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So I have to have health insurance?
Yes, most people are required to have insurance as of Jan. 1, 2014, or else you will be liable for a tax penalty. That coverage can be supplied through your job (including COBRA or a retirement plan), public programs such as Medicare, Medicaid or the VA, or an individual policy that you purchase. There are exceptions.
What is a health insurance exchange?
It’s an online marketplace where individuals and small employers can shop for insurance coverage. Enrollment began Oct. 1 for policies that will go into effect on Jan. 1. The exchanges will also help people find out whether they are eligible for federal subsidies to help cover the cost of coverage or eligible for Medicaid, the federal-state health insurance program for the poor.
How does it work to shop for insurance from an exchange?
In theory, you can do all or most of it online. You go to HealthCare.gov or to your state-run exchange, if there is one, and create an account. You provide some basic information, like where you live and how old you are and you’ll get a list of plans available in your area. If you provide income information, you’ll be able to get an estimate of whether you’ll be eligible for federal help paying for insurance or you might qualify for Medicaid.
The exchange will offer a list of health plans and their premiums and out-of-pocket costs, including deductibles and copayments. If you decide to buy one of those plans, in most cases, you will be directed to the insurer’s website to make the payment. Some plans or insurance companies may require a phone call to set up payment. In some jurisdictions, consumers will make their first premium payment to the exchange and then further monthly payments to the insurer.
If your income makes you eligible for a tax credit subsidy, it will be applied upfront to the monthly premium payment. You won’t have to wait until you file your taxes in 2015 to get the credit.
You can also fill out paper applications or apply over the phone.
The exchange will offer a list of health plans and their premiums and out-of-pocket costs, including deductibles and copayments. If you decide to buy one of those plans, in most cases, you will be directed to the insurer’s website to make the payment. Some plans or insurance companies may require a phone call to set up payment. In some jurisdictions, consumers will make their first premium payment to the exchange and then further monthly payments to the insurer.
If your income makes you eligible for a tax credit subsidy, it will be applied upfront to the monthly premium payment. You won’t have to wait until you file your taxes in 2015 to get the credit.
You can also fill out paper applications or apply over the phone.
Can I keep my doctor?
If you’re shopping for a new policy on the insurance exchanges or are eligible for Medicaid, the answer is “Maybe.” For private policies purchased through the exchange, it all depends on the list of doctors that the health plan considers “in network.” If your doctor isn’t in the plan’s network, you’re likely to pay a higher amount for co-insurance or a copayment. The number of doctors who take Medicaid is growing in states where the program is being expanded, but the number who take Medicaid is still limited in most areas.
If my employer (or former employer, if I’m retired) offers me insurance, can I shop on the exchange to get a better deal?
Even if your employer offers coverage, you can opt to buy a plan on the exchange. However, you may not be eligible for a subsidy.
Which health services are covered?
Each plan offered has to cover 10 “essential health benefits.” These include:
It’s important to keep in mind that insurers do have some discretion about which specific therapies they’ll cover within each category of benefit. So it’s very important to study a plan carefully to make sure it is offering any specific benefits you may need.
There’s a cap on how much you pay out of pocket for medical services each year. That cap is $6,350 for individual policies and $12,700 for family plans in 2014. Your regular monthly premiums do not count toward the cap.
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral (dental) and vision care
It’s important to keep in mind that insurers do have some discretion about which specific therapies they’ll cover within each category of benefit. So it’s very important to study a plan carefully to make sure it is offering any specific benefits you may need.
There’s a cap on how much you pay out of pocket for medical services each year. That cap is $6,350 for individual policies and $12,700 for family plans in 2014. Your regular monthly premiums do not count toward the cap.
My individual policy was canceled because it didn’t meet the requirements of the Affordable Care Act, according to a letter I got.from my insurer. What options do I have?
There are new provisions to help people with canceled policies “transition” to coverage. You may not face a penalty if you don’t purchase a full-fledged policy on the exchange.
If you’ve been canceled and find that a new policy on the exchange is not affordable, you can purchase catastrophic coverage because you qualify for a hardship exemption. A catastrophic plan does not provide the all the minimum benefits found in a standard health insurance policy. Catastrophic plans have low premiums, but very high deductibles and copayments.
If you’ve been canceled and find that a new policy on the exchange is not affordable, you can purchase catastrophic coverage because you qualify for a hardship exemption. A catastrophic plan does not provide the all the minimum benefits found in a standard health insurance policy. Catastrophic plans have low premiums, but very high deductibles and copayments.
What’s this about Bronze, Silver, Gold and Platinum plans?
Plans are divided into four different types – Bronze, Silver, Gold and Platinum – varying based on the size of their deductibles, copayments and other consumer costs. The Bronze plan pays for 60 percent of medical costs; the Platinum, 90 percent. Premiums are highest and deductibles the lowest for Platinum plans. Bronze plans generally have deductibles in the thousands of dollars; $5,000 and $10,000 deductibles. Within each tier, the amount you pay for deductibles, copayments and coinsurance may vary from company to company and even from plan to plan within companies.
No matter which plan you choose, the 10 essential benefits remain the same. There is also the option to purchase catastrophic insurance — low cost plans that cover minimal services but provide a safety net in the event of an accident or serious illness. But those plans do not come with subsidies.
People up to age 30 will have the option of buying a catastrophic plan that will cover only minimal services until they meet a deductible of roughly $6,400. The premium is usually much lower than the other plans. After the deductible is met, the plan covers the 10 essential health benefits — a kind of “safety net” coverage in case you have an accident or serious illness, according to the HealthCare.gov website. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. And there are other limits.
Do small businesses have to shop at the exchanges to cover employees?
Employers with fewer than 50 workers are not required to buy health insurance for their employees. Many small business do offer health care as a benefit, however, and for them, the insurance exchanges represent a new option in terms of where to shop.
Will COBRA rates increase?
COBRA is a transitional arrangement that allows you to stay on a former employer’s health insurance for up to 18 months after you’ve stopped working for the company. It’s expensive: You pay the entire premium — including any share the employer had previously paid on your behalf — plus a 2 percent administrative fee.
Whether your COBRA rate will go up depends entirely on what happens with your former employer’s health insurance plans. If its rates go up, so will yours. You’ll most likely see a higher increase than your former co-workers, however. That’s because their premiums may be subsidized by the employer, whereas yours are not.
Many people who might have used COBRA will find that buying insurance on the exchanges is cheaper. But pay close attention to when the enrollment period for the exchange is. People who enroll in COBRA and later decide they want to switch to an exchange plan generally won’t be allowed to do so until the exchange’s next annual open enrollment period. An exception would be if they exhaust their COBRA coverage.
