Gene, You can change your plan during the year if you have certain events such as if you move, or your family status changes or if your income changes. You find the full list of status changes at Healthcare.gov
I don’t know that I can say what the most common mistake is, but I think one mistake people are making is not looking at the total cost of their insurance plan. If you have a chronic illness or are on a prescription drug, you may be better off paying a higher premium and buying a gold or platinum plan rather than a cheaper silver or bronze plan. WebMD has a Coverage Advisor tool to help you choose a plan based on your predicted medical expenses.
Moving to a different topic, many readers were upset that their doctors were not included in the Marketplace plans.
Here's what the president said: “Well, again, these are private insurance plans, which means that they’re going to have networks. That’s pretty much true of any health insurance plan you’ve got out there right now. You know, if you're signing up for a Blue Cross plan, let’s say, in Florida, then they have a pretty good network of doctors and hospitals, but they probably don’t have 100% participation of every doctor or hospital. So that's not unique to the Affordable Care Act. What we have said is, for example, if you're in the middle of life-saving treatment with a particular doctor, then we will work to make sure that you can keep that treatment and not shift. But for the average person, many folks who don't have health insurance initially, they’re going to have to make some choices. And they might end up having to switch doctors, in part because they’re saving money.”
Plans are going to limit their networks, especially in the first few years, because 1) they don’t know what to expect and 2) some of their other ways of limiting their risk have been eliminated (e.g., denying people for pre-exisiting conditions; charging more for sick people than healthy people; restrictions on how much they can charge older people for coverage compared with younger people). We have seen this trend in limited networks as a way of managing risk prior to the ACA, however.
Donna, all of the plans sold in the Marketplace are required to cover prescriptions. So plans may not cover certain specific drugs but they are required to offer drugs that have similar therapeutic properties.
Eileen, the quote that the President has been taken to task for making was ‘if you like you health plan, you can keep it.’ He had to backpedal on this when insurance companies started canceling policies in anticipation of stricter rules beginning in 2014. Plans are free to contract with doctors, as long as they maintain an adequate network, and there is nothing in the ACA that forces plans to keep doctors in their network. The President is trying to encourage plans to allow people in the middle of a course of treatment to keep their doctor, but there is nothing in the law that requires it.
In states that didn't expand Medicaid, many people said they felt like they were being forgotten. The president said he couldn't force the states to accept the expansion.
Here's what he said: So, in the interim, the best we can do for those unfortunate folks who are caught in this situation is to say to them that they will not be subject to a penalty for not getting health insurance. It’s not their fault that the state is not doing what it should do, but in the meantime, that means that they're still relying on emergency room care or a free clinic or just foregoing care, which is bad policy, it's bad for those families, and I hope that everybody who's watching as time goes on is continuing to put pressure on those states to do the right thing."
The President really wants states to expand their Medicaid programs for the success of the ACA and has shown this by giving states a lot of flexibility in doing so. For example, in Iowa, HHS has approved letting the state use Medicaid funds to buy private polices through the health exchange for those eligible. Expanding Medicaid is one of the easiest ways to reduce the number of uninsured in a state. In most states prior to the passage of the ACA, adults without dependent children did not qualify for Medicaid no matter how low their income.
Medicaid is a state-federal partnership program with the federal government paying at least half the programs costs; more in states with higher poverty rates. As the President said, the federal government is paying 100% of the cost of state’s Medicaid expansion for three years and then a higher than usual percentage for the next several years. So it seems like a no-brainer for states to expand their Medicaid programs and insurer their residents at no cost. The President is correct that states that have not expanded their Medicaid programs have done so largely for political reasons. All of the states that have not expanded are led by Republican governors or controlled by Republican legislatures. In states’ defense, they say they are worried that once people get on Medicaid it will be too difficult politically to eliminate their eligibility once the states are responsible for a higher percentage of their costs.
Oceanlvr722, The fee for not having insurance in 2014 is $95 per adult and $47.50 per child or 1% of your taxable income, whichever is greater. Your tax penalty for not having insurance is paid on your federal income taxes at the end of the year. If your taxable income is below 133% of the federal poverty level you are exempt from this tax. The total penalty for the taxable year cannot exceed the national average of the annual premiums of a bronze-level health insurance plan offered through the health insurance marketplaces. If you are uninsured for more than 3 months but less than the full year you pay 1/12 of the penalty for every month you are uninsured.
Meg, if you are unemployed and have no income, you should check with your state’s marketplace to see if you qualify for Medicaid. You have to apply, Medicaid does not automatically come with unemployment insurance.
rcmodelr - he didn't use a prompter, actually.
Although we didn't get to ask about dental care at the interivew, many readers asked about it.
In states that haven't expanded Medicaid people face a sharp cliff in purchasing health insurance. If your family income is at or above poverty in those states you can get a subsidy for health insurance coverage through Healthcare.gov. If your family income is just below poverty in a state that didn't expand Medicaid you may not have any affordable options for health insurance
Gail, Dental coverage for children one of the essential benefits under ACA, but not for adults. You can shop for Dental coverage on Healthcare.cov
The ACA has a list of 10 essential health benefits, including things like hospitalization and ER visits, maternity care, prescription drugs, mental health treatment. You can find that list on healthcare.gov. I was a little surprised the President didn’t talk about essential health benefits requirements. Prior to the ACA it was very difficult for women to buy an affordable policy in the individual market that included maternity care.
The coverages sold in the Marketplace are private insurance plans. The networks of providers may be narrow, not all doctors are in every plan, but in most markets most doctors and hospitals are in some plan offered on the Marketplace. It is one of the insurance plan features you need to investigate when choosing a plan.
No, you do not have to pick a new plan if you are on Medicaid and Medicare. Your coverage will continue as it has been.