Healthcare FAQs for Individuals

There are many questions surrounding the new healthcare law, the Affordable Care Act (Obamacare). We receive questions on a daily basis from individuals who are unsure about the future of healthcare. We've compiled a list of the most frequently asked questions and answered them for you below. If you have a question that you can't find an answer for below, click here to send us an email with your question.

Do you have any Webinars?

Do you have any Webinars?

Answer:

Yes. One of our Marketplace certified agents had the wonderful opportunity to have a presentation recorded.  You may watch it here http://youtu.be/gnl5lSMAPnc

How do I qualify for a premium subsidy as an individual?

How do I qualify for a premium subsidy as an individual?

Answer:

Subsidies will be calculated at the time you apply through a government exchange.  On July 5, 2013 the Federal government has relaxed the rules that exchanges must verify income levels on individuals for the 2014 year.  This means that exchanges can only conduct random checks of income levels for 2014.

A household with an income level of less than 400% of the federal poverty level may qualify for a subsidy.

 

When will the new health care law start?

When will the new health care law start?

Answer:

The health insurance reforms adopted as part of the Patient Protection and Affordable Care Act (PPACA), and the subsequent reconciliation bill, are phased-in over 5 years. Most provisions will not take effect until January 1, 2014. There are also modifications to certain provisions that will change in the years after 2014. However, there are some new protections that have already been implemented:

  • Lifetime limits are prohibited and annual limits are restricted
  • Enhanced appeal procedures are available to consumers
  • Children under 19 years of age cannot be denied coverage
  • Children up to age 26 may remain on a parent’s policy
  • Preventive services must be coverage and cannot have cost-sharing
  • New rate review transparency requirements are in place
  • Medical loss ratio standards limit insurers’ overhead
  • A standardized summary of benefits must be used by all insurers, allowing for easier comparison of plans

Can I read the law myself?

Can I read the law myself?

Do I have to buy health insurance?

Do I have to buy health insurance?

Answer:

The key goal of the health care reform law is to ensure that nobody can be denied coverage or be priced out of coverage due to a health problem. However, if you allow people to wait until they have a health problem to purchase insurance, then the market simply will not work. There would be few choices available to consumers, and those choices would be expensive for everyone. So, the law requires everyone to have minimum coverage, thus creating a pool of both sick and healthy individuals.You are not required to purchase coverage, however you may be subject to a penalty if you do not.

Where can I obtain quotes for myself or my family?

Where can I obtain quotes for myself or my family?

Answer:

Visit our insurance and coverage finder page to get quote from several different insurance companies. Provide some simple information and you'll find a whole range of options available to you.

Can I keep my current health insurance plan?

Can I keep my current health insurance plan?

Answer:

Yes. Health plans in effect as of March 23, 2010, are grandfathered under the law and will be considered “qualified coverage” that meets the mandate to have health insurance that begins January 2014 as long as the issuer continues to offer it without substantial changes.

Will premiums go up under Obamacare?

Will premiums go up under Obamacare?

Answer:

Unfortunately, the grim fact is that health care spending is likely to continue rising faster than general inflation well into the future, resulting in higher premiums. While some individuals and families with health problems may see their premiums decrease significantly under the new rating rules, for most Americans premiums will continue to increase from year to year.

Will I have more out-of-pocket cost?

Will I have more out-of-pocket cost?

Answer:

All plans sold or renewed in 2014, must limit the out-of-pocket exposure of consumers to approximately $6,000 for individual and $12,000 for families. These limits will be indexed to average premium growth in future years. In addition, the deductible for plans in the small group market will be limited to $2,000 for individuals and $4,000 for families in 2014, also indexed to average premium growth in future years.

Also, all plans must design their cost-sharing (deductibles, copays, coinsurance) to fit into specific levels of coverage. The levels of coverage are defined as follows:

  • Bronze Level – The plan must cover 60% of expected costs for the average individual
  • Silver Level – The plan must cover 70% of expected costs for the average individual
  • Gold Level – The plan must cover 80% of expected costs for the average individual
  • Platinum Level – The plan must cover 90% of expected costs for the average individual

Are older people charged more under the new health care law?

Are older people charged more under the new health care law?

Answer:

Yes, though they may not charge older individuals a premium that is more than 300% of the premium charged a younger individual. Currently, rates can vary based on age as much as 700% in some cases. In addition, insurers may not vary rates based on health, claims, genetic information, or any other health-related factors. Insurers may only vary rates in a state by age (within limits), tobacco use, geography, and the number of family members covered.

Can a child be added to a healthcare plan at anytime?

Can a child be added to a healthcare plan at anytime?