Whether your COBRA rate will go up depends entirely on what happens with your former employer’s health insurance plans. If its rates go up, so will yours. You’ll most likely see a higher increase than your former co-workers, however. That’s because their premiums may be subsidized by the employer, whereas yours are not.
Many people who might have used COBRA will find that buying insurance on the exchanges is cheaper. But pay close attention to when the enrollment period for the exchange is. People who enroll in COBRA and later decide they want to switch to an exchange plan generally won’t be allowed to do so until the exchange’s next annual open enrollment period. An exception would be if they exhaust their COBRA coverage.
Even the Bronze plan is too expensive for me. Are there other options?
People up to age 30 will have the option of buying a catastrophic plan that will cover only minimal services until they meet a deductible of roughly $6,400. The premium is usually much lower than the other plans. After the deductible is met, the plan covers the 10 essential health benefits — a kind of “safety net” coverage in case you have an accident or serious illness, according to the HealthCare.gov website. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. And there are other limits.
According to HealthCare.gov:
According to HealthCare.gov:
In the Marketplace, catastrophic plans are available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received “hardship exemptions”. Also, as of Dec. 19, people whose individual policies were canceled because they did not meet ACA standards can purchase a catastrophic plan. Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost.
How much will insurance cost me on the exchange?
It depends on several factors, including your income, the state in which you live, your age, whether you smoke or not and your family size. You could end up paying very little or nothing at all if your income falls within a certain range. If you don’t qualify for a subsidy, from what we’ve seen so far, premiums for the standard “Silver plan” seem to be averaging between $200 and $400 a month for an individual. Depending on your circumstances and which plan you choose, coverage could be quite expensive — well over $1,000 a month in some cases. But this may still be lower than what you are paying now, if you have an individual policy.
There are caveats. One is that the cheaper plans come with big deductibles and lots of other out-of-pocket costs. Now, if you don’t think you’re going to have much in the way of medical expenses, that may be fine. But people should be aware that if they buy a plan that costs only $40 or $50 a month, they may have a $5,000 or $10,000 deductible before the plan starts paying benefits.
The other is that some of these less expensive plans come with very limited lists of doctors and hospitals. So if you have a particular doctor or hospital you know you want to use, you should check that before you sign up.
There are caveats. One is that the cheaper plans come with big deductibles and lots of other out-of-pocket costs. Now, if you don’t think you’re going to have much in the way of medical expenses, that may be fine. But people should be aware that if they buy a plan that costs only $40 or $50 a month, they may have a $5,000 or $10,000 deductible before the plan starts paying benefits.
The other is that some of these less expensive plans come with very limited lists of doctors and hospitals. So if you have a particular doctor or hospital you know you want to use, you should check that before you sign up.
I have read that the subsidy can only be applied to a Silver plan. Is that true?
It depends on which subsidy you’re talking about.
One subsidy is to help pay your monthly premiums. If you qualify for that subsidy (use our calculator), you can apply it toward the purchase of any plan — Bronze, Silver, Gold or Platinum. Where Silver plans come into play here is in calculating the amount of your subsidy: It’s based on the price of the second-lowest Silver plan in your area. If you choose a Gold or Platinum plan, you’ll still get the subsidy. But those plans have higher monthly premiums and you’ll have to make up the difference. Likewise, if you choose a Bronze plan, you’ll get the subsidy and your monthly premiums will be less.
There’s another subsidy to be had in the form of help with deductibles and copayments. To qualify for that subsidy, you do have to choose a Silver plan. Your income also has to fall below $28,725 for an individual or $58,875 for a family of four.
One subsidy is to help pay your monthly premiums. If you qualify for that subsidy (use our calculator), you can apply it toward the purchase of any plan — Bronze, Silver, Gold or Platinum. Where Silver plans come into play here is in calculating the amount of your subsidy: It’s based on the price of the second-lowest Silver plan in your area. If you choose a Gold or Platinum plan, you’ll still get the subsidy. But those plans have higher monthly premiums and you’ll have to make up the difference. Likewise, if you choose a Bronze plan, you’ll get the subsidy and your monthly premiums will be less.
There’s another subsidy to be had in the form of help with deductibles and copayments. To qualify for that subsidy, you do have to choose a Silver plan. Your income also has to fall below $28,725 for an individual or $58,875 for a family of four.
If I am buying coverage on my own, do I have to buy it on the exchange?
Consumers can shop for coverage on or off the exchange. However, subsidies for those who are eligible are generally available only for plans sold on the exchange.
If I am sick and unable to work and have no income, can I get a plan on an exchange for free?
If you are disabled and have no income, you most likely won’t be shopping for insurance on the exchanges. Rather, you may qualify for Medicaid. In most states, if you qualify to collect Supplemental Security Income, or SSI, you also qualify for Medicaid. For more information on Medicaid eligibility and links to your state’s Medicaid office, click here.
What if I can’t afford the premiums?
The health law provides fairly generous subsidies for many people, effectively lowering their monthly premiums. The subsidies are on a sliding scale, though, so they become less generous as your income grows. If your income is between 100 percent of the federal poverty level ($11,490 for an individual) and 400 percent ($45,960), you can get some help paying for premiums. A family of four can get a subsidy, although just a small one, with income up to $94,200.
Some people also can get help with deductibles and copayments. To qualify, your income has to be less than 2.5 times the poverty level ($28,725 for an individual or $58,875 for a family of four). You also have to choose a so-called Silver plan. That’s the second lowest cost of the four levels of coverage that will be available — Bronze, Silver, Gold and Platinum.
Subsidy amounts are calculated based on your modified adjusted gross income, a figure you can find on your annual tax return by adding lines 8b and 37 on IRS Form 1040. That includes things like wages and interest, less deductions like tuition and alimony, and additional payroll taxes paid by the self-employed. It does not include assets such as the value of your house, stocks or retirement accounts. You’ll be asked to estimate what your income will be for next year; if you’re wrong, you’ll have to reconcile with the IRS come tax time the following year.
Some people also can get help with deductibles and copayments. To qualify, your income has to be less than 2.5 times the poverty level ($28,725 for an individual or $58,875 for a family of four). You also have to choose a so-called Silver plan. That’s the second lowest cost of the four levels of coverage that will be available — Bronze, Silver, Gold and Platinum.
Subsidy amounts are calculated based on your modified adjusted gross income, a figure you can find on your annual tax return by adding lines 8b and 37 on IRS Form 1040. That includes things like wages and interest, less deductions like tuition and alimony, and additional payroll taxes paid by the self-employed. It does not include assets such as the value of your house, stocks or retirement accounts. You’ll be asked to estimate what your income will be for next year; if you’re wrong, you’ll have to reconcile with the IRS come tax time the following year.
