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We’ve already received a lot of questions from readers, so let’s get to it.
You don’t have to re-enlist, no. You’ll automatically be re-enrolled in your current plan, assuming it’s still being offered for 2015. And, you’ll continue to get the subsidy you’re due, an amount the federal government will confirm based on your tax information.
However, the formula for determining subsidies changes each year, which is likely to impact how much you’ll pay for your plan, even if nothing about your situation has changed.
In addition, every year, there are changes to the details of your plan – which doctors participate in the network, which prescription drugs are covered and by how much. Out-of-pocket costs, such as co-pays and deductibles change too. To make sure you’re getting the best plan at the best price, you’ll need to shop. With all the changes, it’s unlikely the plan you have now will give you the best deal for 2015.
Katherine: You will want to go to HealthCare.gov and start an application. In Michigan the federal government is running the Marketplace in partnership with the state. Once you fill out an application on HealthCare.gov you will find out what type of assistance you qualify for to get insurance. Since you are disabled and have a very low income, it’s likely you will qualify for Medicaid. Michigan is one of the states that expanded Medicaid so single adults making up to about $16,000 are now eligible.
CarisaKiera: You have a few options. First, if your parents have health insurance and you are under age 26, you can stay on their plan. Most employer plans used to cut off coverage for dependents at age 18 or 22, but now they are required to allow kids to remain on their parents’ plan until they turn 26. Your parents may have to pay extra, but this may be your most affordable option. If your parents don’t have insurance through their employers you can check with your school. Most universities offer a student health plan. You will want to look closely at the plan and the cost because student plans are usually less comprehensive than plans you could buy through the Marketplace. Which leads us to your final option – check your state’s Marketplace. If you don’t have any income you may qualify for Medicaid in your state. If you don’t qualify for Medicaid you may be eligible for a federal subsidy to help you purchase a private plan through the Marketplace. Go to HealthCare.gov to find out how to begin. HealthCare.gov is the Marketplace for the majority of the states. If your state is running its own Marketplace, HealthCare.gov will direct you to the appropriate website.
Hi, for those of you who are new to the format, we don't have any audio.
We are taking questions on all insurance topics, not just ACA.
Yes, you can apply insurance on your own. When a couple is divorced each party’s eligibility for a tax subsidy will be based on their individual incomes. However, until you’re legally divorced, you may face some trouble getting a subsidy or qualifying for Medicaid.
When you apply for insurance through the exchange (Healthcare.gov), you’ll be asked to project your income for next year. If your estimate is more than 10% less than what your previous tax filing information shows, it will be flagged and you’ll have to reconcile the difference between your actual income and what you projected at tax time next year.
If by next year you’re officially divorced and your taxes are filed separately, it won’t likely be a problem for you. However, if you remain separated but not divorced, you may not be eligible for financial help if your husband’s income is too high (less than $62,920).
If when you apply for insurance through the exchange you're eligible for a tax credit, but by the end of the year your actual income drops below the poverty level, you won't have to repay any of the tax credit you received.
You must be a resident of a state to use that state’s Marketplace. You may already know this, but U.S. citizens living in a foreign country for at least 330 days of a 12-month period are not required to get health insurance coverage for that 12-month period. If you're uninsured and living abroad under this definition, you don't have to pay the fee that other uninsured U.S. citizens may have to pay.
If you have insurance through your job, Medicare, Medicaid or through Tricare or the VA, you likely already have coverage that meets the law's requirements and don't need to buy insurance during the ACA open enrollment period. Stick with what you've already got.
Cathy: Small employers are not required to provide insurance to their employees. If you do, you can purchase coverage through the Marketplace. For small employers this is called the SHOP (Small employer Health Options Program). Go to HealthCare.gov or your state’s Marketplace to find out more information.
Small employers can receive a tax credit of up to 50% of the premiums they pay for employees’ health insurance, but insurance must be purchased through the SHOP. Employers must pay at least 50% of the premium. Tax credits are available for employers with 25 or fewer employees. It sounds like this tax credit may help you. If you are not providing coverage for your employees but only looking for insurance for you and your spouse, you can still use HealthCare.gov to purchase insurance. Depending on your income, you may qualify for a subsidy to offset your premium.
When it comes to choosing a plan type -- PPO or HMO, for example -- it's really about understanding the tradeoffs of each and deciding what's most important to you.
