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Hi, looking forward to our discussion this afternoon.
Hi, I'm looking forward to today's web chat and your questions.
Lisa and Sarah, can you talk about what things people need to consider before choosing a health insurance plan?
For starters, people need to know that there time is running short to either sign up for or switch health plans. Open enrollment ends on February 15th.
One of the things people need to consider when evaluating plan option is the out-of-pocket costs (copayments and deductibles) in addition to monthly premiums. Generally plans with the lowest premiums will have the highest out of pocket costs. People should also look at the plan's network. This information usually isn't available on the Marketplaces so you will have to contact the individual plans to find out if your doctor is in the plan's network.
Cost is such a huge issue for most people when it comes to health insurance. To get the best coverage for you at the best price you need to evaluate a number of different things.
In most markets, the “benchmark” plans have changed this year. That's the second lowest cost, silver-level plan sold in your area, and it’s used to determine the amount of subsidies you may receive.
If your plan is no longer the benchmark, it’s likely you’re now paying more than you need to for coverage. According to the Department of Health and Human Services, 70% of people re-enrolling in a plan this year can find one with a lower premium by shopping new options. So it really pays to look around.
As Sarah mentioned, be sure to take a close look at the provider networks. If you take medications, confirm that your medications are covered by your plan, and how much of the cost is covered. Also watch for any limitations on specific services. For example, the number of rehabilitation sessions may be limited. And, if you have a chronic condition and go to the doctor frequently, it's somewhat counter-intuitive, but you may save money in the long run by buying a plan that costs more each month, but less each time you visit the doctor.
Martina: one of the big benefits of the Affordable Care Act is that insurance plans can no longer charge a higher premium because you have a pre-existing conditions. So, they will not ask about your previous cancer treatment. The first place to go to see your insurance options is HealthCare.gov. This is the Marketplace run by the federal government. Even if your state is running its own Marketplace, you will find a link at HealthCare.gov. Good luck.
Hi Joe, I can relate to your feeling about shopping being a pain. The answer is you don't have to go back and shop, but it is a good idea to do so. The costs, specific benefits, provider networks and other details of each plan do tend to shift each year, and according to government reports most people who go back and shop will save money by selecting a new plan. In any case, I recommend you go back into the system to update your financial information. It's in your best interest even for tax purposes to do so to ensure you're not getting too much or too little tax credit, which can impact your finances. The good news is your information is saved in the system so you won't have to fill it all out again as you did last year.
Julia: You should check with a Marketplace Navigator or a tax advisor to find out if you need to include your husband's income even if you are legally separated.
You're correct, Sophia. Penalty costs are going up. Going uninsured last year will cost $95 per adult or 1% of taxable household income, whichever is the larger amount. If during 2015 you go without health insurance, you’ll pay the greater of $325 per adult or 2% of your household’s taxable income.
Johnny: Generally you can only purchase catastrophic insurance if you are under the age of 30. If you can show that other plans are too expensive based on your income, you can apply for an exemption through your Marketplace and may be eligible to purchase one. I would encourage you to apply to the Marketplace because you may be eligible for a premium subsidy, depending on your income, which would lower the cost of insurance.
There's nothing worse than sitting down to get started and realizing there's some information you need that you don't have in front of you. What documents should people gather before they start shopping?
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Ashley: Your mother should go to HealthCare.gov to find out the amount of premium subsidy she qualifies for and look at all the plans available to her. In many states the “benchmark plan”, the plan on which the premiums subsidy is based, changed from last year which can affect your mother’s premiums. In addition, some plans have raised their premiums significantly, but others have not. It definitely pays to shop around. She needs to shop quickly, though, because open enrollment ends on Feb. 15th.
Hi Brent, this is very tough question to answer for many people in your situation, and there's no one right answer. The best advice I can offer is to do your best to come up with a reasonable estimate of what you expect to make, and then to plan on updating the Marketplace if/as changes to your income occur mid-year. Many people aren't aware that they can and should update the Marketplace year-round with changes to income and/or family size. A good general rule is when a shift up or down of about 10% occurs, pick up the phone to report it and have your subsidy adjusted. That's the best way to avoid a large tax bill or to overpay for coverage during the year if it turns out you're entitled to a bigger tax break on your insurance premium.
Lisa, you mentioned that the deadline to enroll is Feb. 15. Does that same deadline apply to Medicaid?
Good question. The answer is no. Unlike with private health insurance sold through the Marketplace, if you're eligible for Medicaid, you can sign up at any time during the year.
We often get people wondering if the Marketplaces are for Medicare as well.
No, if you have Medicare you do not need to apply for a health plan through the Marketplace. Medicare is considered "minimum essential coverage" for purposes of the individual mandate, meaning you will not have to pay a penalty for being uninsured if you have Medicare.
Lisa, can you talk about what people need to do when they file taxes this year to prove they had insurance coverage?
Most people have health insurance, so they will simply need to check a box on their tax form stating so.
If you bought insurance through the Marketplace and received a tax credit, you likely received form 1095-A in the mail. This will show how much advance premium tax credit the government paid to your health plan on your behalf during the year. Think of it like a W-2 form for your insurance coverage. You’ll need form and the information it contains when you file your 2014 taxes, so keep it with your other tax-related documents. You'll have to match up the advanced tax credit you received with the amount of credit you were actually entitled to based on your final income and household size.
You may get more money or owe some of the tax credit back. If you file taxes with a tax preparer -- either an accountant or online software -- you'll be prompted with simple questions to fill out the needed paper work just as you are with all other tax-related matters.
Betsy: You don’t have to enroll in your employer plan, but if the employer coverage is considered “affordable” meaning it does not cost more than 9.5% of your income, you will not qualify for a premium subsidy through your state’s Marketplace. If your employer coverage does cost more than 9.5% of your income or it does not provide “minimum essential coverage” (you can ask your HR department about this) you may qualify for a premium subsidy depending on your income. Before you drop your employer plan, find out the answers to these questions.
Do the Marketplace plans offer dental coverage?
Dental benefits for children are one of the essential health benefits. This benefit may be offered in two ways. Some plans include children’s dental benefits as part of their medical benefits. Marketplaces may also offer stand-alone children’s dental plans. A plan does not have to cover children’s dental benefits if a stand-alone dental plan is available through the Marketplace. In that case to get the children's dental benefit you would have to purchase two plans - a medical and a dental.
We often hear from small business owners who want to know if it's better to buy an individual plan on the Marketplace or group coverage?
If people miss the Feb. 15 deadline, is there any other way for them to get health insurance?
If you miss the Feb. 15th deadline you will have to wait until next fall to shop for a health plan through the Marketplace UNLESS you qualify for a special enrollment period. Here are a few common ways you can qualify for a special enrollment period: losing your existing insurance (for example, if you had insurance through your employer and you lose your job), you get divorced, have a baby, or adopt a child. The special enrollment period lasts for 60 days. During that time you can apply for premium assistance and shop for a plan.
Thank you Lisa and Sarah for this informative chat. Before we go, can you remind us what counts as income for people applying for insurance?
Here's a list of items that count toward your total adjusted gross income when applying for health insurance through the Marketplace...get ready for an exciting read!
Wages, salaries, tips, taxable interest, taxable amount of pension, annuity or IRA distributions. Social Security benefits, business income, farm income, capital gain, other gains (or loss), unemployment compensation, ordinary dividends, alimony, rental real estate, royalties, partnerships,taxable refunds, credits, or offsets of state and local income taxes.
If you refer to last year's tax returns, here's where you can find the info: Line 4 on a
Form 1040EZ - Line 4
Form 1040A - Line 21
Form 1040 - Line 37