I really can’t afford a policy even with the subsidy. What can I do?
Check out the list below because you may qualify for a “hardship exemption.”
There are several other exemptions available as well.
- You were homeless.
- You were evicted in the past 6 months or were facing eviction or foreclosure.
- You received a shut-off notice from a utility company.
- You recently experienced domestic violence.
- You recently experienced the death of a close family member.
- You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
- You filed for bankruptcy in the last 6 months.
- You had medical expenses you couldn’t pay in the last 24 months.
- You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
- You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
- As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
- You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
There are several other exemptions available as well.
What if I don’t have health insurance and I get sick or have to go to the emergency room?
If you don’t have insurance, you’ll get a bill, just as it’s always been. If you can’t pay, the hospital or other health care provider will still try to collect from you, although there are some provisions of the law aimed at discouraging some of the most aggressive collection tactics that have been used in the past. If it doesn’t collect, the health care provider will have to eat the cost. That’s why hospitals have been so anxious to have most people covered by insurance, so they can stop providing so much free care to people who can’t pay.
What if I’m wrong about my estimated income for next year?
If your income increases during the year, notify the exchange promptly so that you can avoid having to pay back the subsidy. On the other hand, if your income goes down, you could be eligible for a bigger subsidy. Either way it’s important to notify the exchange if your income changes.
I recently started working in July and now make $800 per week. When I’m listing my annual income, can I include the months that I wasn’t working? I’ll make about $20,000 this year.
You just need to make your best guess at what your ‘modified’ annual gross income (MAGI) will be. According to the government, this is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income. If you qualify for a subsidy, you’ll need to report significant changes in your income — up or down — to the exchange. If your income goes up substantially beyond your initial estimate, it will affect the amount of the subsidy. If you don’t report it during the year, you may have to pay back part of the subsidy at tax time in 2015.
My employer is not required to offer health insurance because we have less than 50 employees. I am shopping for insurance on the exchange but even with the subsidy I will have a difficult time affording the premium. My employer wants to contribute to help with the cost. How does he do this?
Your employer would need to give you the amount he wishes to contribute as part of your wages/salary. It would be counted as part of your modified adjusted gross income. In turn, that would decrease the amount of the subsidy you’re eligible for. The size of the decrease would depend on the amount of the contribution.
Will everyone pay the same price?
You won’t have to pay more for insurance if you have a medical condition and that condition will be covered when your policy begins. But older people can be charged more than younger people and smokers face a surcharge.
Can I change insurance plans later?
Generally, you are only able to enroll in or change plans once a year during the open enrollment period. This first year, that period runs from Oct. 1, 2013 to Mar. 31, 2014. In subsequent years, the time period will be shorter, running from Oct. 15 to Dec. 7.
There are certain circumstances in which you’ll be allowed to change plans or add or drop someone from coverage outside of the regular annual enrollment period. This could happen if you lose your job; get married or divorced; give birth to or adopt a child; or move to a different state. Any such life events trigger a special 60-day enrollment period where you can change or buy health insurance on an exchange. Otherwise, you’ll have to wait until the next open enrollment.
There are certain circumstances in which you’ll be allowed to change plans or add or drop someone from coverage outside of the regular annual enrollment period. This could happen if you lose your job; get married or divorced; give birth to or adopt a child; or move to a different state. Any such life events trigger a special 60-day enrollment period where you can change or buy health insurance on an exchange. Otherwise, you’ll have to wait until the next open enrollment.
Can I wait until I get sick to sign up for insurance?
No. You can’t just sign up when you’re sick and facing big medical bills. Otherwise, that’s what everyone would do. The exchanges under the Affordable Care Act have been designed pretty much the same way most employer insurance plans are: There’s an open season every year when you can buy or change plans, and that’s generally the only time you can buy or change plans. This year’s open season is a lengthy one — it runs from Oct. 1 to March 31, 2014. In future years, it will begin in October and end in December of each year.
Can young adults qualify for Medicaid?
Depending on your income and where you live, some young adults may qualify for Medicaid if they earn less than $16,000. States can decide whether to adopt the expansion; about half have done so. (See our FAQ on the Medicaid expansion here.)
Could I be eligible for Medicaid now?
The Affordable Care Act greatly expanded the number of people who qualify for Medicaid, the state-run health insurance program for people with low incomes. Previously, it was difficult for anyone other than pregnant women, parents and children to qualify. The law expands eligibility in ways that will allow many more people, including single and childless adults to qualify.
Do I have to buy insurance on an exchange?
No. You can get insurance through traditional methods. You may want to use a broker or buy insurance independently through one of several online websites. The exchanges may make it easier for you to find out if you qualify for a subsidy or for Medicaid, but enrolling through the exchange is not mandatory.
The exchanges are designed for two major groups of people: those who don’t have insurance now, and those who currently purchase their own insurance, meaning they don’t get it through an employer.
If you have insurance at your job or through a public program like Medicare, Medicaid or the VA, you don’t need to pay attention to the exchanges unless you lose that coverage for some reason. If you have insurance through your employer, you can shop for and buy insurance on an exchange if you like, but you probably won’t qualify for a subsidy or tax credit. And you will lose the contribution your employer makes toward health insurance.
The exchanges are designed for two major groups of people: those who don’t have insurance now, and those who currently purchase their own insurance, meaning they don’t get it through an employer.
If you have insurance at your job or through a public program like Medicare, Medicaid or the VA, you don’t need to pay attention to the exchanges unless you lose that coverage for some reason. If you have insurance through your employer, you can shop for and buy insurance on an exchange if you like, but you probably won’t qualify for a subsidy or tax credit. And you will lose the contribution your employer makes toward health insurance.
How do I know if I’m eligible for Medicaid?
The law extends eligibility to all adults under the age of 65 whose modified adjusted gross incomes fall below $16,000 for individuals and $32,500 for a family of four.
In states that decided not to participate in the Medicaid expansion, the rules are different, varying from state to state. About half of the states opted out of the Medicaid expansion, which is something that the U.S. Supreme Court gave them permission to do. In those states, the income cutoff to be eligible for Medicaid is generally much lower than what was set in the Affordable Care Act, so fewer people will qualify. And if you’re a childless adult, you’re most likely not eligible in states that rejected the Medicaid expansion. To find out the income cutoff in your state, check out the tables here.
