Hi everyone! I’m Valarie Basheda, a member of WebMD’s Affordable Care Act team. I’m excited to be hosting our first live event about the health reform law. We know the law is bringing a lot of changes, but it’s so complicated and confusing that it can be difficult to understand what it really means. We hope today’s chat will offer information to help everyone make the best decisions possible, whatever their health insurance situation. We’ll get started in just a few minutes, but you can go ahead and submit your questions now by clicking the “comment” link.
And as a reminder: WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD.
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Joining us today to answer your questions are two members of WebMD’s expert panel on health reform – Dean Rosen and Lisa Zamosky. 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. Lisa is a healthcare journalist and longtime WebMD health insurance columnist and blogger. She specializes in helping consumers understand their health insurance options and how to access and pay for healthcare. Welcome, Dean and Lisa.
Hi Valarie. Glad to be here. I'm looking forward to everyone's questions and to a lively conversation about the ACA.
Hi Valerie, I am so glad to be here. And excited to be part of the WebMD team! I look forward to helping folks answer their questions about the impact of health reform
We want to get to as many questions as possible, so let’s go ahead and jump into some questions that our readers have submitted over the past couple of days. Our first question was emailed to us from Tommy, who has health insurance and wants to know, will his current policy will be required to follow the new guidelines?
Tommy, that is a really great question. Most likely, your current insurance policy will have to follow the new rules under the Affordable Care Act, or "health reform." So, it is most likely that your policy will have to follow rules like no denials for pre-existing conditions, improved coverage for preventive care, etc. The one exception to this rule is if you have coverage through an employer, some employer plans may be "grandfathered" and not have to make major changes.
Hi Dalynn, It sounds like you and your family are covered by a "grandfathered" health plan. These are plans that were in place prior to the ACA becoming law in March, 2010. Grandfathered plans lose their status when they make significant changes to their benefits or charge considerably more for things like co-pays, co-insurance, and deductibles. It's expected that in the next few years that most employer-sponsored plans will lose their grandfathered status, which means they will have to comply to all parts of the law, including providing preventive services with no cost-sharing.
Candie, your question raises a real dilemma for many families. If you are not age 65 and over, and not disabled, you will not qualify for Medicare. And, if your current income is too high for Medicaid, you will not be eligible for that program. But, there is good news for many families under health reform. First, Medicaid will be expanded in MOST states for people with incomes up to 133 percent of poverty (about $15,000 for an individual and $31,000 for a family of 4). And, for those above that income threshold who have incomes up to 400 percent of poverty, you are likely going to be able to receive some kind of tax subsidy to help offset the cost of your health coverage beginning in 2014. This is about $89,000 in income for a family of 4. hope that helps.
Hi George, many people have expressed similar frustrations. It's understandable that the requirement to purchase a product you feel you won't need would be bothersome. However, I think it's worth noting that while you're healthy today, that's not likely to always be the case. If you were in an accident or suddenly diagnosed with a serious illness, the cost of medical care and hospitalization could ruin you financially.
We received several questions from readers with pre-existing conditions who are losing or have been denied coverage. They want to know if they can get insurance under Obamacare and will it be affordable?
Valerie, I know a lot of Americans are concerned about getting health coverage if they have a pre-existing medical condition. Indeed, people who have medical conditions and may have been denied coverage in the past because of their health status will be able to get coverage under health reform, beginning in 2014. The question of affordability is a bit more complicated. The cost of health insurance (we sometimes call "premiums") will vary by plan and from state to state. You may be eligible for subsidies to help you afford coverage if your income is below a certain amount. The best thing you can do is to look closely at the specific coverage options available to you, compare the costs and benefits when the new marketplaces go live in October 1, and make a good decision for you and your family for coverage by January.
Michael, good question on the impact of health reform on Medicare coverage. The short answer for you and other seniors with Medicare is that health reform will have little or no impact on Medicare customers. If you have Medicare drug coverage, your Part D plans will actually provide greater coverage for the "donut hole" under Medicare. But otherwise no changes. And, if you buy a Medicare Supp policy (I think what you are referring to with "Part F") there will be no impact on those policies.
That's a great question, Adriana. There are a few ways you can take the tax credit. First, the full credit can be sent directly to your insurer to lower your monthly premium. Second, you can decide to pay your full insurance premium throughout the year and take your credit at tax time to reduce the amount you owe the government (or to increase your refund). There's also a third option in which you'll be able to apply part of the credit to lower your premium and take the remainder at tax time. You'll work all this out when you apply for coverage through your state's marketplace.
We have a few questions coming in about the penalties.
For those with the question about penalties under the new law, here is how it works. Everyone is required to show proof of health coverage, or pay a tax penalty. That penalty is $95 per adult and $47.50 per child beginning in 2014. (A maximum of $285 per family). Then, that penalty increases in subsequent years. It goes to $325 per adult in 2015 (family max of $975) and $695 per adult in 2016 and beyond (family max of $2,085).