Answer:

The health reform law requires that insurers and employers that provide dependent coverage to children make that coverage available to adult children of enrollees up to their 26th birthday. This requirement became effective for “plan years” beginning September 23, 2010, so parents will be able to enroll a child in group coverage during the next open enrollment period. Children can be added to an individual policy when it is renewed.

Of course, adding an adult child to the plan will likely increase your premiums. If the child is 19 or older, the insurer may exclude coverage of pre-existing conditions for a period of time, as allowed by existing state and federal law, until the prohibition on preexisting condition exclusions takes effect in 2014.

What penalties do I have to pay for not having insurance? And when does it go into effect?

What penalties do I have to pay for not having insurance? And when does it go into effect?

Answer:

Starting in 2014, most Americans will be required to have health insurance and could face federal penalties if they do not. Taxpayers will be required to indicate on their tax returns whether they have health insurance that meets minimal benefits standards. If consumers do not have insurance by 2014, they would owe $95, or 1 percent of taxable income, whichever is greater. The penalty rises to $325, or 2 percent of taxable income in 2015, and then $695, or 2.5 percent of taxable income in 2016, up to a maximum of $2,085 per family.

Where do I go to see what the premiums are on the private or public exchange?

Where do I go to see what the premiums are on the private or public exchange?

Answer:

Prices for policies sold in Affordable Insurance Exchanges (Public Exchange) have not been established yet. Public Exchanges—state-run marketplaces where individuals and small businesses can purchase private insurance policies—will begin operation in 2014. Insurers will offer plans with a certain guaranteed set of benefits at a range of prices. Members of Congress will purchase their health insurance through the new Exchanges, and you will be able to as well. The law makes clear that insurers won’t be able to charge more based on your gender or your health status, and there will be limits to how much premiums can vary based on your age. Private Exchanges are available and have their own rates established. Our exchange can be accessed through our insurance and coverage finder page.

How do I know if an insurance plan on the internet is good and not a scam?

How do I know if an insurance plan on the internet is good and not a scam?

Answer:

There are a number of things you can do to make sure that a plan is legitimate. If you have questions about a plan, one of your best options is to contact your state’s Consumer Assistance Program or your state’s Department of Insurance.

Also, you may want to review the suspected plan to make sure it is comprehensive. Some insurance may not really be health insurance. Read this guide to learn more about different kinds of insurance.

Are there specific coverages that my new health insurance plan has to have?

Are there specific coverages that my new health insurance plan has to have?

Answer:

Every plan sold or renewed in the individual and small group market after January 1, 2014, must include all the benefits in a “benchmark” plan – a plan chosen for the state based on coverage currently available in the state – and will cover services in the following categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse 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 and vision care

Can I have a free physical each year?

Can I have a free physical each year?

Answer:

For people with individual or job-based health insurance plans that are not grandfathered, the Affordable Care Act makes certain preventive services available without a copayment. An annual physical exam is not one of those services, however. See what’s covered and find out what this means for you.

What does the Affordable Care Act have to do with my taxes?

What does the Affordable Care Act have to do with my taxes?

Answer:

The law imposes tax changes that would affect some people who are covered through their employers, especially those in higher tax brackets. Beginning next year, the law increases the Medicare tax by 0.9 percent on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly. It also imposes a 3.8 percent tax on unearned income for high-income households.

Do Veteran's Benefits (VA Benefits) qualify under the new health care law?

Do Veteran's Benefits (VA Benefits) qualify under the new health care law?

Answer:

If you are covered by VA health benefits, you are considered covered under the Affordable Care Act.

Can I use my agent to sign up in the exchange?

Can I use my agent to sign up in the exchange?

Answer:

Exchanges are the central mechanisms created by the health reform bill to help individuals and small businesses purchase health insurance coverage. On October 1, 2013, an Exchange in every state will begin enrolling individuals and small businesses into qualified health plans. The Exchange, operated by the federal government or by the state, will provide information to consumers about their coverage options and what assistance is available to them. The Exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid, and the Children's Health Insurance Program (CHIP). The federal law does not require anyone to purchase health insurance through the Exchange, though subsidies will only be available for plans sold through the Exchange. You will be able to purchase this coverage right on the Exchange’s website or through your agent if he or she is approved to sell Exchange plans. If you would rather buy other health insurance through an insurance agent or broker, you will be free to do so.

What preventive benefits are covered?

What preventive benefits are covered?

Are there pre-existing conditions for children?

Are there pre-existing conditions for children?

Answer:

The law and subsequent regulations prohibit insurers from denying coverage for children based on health status or excluding coverage of their pre-existing conditions if otherwise covered under the policy. This protection became effective after September 23, 2010. A child can be added to an existing policy under the enrollment rules of the policy. If you are seeking a child-only policy, you will need to inquire whether child-only coverage is available in your state. If you are covered under a group plan, you may add your child to your policy at the next open enrollment period.

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