Or, just try signing up for coverage at your health insurance exchange. The exchange will calculate whether you are eligible for Medicaid in your state, and, if you are, direct you to the proper state agency to get signed up. (Click here for our FAQ on how to navigate the exchanges.)
In states that decided not to participate in the Medicaid expansion, the rules are different, varying from state to state. About half of the states opted out of the Medicaid expansion, which is something that the U.S. Supreme Court gave them permission to do. In those states, the income cutoff to be eligible for Medicaid is generally much lower than what was set in the Affordable Care Act, so fewer people will qualify. And if you’re a childless adult, you’re most likely not eligible in states that rejected the Medicaid expansion. To find out the income cutoff in your state, check out the tables here.
Or, just try signing up for coverage at your health insurance exchange. The exchange will calculate whether you are eligible for Medicaid in your state, and, if you are, direct you to the proper state agency to get signed up. (Click here for our FAQ on how to navigate the exchanges.)
How do I know which health plan is best for me?
You should carefully weigh the state of your health and your financial situation to figure that out. For example, a person who’s 27 and in excellent health may decide that the low premium and high deductibles of a Bronze or Silver plan are his best bet. Of course, an illness or accident could arise at any time, so you’ll need to take that into consideration. That’s why it’s called it insurance.
For older adults with a chronic health condition or regular prescription expenses, it may be best to consider a Gold or Platinum plan with a higher premium that gives you a policy with lower out-of-pocket expenses for doctor visits and hospital stays.
For older adults with a chronic health condition or regular prescription expenses, it may be best to consider a Gold or Platinum plan with a higher premium that gives you a policy with lower out-of-pocket expenses for doctor visits and hospital stays.
How long can I stay covered by my parents’ insurance?
Nearly all young people can stay on their parents’ plan until age 26, even if they’re married, financially independent and no longer live with their parents. Young adults who are offered coverage through their own jobs can choose that plan or stick with their parents’ plan if they prefer. Depending on the policy, coverage may continue through the end of the year you turn 26. Check with your plan.
I am on Medicare. Do I need to use an exchange?
No. Medicare is not part of the health insurance exchanges and Medigap policies are not being sold or subsidized through the exchanges. As a Medicare beneficiary, you can enroll at Medicare.gov to get the program’s traditional drug coverage or a Medicare Advantage plan. The Medicare open enrollment season begins on Oct. 15.
I’m a U.S. citizen living abroad. Do I need to buy health insurance on an exchange?
No, if you live abroad for at least 330 days within a 12-month period, you are not subject to the mandate to have health insurance. Insurance bought on the exchanges generally wouldn’t cover you while overseas anyway (neither does Medicare, by the way). Ex-pats need to find insurance that will cover them in the country where they live. The State Department keeps this list of companies that provide international coverage. For country-specific information, look here.
I’m currently employed part time, and I pay for my own health insurance (not through my employer). Will I be eligible to participate in the exchanges, or to take advantage of the tax credits?
This is one of the biggest misconceptions about the exchanges — that they’re only for people who don’t have insurance.
The big PR campaigns you’ll be seeing in the coming weeks are aimed mostly at the uninsured, but the exchanges are definitely also open to people who currently buy their own insurance.
In fact, there are about 14 million people in the individual insurance market now. That includes people who work part time and don’t qualify for benefits; people who are self-employed; or people who may have retired early and don’t yet qualify for Medicare.
If I’m retired and my former employer offers me insurance, can I shop on the exchange to get a better deal?
Even if your former employer offers coverage, you can opt to buy a plan on the exchange. However, you may not be eligible for a subsidy.
Is there anybody who doesn’t have to have insurance?
Yes, the government has identified exemptions. Individuals who cannot afford coverage because the cost of premiums exceed 8 percent of their household income or those whose household incomes are below the minimum threshold for filing a tax return are exempt. People experiencing certain hardships, including those who would have been eligible for Medicaid under the health law’s new rules but whose states chose not to expand their programs, also are exempt.
Other exempt groups include prisoners, Native Americans eligible for care through the Indian Health Service, immigrants who are in the country illegally, people whose religion objects to accepting insurance benefits, members of a health care sharing ministry and individuals who experience a short coverage gap of less than three consecutive months.
If you are seeking an exemption for incarceration, or membership in an Indian tribe or health care sharing ministry, you can apply through the health insurance exchanges or make a claim when you file taxes. If you are claiming economic hardship or a religious exemption, you must get an exemption certificate from the online insurance exchange. If you are claiming that coverage is unaffordable, that you are in the United States without proper documentation or that you have a coverage gap of less than three months, you can make the claim when you file your 2014 taxes in 2015.
Americans who live abroad for at least 330 days within a 12-month period also are not subject to the mandate. Insurance bought on the exchanges generally wouldn’t cover them while overseas anyway (neither does Medicare, by the way). Expats need to find insurance that covers them in the country where they live. The State Department keeps this list of companies that provide international coverage. For country-specific information, look here.
What about federal workers?
Most federal workers will continue to get their health coverage through the Federal Employees Health Benefits Program and will not be required to purchase coverage through the health law’s marketplaces. The only exceptions are for members of Congress and their personal staffs, who will be required to buy health insurance through the exchanges.
What if I am an immigrant in the U.S. legally?
Legal immigrants are permitted to use the marketplaces — and may qualify for subsidies if their income is less than about $46,000 for an individual and $94,200 for a family of four. Legal immigrants may qualify for Medicaid if their income is low enough. The laws governing benefits to lawful immigrants are quite complex. The federal Department of Health and Human Services has a guide to Medicaid and other benefits for immigrants.
What if I am an undocumented immigrant?
Immigrants who are in the country illegally are barred from buying insurance on the exchanges.
What if my parents are on Medicare? Can I join them?
No. Medicare is primarily a program for individuals who are 65 and older. There’s no family coverage available.
What if my parents don’t have insurance or buying subsidized coverage on the exchange is cheaper than staying on my parents’ insurance?
Almost anyone can shop for coverage on the health insurance marketplace. But you will only be eligible for subsidies to reduce the cost of coverage under certain circumstances. If your parents don’t claim you as a dependent on your tax return and your own income is between 100 and 400 percent of the federal poverty level ($11,490 and $45,960 in 2013), you could be eligible for premium tax credits on the exchange. But if your parents do claim you as a dependent, your eligibility for subsidies will be based on your family’s income, not just your own.
If your employer currently offers insurance, do you have to use that insurance, or do you have the option of selecting another plan?
This is one of the most frequently asked questions about the health law. And the answer is, it depends. Pretty much anyone can drop employment-based insurance and buy a policy on the exchange instead. But in most cases you won’t be eligible for a subsidy, no matter how low your income is.