Generally, with a PPO you have access to a wider choice of doctors. You can see those who participate with your plan and also often get at least some coverage if you go outside of your plan's network, and you don't need a referral from a primary care doctor before seeing a specialist. However, you'll always pay less when you stick with an in-network doctor.
HMOs generally require you to stay within the plan's network and to choose a primary care physician who will provide most of your care and who must give you a referral before you see another doctors, such as specialists.
Generally (and I say generally, because the lines are blurring between all plan types so you must carefully check the details of each policy), you'll pay less out of your own pocket when you go for care with an HMO, but you'll also have less choice.
We have a qustion from mlucero, who asks if her daughter who works part-time is eligible for insurance.
Mlucero: There are two things for you to consider. First, if your daughter is under age 26 and you or your spouse has insurance through an employer, she is eligible to stay on your employer plan. She may be required to wait until open enrollment to join the plan and you will likely have to pay an extra premium to include her, but it may still be her most affordable choice. If your employer plan is not an option, your daughter should go to HealthCare.gov and start an application to see whether or not she would qualify for financial assistance to purchase a health plan. HealthCare.gov is run by the federal government and is the Marketplace for the majority of the states. If you live in a state that is running its own Marketplace, HealthCare.gov will direct you to the appropriate website.
If you get coverage at work, your employer may offer you the chance to earn money for your HSA if you participate in certain wellness program activities. However, if you buy coverage on your own, you'll want to check directly with your insurer to find out what other opportunities there are to do so. I'm guessing the incentives available through the program you mentioned is probably your only option, but you really need to call them directly to confirm. They all operate a bit differently.
You can find out what Medicare Part D plans are being sold in your area by going to Medicare.gov. There is a feature once you click on “find a plan in your area” where you can enter the drugs you are on and it will tell you what plans cover the drugs and how much they charge.
Obamacare is designed to be especially helpful for people with low incomes. I would encourage you to go online at Healthcare.gov to see what's available to you.
Based on the income you report, it's likely you will qualify for Medicaid. However, if you live in a state that chose not to expand, you may face trouble finding affordable coverage.
I suggest you log onto the website (again, Healthcare.gov) and also consider calling the 800 number on the site to get personal assistance.
SHEro Mom: I’m not sure if you have employer sponsored insurance or you purchased insurance through the marketplace. If you purchased insurance through the marketplace, you will want to let them know about any changes in income or family circumstances as soon as possible so your premium subsidy can be adjusted.
On the exchange, you can find what are called Multi-State plans. The Blue Cross/Blue Shield Multi-State program is available in 36 states, including the District of Columbia, for 2015. There will be more than 200 plans offered nationwide.
Some Multi-State Plans will reimburse providers you get care from in other states as “in-network”, though that's not always the case. Check carefully the description of the Multi-State Plan’s features when you shop for policies.
Unemployed: If insurance would cost more than 9.5% of your income in 2014 you qualify for a hardship exemption and do not have to pay the penalty.
Your best bet is to start on the exchanges. It's the easiest way to see a list of plans available to you in your area and compare them side-by-side. Going from one insurer to the next will be much more time consuming.
The government's site is Healthcare.gov. You also mentioned a private exchange like ehealth.com, which you can also use to shop.
The key is whether you qualify for a subsidy. If you do, the only place to get it is by buying a plan through the government exchange. However, private insurance agents, including websites like ehealth, can help you do this. If you don't qualify for a subsidy you'll also be able to look at a wider range of policy options by working with an insurance agent, whether in-person or online.
Barry: Some states do have the ability to deny premium increases if they determine them to be excessive, but it sounds like that won’t help you. I’d recommend you go back to HealthCare.gov and see what premiums other insurers are offering. Overall, we are seeing a wide range in premiums with some plans increasing premiums double digits, while others are not increasing or even lowering their premiums. It definitely pays to shop around.
When it comes to income, you'll need to count your salary or money earned from your job or your own business. In addition, you'll need to include items such as:
Social Security income
Funds pulled from retirement accounts
It’s only income – not one’s assets – that will be factored when determining whether or not you qualify for financial assistance from the federal government to help pay for the cost of your insurance.
Dave: If you have COBRA, you do not have to enroll in a marketplace plan and you will not be subject to a tax penalty while you have insurance. When you drop COBRA you can use the marketplace to shop and enroll in a plan even if the official open enrollment period has ended. Losing your insurance qualifies you for a special open enrollment period. You do not have to have a job to enroll in a marketplace plan and if your income is low you may qualify for a subsidy to help you pay your premium.