Just a quick follow up on the penalty question. In several cases, you can get a "hardship exemption" so you don't have to pay the penalty if you cant afford it, or on a case by case basis for other reasons.
We have this question from Edward: I am unemployed, on state unemployment insurance benefits, 54 year old male in New Jersey. Will I need to pay for insurance, or will the state cover it because I am on unemployment insurance?
Hi Edward, you'll likely be required to have health insurance (although there are hardship exemptions available to people who don't have access to an affordable option) and your income will determine the kind of financial help you receive to pay for it. If you're currently unemployed, it's likely you'll qualify for Medicaid, which will be made available to you at virtually no cost. If your income is too high for Medicaid (about $15,856 annually), you're likely to qualify for tax credits to lower your premiums and possibly subsidies to lower your out-of-pocket costs when you go for medical visits.
Adriana, good question about employer coverage. You actually are not required to accept your employer's coverage, and you are not prevented from shopping for coverage in the individual marketplace or through a state insurance exchange just because you have employer coverage. But, be sure to look carefully and make sure you are comparing apples to apples. Even though your employer coverage may feel like it is too costly an option, because most employers provide some kind of premium assistance, that still may be your best option even after health reform takes effect next year.
For those of you in Massachusetts, looks like you will have to fill out some new paperwork. There will be something called the "integrated eligibility system" that will connect you with the new federal requirements. It is supposed to help you get an eligibility determination online in real time, starting October 1
We have this question from a reader: Some drugs’ costs have gone through the roof. Is this from the new health care? Will it affect it later on?
Regarding the question about drug costs, in actuality 80% of prescription drugs sold in this country are generic -- and prices of drugs haven't risen greatly in the past few years. What has increased, however, is the portion many of us have to pay toward the cost of our drugs, which is likely what you're experiencing. That's not a function of Obamacare, but rather a function of employers (assuming you get insurance at work) and insurers shifting more costs onto consumers as a way of getting control over their own costs. Unfortunately, that's a trend that's likely to continue.
Here's a question from a reader about maternity benefits: My daughter currently has a plan through Health Partners and recently found out that she is pregnant. The current plan doesn’t cover labor and delivery. Will she be able to increase her insurance coverage for that?
For those concerned about maternity benefits, including labor and delivery, most health plans will have to cover these benefits beginning in 2014. The one exception is if your daughter's coverage is through a "grandfathered" employer plan. Some of those plans may not have to add new coverage for labor and delivery right away.
Janet59inCA -- you bring up a very important issue regarding the tax credits. Eligibility is based on income and there are thresholds used to determine whether or not you qualify. For a couple with an annual income of around $62,000 tax credits will be available. But if your income is above the threshold -- even if by a small amount -- you could be out of luck with regard to your eligibility for financial assistance.
jskdn - great question on advanced payments and how they will be reconciled. If you are eligible for a subsidy based on your income (see one of my previous answers on income eligiblity and subsidies) and then your income rises during the year and you no longer qualify, or you qualify for a lower subsidy, you may have to effectively repay the government. This is because, as you said, your insurer would have already received payments directly from the government in advance to help lower your premium. My understanding is that those amounts would be paid back or "reconciled" by increasing the amount of taxes you owe in a subsequent year.
Just a quick follow up on how those tax credits are reconciled. The law has certain limits on what you may be required to repay. For those at the upper income level of subsidy eligibility (400 percent of poverty), the limit you will have to repay in any year is $2500 for example. And will be lower if your income is lower than that.
Here's a question from a reader about smokers and the law: Is it true that in Pennsylvania those who are addicted to nicotine will be charged an additional 50% on their premium, and why isn’t it considered a pre-existing condition the first year to give the smoker time to quit the terrible addiction?
Under the ACA insurers are allowed to charge smokers a 50% surcharge. Some states (though unfortunately PA isn't one of them) have chosen not to allow this extra charge. The good news, however, is that if you agree to participate in a smoking cessation program you can offset higher costs. So there is an opportunity to quit and to avoid higher costs if you agree to try.
The health reform law regarding covering kids up to age 26 on a parents' plan actually started in 2010 and will remain in effect even after most of the other provisions of the law become effective next year. So, children can remain on your plan. For now, if they have an offer of coverage through an employer, they have to take that coverage instead-- until 2014. After 2014, your kids can stay on your plan up to age 26 even if they have another option through their job.
Hi Patty, this is an issue of concern for many families. The law states that employer-sponsored health insurance is "affordable" if individual coverage doesn't exceed 9.5% of your annual income. It doesn't include the cost of family coverage, which is obviously much higher. Under the law if you have an offer of affordable employer coverage you're not eligible for subsidies through the marketplaces, meaning your family will have to pay the full cost of coverage with no financial assistance from the government. You can shop outside of the marketplace if you wish and if you're not eligible for a tax credit you may find broader options available to you. You can work with an agent.