That’s because the members of Congress who wrote the law didn’t want people rushing out of their employment-based plans to the exchanges and getting federal subsidies. That would have run up the law’s price tag considerably. For most people, though, it won’t make a lot of economic sense to switch. Most employers pay at least some, and usually a lot, of the cost of employee health insurance.
But there are two situations in which you can drop the health insurance you’ve been getting through your job, and get a subsidy on the exchanges instead. One is if your employer’s insurance plan is on the skimpy side and doesn’t pay at least 60 percent of your typical health expenses. The second is if your coverage — not your family’s coverage, but your coverage — costs more than 9.5 percent of your family income.
Do the exchanges have a good selection of plans to choose from?
The number of plans that you can choose from varies widely. In some states, only a couple of insurers are offering policies though the marketplace, while in others there may be a dozen or more. Even within a state, there will be differences in the number of plans available in different areas. Insurers generally offer a variety of types of plans, including familiar models like PPOs and HMOs.
When can I shop at my exchange?
Generally, people will be able to enroll in or change plans once a year during an annual open enrollment period. This first year, that period is unusually long. In subsequent years, the time period is supposed to be shorter, running from Oct. 15 to Dec. 7.
You can enroll — and avoid paying any penalty — until March 31, 2014. If you sign up and pay your premium between Dec. 16 and Jan. 15, 2014, coverage starts on Feb. 1.
Jan. 16 - Feb. 15: Coverage begins March 1.
Feb. 16 - March 15: Coverage begins April 1
March 16 - 31: Coverage begins May 1.
For coverage starting in 2014, the open enrollment period is October 1, 2013–March 31, 2014.
For coverage starting in 2015, the open enrollment period is November 15, 2014–January 15, 2015.
Generally, people will be able to enroll in or change plans once a year during an annual open enrollment period. This first year, that period is unusually long. In subsequent years, the time period is supposed to be shorter, running from Oct. 15 to Dec. 7.
Update (Dec.18): Due to problems with the rollout of the law, insurance companies have voluntarily extended the payment deadline for coverage starting Jan. 1. Consumers will have until Jan. 10 to make the first payment - as long as they’ve signed up by the Dec. 23 deadline.
You can enroll — and avoid paying any penalty — until March 31, 2014. If you sign up and pay your premium between Dec. 16 and Jan. 15, 2014, coverage starts on Feb. 1.
Jan. 16 - Feb. 15: Coverage begins March 1.
Feb. 16 - March 15: Coverage begins April 1
March 16 - 31: Coverage begins May 1.
For coverage starting in 2014, the open enrollment period is October 1, 2013–March 31, 2014.
For coverage starting in 2015, the open enrollment period is November 15, 2014–January 15, 2015.
Generally, people will be able to enroll in or change plans once a year during an annual open enrollment period. This first year, that period is unusually long. In subsequent years, the time period is supposed to be shorter, running from Oct. 15 to Dec. 7.
Update (Dec.18): Due to problems with the rollout of the law, insurance companies have voluntarily extended the payment deadline for coverage starting Jan. 1. Consumers will have until Jan. 10 to make the first payment - as long as they’ve signed up by the Dec. 23 deadline.
What if I need help with signing up?
The federal government has set up call centers to answer questions from people in states using the federal exchanges. That phone number is 800-318-2596. States running their own exchanges also have call centers.
Most states also have trained people called “assisters” and “navigators” who can walk people through the process, although in some states their training has been delayed. Contact information can be found on the exchange websites.
What personal information will I have to give the exchange?
You’ll need to set up an account with your name, address and Social Security number. If you have an email address, you can provide that, too. The exchange will want to know about your marital status; the number of children under 18 birthdays of anyone wi be covered; whether you smoke; financial information and citizenship status. The financial and citizenship information will be checked against records at the Internal Revenue Service and other government agencies.
I’m having trouble signing up through HealthCare.gov. How can I get a paper application?
There are several ways to get a paper application. One of them is actually from the much-maligned HealthCare.gov website. On the home page there are now four icons that have replaced the photo of the smiling lady later identified as a Columbian immigrant who released the rights to her photo for the website. One of those icons connects to the paper application. Operators at the HealthCare.gov call center (1-800-318-2596) can also provide paper applications, as can health care navigators or assisters. They are usually affiliated with local civic or health organizations such as community health centers or hospitals.
What happens if I sign up for a plan on the health exchange and get federal subsidies to help pay the premiums, but then don’t end up earning enough and should have been on Medicaid instead? Will I be expected to pay those subsidies?
No. The way the law was written, it was expected that most people with low incomes would be enrolled in the Medicaid program. Because of that, if your income is under the poverty line — $11,490 for an individual this year — you’re not eligible to buy coverage on the exchange. You could enroll in Medicaid instead, but only if your state is one of the 26 that are expanding the program. If not, you may fall into the gap where there is no program for you.
The catch is that you have to estimate your income in advance. So you may overestimate your income, buy coverage and get subsidies, and then discover when tax time comes that you weren’t actually eligible, after all, because you earned too little. Experts assure us that this possibility has been taken into account, and you won’t be punished or thrown into jail or even asked to pay back the subsidies in those situations.
On the other hand, if you underestimate your income and get subsidies, then end up earning more, come tax time the following year you will be expected to pay back subsidies you weren’t eligible for.
The catch is that you have to estimate your income in advance. So you may overestimate your income, buy coverage and get subsidies, and then discover when tax time comes that you weren’t actually eligible, after all, because you earned too little. Experts assure us that this possibility has been taken into account, and you won’t be punished or thrown into jail or even asked to pay back the subsidies in those situations.
On the other hand, if you underestimate your income and get subsidies, then end up earning more, come tax time the following year you will be expected to pay back subsidies you weren’t eligible for.
Can insurers deny me coverage because I have an existing medical condition?
No. The Affordable Care Act prohibits discrimination on the basis of prior or existing health conditions.
Can my insurer drop me?
Your insurer generally can’t drop you, as long as you keep up with your insurance premiums and don’t lie on your application.
Do all insurance companies have to offer policies through the exchange?
No. Insurers are not required to sell insurance through the exchanges. In several states, for example, the largest insurers decided not to offer insurance this year, while they wait and see how everything pans out. Some are concerned about the negative publicity that might result if the exchanges get off to a shaky start. Others want to wait and see whether the exchanges will be profitable.
Does the health care law offer any new benefits for Medicare beneficiaries?
