
Under the law a husband and wife who have been buying a small group plan will need to switch to the individual insurance market. To buy a small group plan at least one full-time employee must not be a relative. You can buy a family plan for the two of you.
You will have many different coverage options to choose from depending on where you live. About 95% of consumers will have a choice of 2 or more plans. There is no government plan. All the health plans are offered through private insurance companies. The website www.healthcare.gov will let you look at all your coverage options in your area.
Medicare open enrollment begins October 15, which can be confusing since it's happening during the same time as open enrollment under Obamacare. But the two are not the same. I suggest you contact your State Health Insurance Assistance Programs for free, unbiased help. Find your local program by visiting the Medicare.gov Medicare Helpful Contacts page or by calling 1-800-MEDICARE (1-800-633-4227).
Your son can remain on CHIP and you don’t need to do anything right now. Your state Marketplace offers one-stop shopping for private insurance, Medicaid, and CHIP. Early next year you can visit the Marketplace to find out if he still qualifies for CHIP. If he’s not you may be eligible for financial assistance to purchase a private policy for him.
Yes, you can buy two separate policies if you wish, however, when reporting your income, you must use your household income, not your individual income.
Yes, beginning in 2014 health insurers can no longer impose pre-existing condition exclusions. They also cannot base your premium on your health status.
No, you need to carefully examine the network of each plan you're considering buying. Not all hospitals and doctors in your area will participate with the health plans sold through the marketplace.
You can go to www.healthcare.gov to see what plans are being offered in your state. You can also check out the WebMD Coverage Adviser (http://bit.ly/16Kn9uh) which is a model that lets you compare total costs (premiums and out-of-pocket expenses) based on where you live, your family size, and what conditions or prescription drugs you use. You may find that a plan with a higher premium, but lower out-of-pocket costs, is better for you based on your individual characteristics.
Modified Adjusted Gross Income for most people will be the same as Adjusted Gross Income.
Here’s where you can easily find the AGI, depending upon the tax form you use:
Form 1040 EZ – Line 4
Form 1040A – Line 22
Form 1040 – Line 38
Yes, your husband can apply for coverage through the Marketplace. Employers are not required to offer coverage to spouses.
We received this question from a reader: "I am retired, and I am 63 years old. Currently I self-pay Highmark for coverage. Can I go directly to Highmark and sign up so I can try to get a subsidy? Or do I have to go to the Marketplace site to sign up?"
In order to take advantage of subsidies you must buy your insurance policy through your state’s marketplace. You can buy directly from the insurer, but then you’ll miss out on any cost savings for which you’re eligible.
Many people will qualify for subsidies to help pay their premiums. Individuals between about $11,500 and $45,000 will qualify for financial assistance. That being said, there are exceptions to the requirement to buy insurance, including if the lowest cost available plan is more than 8% of your income.
Losing coverage is considered a qualifying event, meaning you'll be allowed to sign up for a health plan even if it's outside the open enrollment period. Also, keep in mind that this first Obamacare open enrollment period goes through the end of March, 2014 so if you lose coverage at the first of the year, you'll still have a few months to sign up during open enrollment.
If your employer-sponsored insurance costs more than 9.5% of your income or covers less than 60% of your medical expenses, you may qualify for financial assistance through the Marketplace, depending on your income. Even if your employer plan does meet these tests you can still shop on the Marketplace, but you cannot get a subsidy. You would also lose any contribution your employer makes towards you insurance.
Pam, you'll actually want to project what you expect to make in 2014 when applying for insurance. If you're unclear, perhaps it's best to report what you made in 2013. If you find a job and your income changes you'll want to report that right away to your state's marketplace so adjustments to your subsides can be made. That will help you avoid having a bill to repay the subsidies at tax time.
We received this question from a reader: "We own our own business and provide and pay 100% of our employees’ health insurance. As a small business with 5 employees will there be tax credits available for employers?"
The best place to shop for insurance would be through your state's health insurance marketplace. Depending on your income, you may qualify for a subsidy that will lower your costs.
To find your state's marketplace, go to Healthcare.gov.