Yes. Medicare beneficiaries will receive more preventive care services – including a yearly “wellness” visit, mammograms, colorectal screening, and more savings on prescription drug coverage. By 2020, the law will also close the Medicare gap in prescription drug coverage, known as the “doughnut hole.” Seniors will still be responsible for 25 percent of their prescription drug costs.
Does the health law require higher-income Medicare beneficiaries to pay more for their Medicare prescription drug coverage?
It does. Currently, Medicare beneficiaries who earn more than $85,000 ($170,000 for a couple) pay more for their Medicare Part B premiums, which cover physician and outpatient services. The health law brought that same sliding-scale approach to beneficiaries’ prescription drug coverage in Medicare Part D, for those with incomes of more than $85,000 ($170,000 for a couple). Those income thresholds will be frozen through 2019.
I am on Medicare. Do I need to use one of the new health insurance exchanges?
No. Medicare is not part of the health insurance exchanges. The exchanges won’t be selling so-called Medigap policies that supplement the coverage seniors get through Medicare.
Seniors will still get health coverage through Medicare’s traditional fee-for-service program or Medicare Advantage plans, private health insurance plans that are approved by Medicare. Those who are enrolled in Medicare Part A, which covers hospital care, or the Advantage plans will meet the health law’s mandate for individuals to have insurance.
Seniors will still get health coverage through Medicare’s traditional fee-for-service program or Medicare Advantage plans, private health insurance plans that are approved by Medicare. Those who are enrolled in Medicare Part A, which covers hospital care, or the Advantage plans will meet the health law’s mandate for individuals to have insurance.
How much will the tax penalty go up in future years?
The tax for remaining uninsured goes up substantially starting in 2015. Then, it’s $325 per adult and $162.50 per child, or 2 percent of your family’s income — whichever is greater. In 2016 and beyond, the tax is higher still: $695 per adult and $347.50 per child, or 2.5 percent of your family’s income — whichever is greater.
I’ve heard there might be some kind of a grace period when it comes to signing up.
Sort of. The IRS has said that people don’t have to pay a tax penalty if they have a “short gap” in their coverage. The agency defined a short gap as lasting less than three months. It’s complicated, though. Look here for the details.
If I choose to simply pay the tax and not purchase actual health insurance through the website or exchanges, am I covered for any health care expenses, such as private doctor visits or emergency room visits?
That’s easy: No. You have person has chosen to remain uninsured and therefore are financially responsible for your own medical bills.
There is a separate federal law, called EMTALA, that requires hospitals to treat people who show up in emergency rooms. But those hospitals will send you a bill. In many cases people without insurance are also poor and can’t pay those bills, and hospitals end up eating the cost. But hospitals work hard to collect what they can, so they will come after people they think might be able to pay.
There is a separate federal law, called EMTALA, that requires hospitals to treat people who show up in emergency rooms. But those hospitals will send you a bill. In many cases people without insurance are also poor and can’t pay those bills, and hospitals end up eating the cost. But hospitals work hard to collect what they can, so they will come after people they think might be able to pay.
If I opt to pay the tax penalty, am I covered with insurance?
No. Paying the tax penalty does not buy you anything. If you decide to go that route, you do not have insurance. You can still see a doctor or go to a hospital, but you’ll have to pay all the bills.
What is the penalty for not having health insurance?
The penalty for not having health insurance, at least for 2014, is up to $95 per adult and $47.50 per child or 1 percent of your taxable income — whichever is greater. It is supposed to go up substantially in a couple of years. The amount you owe will be prorated to reflect the number of months you were without coverage.
If you owe the penalty, it is assessed on your 2014 income tax form that’s due on April 15, 2015. And that’s how the government finds you — it asks on your income tax form if you had health insurance. People who have it will get some sort of certificate of coverage from their health insurers. If your income is so low that you do not file a tax return, you are exempt from paying the penalty.
If you owe the penalty, it is assessed on your 2014 income tax form that’s due on April 15, 2015. And that’s how the government finds you — it asks on your income tax form if you had health insurance. People who have it will get some sort of certificate of coverage from their health insurers. If your income is so low that you do not file a tax return, you are exempt from paying the penalty.
How will the government know that someone does or doesn’t have health insurance if they don’t use the exchanges??
The Internal Revenue Service will ask if you have insurance on your 2014 income tax form, which is generally due by April 15, 2015. Your insurance company can provide proof of coverage.
What type of penalties are involved if you start 2014 without insurance but get covered at some point in the year? Is the penalty pro-rated?
If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you’re uninsured for less than 3 months, you don’t have a make a payment.
I know that the insurance companies will no longer be able to turn down people with pre-existing conditions. But can they ask about them? And if so, will such people have higher premiums than those without them?
In a word, no. Starting Jan. 1, 2014, discrimination based on pre-existing conditions will not be allowed. You can’t be turned down, and you can’t be charged more. This will mean that some healthy people will pay higher premiums to offset the cost of those sicker people who are paying less. But the whole idea of requiring most people to have coverage is to get more healthy people into the insurance pool and spread the risk more broadly.
I have insurance through my spouse’s employer, but I might be able to get a better deal on the exchanges. Will I be able to buy health insurance through the health insurance exchanges?
Probably not. You know how President Obama has been saying, “If you like the coverage you have you can keep it?” That was shorthand for saying that the law was intended to maintain the existing system, where people get insurance through a job or through a family member’s job. And to make sure that didn’t change — for the first several years at least — people who are offered health insurance through an employer or a family member’s employer are not allowed to go to an exchange to get insurance, except in very limited cases. Or they can go to an exchange, but they won’t be eligible for any help paying their premiums.
But there are exceptions: If the individual premium offered by the employer costs more than 9.5 percent of your household income — for coverage of an individual, not a family — or if the employer’s plan pays less than 60 percent of the cost of covered benefits, then the employee is allowed to opt out of employer coverage and go to an exchange for health insurance.
Do all states have exchanges?
Yes. Sixteen states and the District of Columbia are running their own exchanges and the federal government is setting them up in 27 states. In seven states, federal and state officials are partnering to run the exchanges. You can get information about the exchange at HealthCare.gov, which has details on the federal exchanges and links to state-run exchanges.
How do I know if my state has expanded Medicaid?
The following states have said yes to the Medicaid expansion:
Arizona, Arkansas, California, Colorado, Connecticut, Delaware, D.C., Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, Vermont, Washington, West Virginia
Indiana and Pennsylvania have decided to move forward with expansion after 2014. The following states have said no to the Medicaid expansion or have not yet decided:
Alabama, Alaska, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wyoming
Wisconsin is “not moving forward at this time.” This list is current as of Dec. 11, 2013. Check here for updates.
Arizona, Arkansas, California, Colorado, Connecticut, Delaware, D.C., Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, Vermont, Washington, West Virginia
Indiana and Pennsylvania have decided to move forward with expansion after 2014. The following states have said no to the Medicaid expansion or have not yet decided:
Alabama, Alaska, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wyoming
Wisconsin is “not moving forward at this time.” This list is current as of Dec. 11, 2013. Check here for updates.
What if my state didn’t expand Medicaid?
If your income is too high to qualify for Medicaid under your state’s rules, you can still try enrolling at an insurance exchange. You may not qualify for subsidies, though. The subsidies are for people whose income falls between 100 percent of the federal poverty level ($11,490 for an individual) and 400 percent ($45,960).
If you make too much to qualify for Medicaid but too little to qualify for subsidies on the exchange, then you are exempted from the new mandate to carry health insurance. (See our FAQ on the individual mandate here.)
If that’s your situation — you’re poor and still have no health insurance — you can still seek health care with other safety net providers, such as federal community health centers and free clinics run by local nonprofits.
If you make too much to qualify for Medicaid but too little to qualify for subsidies on the exchange, then you are exempted from the new mandate to carry health insurance. (See our FAQ on the individual mandate here.)
If that’s your situation — you’re poor and still have no health insurance — you can still seek health care with other safety net providers, such as federal community health centers and free clinics run by local nonprofits.
I’m a college student. How does the Affordable Care Act affect me?
The first thing students need to know is that if they do have student insurance through their college or university, that’s been deemed to satisfy the requirement that individuals have health insurance starting in 2014.
If you can’t afford the insurance your school offers or your school doesn’t offer coverage, you might fall into one of a few categories.
First, if you’re a full-time student and you’re not working, or if you’re working just part-time, you probably don’t earn enough to trigger the requirement to have health insurance. It applies only to people who earn enough to have to file income taxes; that’s just under $10,000 this year for a single person under age 65.
But what if you want insurance? Well, if you’re under 26 and your parents are insured, you’re in luck. One popular part of the law lets young adults stay on their parents’ health insurance plans until they turn 26. In states that opt to expand Medicaid, that will also become an option for many college and graduate students. It’s for people who earn up to 133 percent of poverty, or about $15,000 a year for an individual. But only about half the states are planning to expand Medicaid.
If you can’t afford the insurance your school offers or your school doesn’t offer coverage, you might fall into one of a few categories.
First, if you’re a full-time student and you’re not working, or if you’re working just part-time, you probably don’t earn enough to trigger the requirement to have health insurance. It applies only to people who earn enough to have to file income taxes; that’s just under $10,000 this year for a single person under age 65.
But what if you want insurance? Well, if you’re under 26 and your parents are insured, you’re in luck. One popular part of the law lets young adults stay on their parents’ health insurance plans until they turn 26. In states that opt to expand Medicaid, that will also become an option for many college and graduate students. It’s for people who earn up to 133 percent of poverty, or about $15,000 a year for an individual. But only about half the states are planning to expand Medicaid.
I’m a veteran who participates in my regional healthcare plan through the military TRICARE system. Will the ACA affect my health care?
Not at all. The health law lays out several categories of what it considers minimum coverage
Is there any reason not to sign on with my parents’ plan?
Apart from general cost and coverage considerations, there are a few specifics to keep in mind when weighing a parent’s plan. If you are studying or working in areas away from your parents’ home, there may be no local providers who are in their insurance network, and going to out-of-network doctors or hospitals can be expensive. If you’re healthy, delaying a doctor visit until you return home may not be a problem, but if you have chronic conditions, that may not be feasible.
In addition, if you plan to become pregnant while on your parents’ plan, you should check to make sure maternity benefits are covered. Although by law most group plans must provide maternity coverage for employees and their spouses, children aren’t protected by the law, and employers don’t always provide coverage.
In addition, if you plan to become pregnant while on your parents’ plan, you should check to make sure maternity benefits are covered. Although by law most group plans must provide maternity coverage for employees and their spouses, children aren’t protected by the law, and employers don’t always provide coverage.
Are Americans living overseas required to purchase health insurance?
The estimated 6 million American expats were not forgotten by those who wrote the health law. The law stipulates that anyone who lives outside the U.S. for at least 330 days in a 12-month period is “treated as having minimum essential coverage for the year or period” and thus meets the requirement to have health insurance.
Are employers reducing their workforce as a result of the Affordable Care Act?
There have been reports of employers holding back on hiring to stay under the 50-employee threshold that triggers health insurance responsibilities. There also have been reports of employers cutting workers’ hours to below 30 per week so that they don’t count as full time. While there is anecdotal evidence of both things happening, there’s no evidence that those cases have added up to a broader drag on the economy as a whole.
Do employers have to do anything different under the Affordable Care Act?
Not right away. The only thing required of employers at the start is that they notify workers that the new health insurance exchanges have opened. You may have received a letter from your employer to this effect — you probably don’t need to do anything.
Starting in 2015, employers with 50 or more workers have a responsibility — but no mandate — to offer employees health coverage. If they don’t, they may face fines, but only if their workers go to health insurance exchanges and have earnings low enough to qualify for federal subsidies. Stores and restaurants — less likely to offer health insurance in the past — may be most affected. The coverage rule doesn’t affect workers who put in less than 30 hours a week.
There are no responsibilities for small employers with fewer than 50 workers. If they want to buy coverage for their employees, the insurance exchanges represent a new option for them in terms of where to shop. Certain employers with fewer than 25 workers are eligible for federal tax credits. To qualify, the company has to cover at least half of the premium for all of its employees, and also have average wages of less than $50,000. For details on these tax credits, see this answer sheet from the IRS.
Starting in 2015, employers with 50 or more workers have a responsibility — but no mandate — to offer employees health coverage. If they don’t, they may face fines, but only if their workers go to health insurance exchanges and have earnings low enough to qualify for federal subsidies. Stores and restaurants — less likely to offer health insurance in the past — may be most affected. The coverage rule doesn’t affect workers who put in less than 30 hours a week.
There are no responsibilities for small employers with fewer than 50 workers. If they want to buy coverage for their employees, the insurance exchanges represent a new option for them in terms of where to shop. Certain employers with fewer than 25 workers are eligible for federal tax credits. To qualify, the company has to cover at least half of the premium for all of its employees, and also have average wages of less than $50,000. For details on these tax credits, see this answer sheet from the IRS.
I would like to know if it is true that some people, for so-called religious reasons, will be getting a free ride. If this is true, then who are these people, how many are there and who will pay for their coverage?
It is true that people who are members of certain religious groups are exempt from the requirement to have health insurance. Examples include the Amish and some Mennonite sects, because they don’t pay into Social Security. But they are not “getting a free ride.” Some members of such groups have a form of insurance through cooperative ventures or “health care sharing ministries,” where members of a group pool together to pay each other’s medical bills. Others may remain uninsured.
I’m restricted to doctors in my state, and they are more expensive than if I were to buy a plan in a neighboring state. Is it possible for me to buy an out-of-state plan?
Not right now. At the moment you’re required to sign up in the exchange for the state that matches your mailing address. There actually is a provision in the Affordable Care Act to allow something called health care choice compacts that would allow for this. So far, though, only seven states have passed legislation that would allow their health insurance policies to be sold across state lines, and none of those states have taken the necessary steps to make this happen. So, right now, you have to stay in your home state.
But insurance plans can and do include doctors and hospitals in other states, particularly in areas located near a state border.
What if I don’t qualify for assistance by the government’s definition, but I still can’t afford insurance on my own?
If you’re an individual making up to $45,950, you should be eligible for at least a little bit of a subsidy.
Now, there may be cases where someone doesn’t qualify for help, or does qualify for help but still can’t afford the premium. Those people won’t be required to have insurance. The law says if you would have to spend more than 8 percent of your income on insurance, you are excused from having to pay any penalty for not buying it. There are several other types of people who are excused. And you can always seek a hardship exception if you think you truly can’t afford coverage.
How much will the premiums be? That information is just starting to come in from some of the states. It will depend on a lot of factors — where you live, how old you are, whether you want to pay a higher premium and have a lower deductible, or pay a lower premium and have a higher deductible. And, of course, whether you’re eligible for a subsidy. But from what we’ve seen so far, premiums for the standard Silver plan seem to be averaging between $200 and $400 a month for an individual, without subsidies.
If you are self-employed, is there a cap to how much you can make to use the Affordable Care Act insurance?
No. There’s no upper limit to how much you can earn and still be able to buy health insurance on the exchange. But there is an upper limit on how much you can earn and qualify for a subsidy to help offset the costs. That upper limit is 400 percent of the federal poverty level — about $46,000 in modified adjusted gross income for an individual and about $94,000 for a family of four. If you earn less than those amounts, you can qualify a subsidy that will lower your premiums. Earn more than that, you’ll have to pay full freight.
Is it true that subsidies apply only to Silver-level plans, and that if a person decides to purchase a lower-cost Bronze plan, the subsidy cannot be applied?
That’s actually not the case. But first let’s back up a bit and explain the question. There are four different levels of coverage you can choose on the exchanges, and they’re named for metals: Bronze, Silver, Gold and Platinum. Bronze plans have the lowest premiums but also the fewest benefits; Platinum plans, the highest premiums and most generous benefits.
People under age 30 have another option: a basic plan that covers just preventive services and three primary care visits before deductibles are met. But the plan also covers care for a catastrophic illness or injury.
The confusion arises because the amount of subsidy someone gets is calculated based on the Silver plan. But that subsidy can then be applied to any plan you want. For many people, that subsidy may be enough to get Bronze-level coverage free.
Of course, there’s an exception to that, too. Some people will qualify for help with not just premium but deductibles and copays as well. That’s for people with income under 2.5 times the poverty level, or about $23,000 for an individual. To get that extra help, yes, you do have to buy a Silver-level plan.
What about part-time workers?
Nothing in the Affordable Care Act says that employers have to cover part-time workers. The law defines part time as someone who works less than 30 hours a week.
Some employers that have offered part-time workers minimal coverage, such as Trader Joe’s and Home Depot, have dropped it on the grounds that those workers can now find coverage through the insurance exchanges. Most workers in this situation will be pleased with the outcome. They’ll most likely find better coverage than what they had for less money. Although depending on the situation, some people may see their premiums go up.
Some employers that have offered part-time workers minimal coverage, such as Trader Joe’s and Home Depot, have dropped it on the grounds that those workers can now find coverage through the insurance exchanges. Most workers in this situation will be pleased with the outcome. They’ll most likely find better coverage than what they had for less money. Although depending on the situation, some people may see their premiums go up.
Will my company stop offering coverage to my spouse and dependents?
Some companies, including UPS, have decided to stop covering working spouses if they have access to coverage at their own jobs. The health law does not require employers to cover spouses, but surveys show that only a minority of companies have implemented a “spousal exclusion.”
However, employers increasingly offer incentives to get spouses off their plans. They may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy.
The health law does require employers who offer coverage to employees to also offer coverage to dependent children, or pay a penalty.
However, employers increasingly offer incentives to get spouses off their plans. They may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy.
The health law does require employers who offer coverage to employees to also offer coverage to dependent children, or pay a penalty.
Will my employer cut back on my insurance coverage?
A number of employers have been overhauling the health benefits they offer employees, citing rising costs.
There are two themes to what they are doing. In trying to control their own spending, employers are often shifting health costs to employees. So the average annual deductible for an individual — what consumers pay before insurance kicks in — nearly doubled in the past seven years, from $584 in 2006 to $1,135 this year, according to the Kaiser Family Foundation.
But employers aren’t just making workers pay more. They’re also trying to make them think more about health-related expenses and behavior.
Companies such as grocer Kroger Co. pay only a fixed amount for particular drugs or procedures, giving patients incentive to shop around for the best price. IBM started giving rebates to workers who adopt healthful lifestyles. Penalizing smokers with surcharges is one of the few discriminatory measures the health act allows.
There are two themes to what they are doing. In trying to control their own spending, employers are often shifting health costs to employees. So the average annual deductible for an individual — what consumers pay before insurance kicks in — nearly doubled in the past seven years, from $584 in 2006 to $1,135 this year, according to the Kaiser Family Foundation.
But employers aren’t just making workers pay more. They’re also trying to make them think more about health-related expenses and behavior.
Companies such as grocer Kroger Co. pay only a fixed amount for particular drugs or procedures, giving patients incentive to shop around for the best price. IBM started giving rebates to workers who adopt healthful lifestyles. Penalizing smokers with surcharges is one of the few discriminatory measures the health act allows.
What about dental benefits?
Some plans in the exchanges do include dental coverage. You can also buy a separate, standalone dental plan. If you choose a separate plan, you’ll pay a separate, additional premium over and above your premium for health coverage. Having dental coverage is not required to avoid paying a penalty.
Insurers are required to provide dental coverage for children 18 and under, but not for adults.
Insurers are required to provide dental coverage for children 18 and under, but not for adults.