Affordable Care Act Frequently Asked Questions

Affordable Care Act: Frequently Asked Questions

FAQs About Health Care Reform

Q When will the health care reform law take effect?

A Some provisions of the law are already in effect, while most of the more complex changes begin in 2014. Some of the provisions in effect now are:
  • Adult children may stay on their parents’ health insurance policy until they turn 26
  • Children age 19 and under can no longer be turned down for coverage because of a pre-existing condition
  • Health insurance policies cannot put any lifetime limits on essential health coverage
  • Small businesses that provide health coverage for employees can apply for tax credits
  • Eligible seniors with Medicare Prescription Drug Coverage receive a rebate
  • Preventive services must be provided without cost-sharing
  • Insurance companies can no longer cancel coverage for reasons other than fraud
  • Standards for the appeals of claims are strengthened and an external review process has been established
  • Incentives are available for primary care doctors and nurses to work in underserved areas
  • Insurance companies must justify unreasonable rate increases
  • Changes coming in 2014:

  • Establishment of the Health Insurance Marketplace
  • Guaranteed issue and renewability of coverage
  • Nearly all individuals will be required to obtain health insurance coverage or pay a penalty
  • Elimination of annual limits on insurance coverage
  • Financial assistance may be available to purchase a health insurance plan
  • All new health plans must cover a core package of items and services, known as “essential health benefits”
  • Tax credits will increase for small businesses providing coverage to their employees
  • Individuals cannot be charged higher premiums because of their health status

Q Will every individual have to have health insurance in 2014?

A Almost everyone will have to have coverage in 2014. There are some exceptions to the individual mandate. They include the following individuals:
  • People who do not file an income tax return
  • Members of a Native American Tribe
  • Members of a health care sharing ministry
  • Undocumented immigrants
  • People who already have insurance through Medicare, Medicaid or veteran’s programs
  • Employees who would have to pay more than 8% of their income (earnings, employer contribution and exchange subsidies) for coverage

Q What is the penalty if I do not obtain coverage by January 2014?

A For individuals, the penalty would start at $95 a year, or up to 1% of income, whichever is greater, and increase to $695, or 2.5% of income, by 2016. For families the penalty would be $2,085 or 2.5% of household income, whichever is greater. This requirement may be waived for a few reasons, including financial hardship or religious objections.

Q What if I can’t afford health insurance?

A The Federal government has some financial assistance programs in place to make insurance more affordable for those who qualify.

Q Can you tell me more about the financial assistance?

A Premium tax credits that help people pay for coverage in the Health Insurance Marketplace are available to people who lack other affordable coverage and meet certain income standards. People who qualify for the premium tax credits can get them in advance without waiting until they file their taxes. The advance payment is sent to the insurance company that the consumer selects to reduce his or her monthly insurance premium. The amount of the premium tax credit depends on the size of the family and the individual’s or family’s annual income. In addition, some people receiving the premium tax credit will also be eligible for additional help to reduce the cost-sharing charges under the plan, such as copayments when they go to the doctor or fill a prescription. People with access to Medicaid, Medicare, Children’s Health Insurance Program (CHIP) or job-based coverage that meet certain standards are not eligible for a premium tax credit through the Health Insurance Marketplace.

Q I already have health insurance coverage at work and like my plan. Can I keep my current insurance plan?

A Most likely, yes. Health plans in effect by March 23, 2010 are grandfathered under the health care reform law as long as the insurer continues to offer it without substantial changes. However, your employer is not obligated to keep your current plan and may choose to modify your coverage options. Some employers may also choose to assist employees with purchasing insurance through the Health Insurance Marketplace.

Q What is the Health Insurance Marketplace?

A The Health Insurance Marketplace is an internet-based mechanism through which individuals, families and small employers can compare health insurance plans and purchase the plan that best suits their needs. The Health Insurance Marketplace, which in Mississippi will be operated by the Federal government, will provide information to consumers about their coverage options and what financial assistance is available to them. You can apply for coverage through the Health Insurance Marketplace online, via toll-free telephone or in person with assistance from a licensed insurance agent.

Q Who operates the Health Insurance Marketplace?

A Some states will operate their own Health Insurance Marketplace. Other states have chosen to let the Federal government operate the Marketplace in their state. Mississippi will have a Federally-facilitated Marketplace.

Q When can I enroll in the Health Insurance Marketplace?

A For individuals and families, enrollment in the new Health Insurance Marketplace begins October 1, 2013 and continues through March 31, 2014. If you sign up for coverage between October 1 and December 13, 2013, your coverage will become effective on January 1, 2014. In special circumstances, such as losing your health insurance coverage, marriage or moving, you may also be eligible to enroll in coverage outside of these dates. In future years, open enrollment will occur each year beginning October 13 through December 7.

Q Is the Internet the only way to purchase policies in the Health Insurance Marketplace?

A No. While there will be a website (www.healthcare.gov) for access to coverage, you can also submit your application over the telephone or in-person with assistance from a licensed insurance agent or broker. Local community organizations will also be trained to assist you with the process.

Q What companies will offer coverage in the Health Insurance Marketplace?

A The health plans available in Mississippi will be listed on the Marketplace website (www.healthcare.gov).

Q What kinds of insurance policies may I purchase in the Health Insurance Marketplace?

A Under Federal law only two kinds of insurance policies may be sold in the Marketplace: 1) major medical coverage, which is commonly referred to as health insurance; and 2) dental insurance that includes at least the minimum essential pediatric dental benefits.

Q What is the difference among the types of plans offered in the Health Insurance Marketplace?

A To help consumers compare costs, four tiers of coverage will be available through the Health Insurance Marketplace:
  • 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

Q Will I be able to see separate prices for the insurance sold in the Health Insurance Marketplace so I can

compare prices?

A Yes, you can. One of the key features of the Health Insurance Marketplace is that it allows consumers to compare policies based on what matters most to consumers: price, provider network, value, etc.

Q Do all plans have the same deductible?

A No. Deductibles will vary based on the plan’s coinsurance amount. Those with lower coinsurance amounts will have higher deductibles and those with higher coinsurance requirements will have lower deductibles.

Q How will my out-of-pocket costs be impacted?

A All plans sold or renewed in 2014 must limit the out-of-pocket expenses of consumers to approximately $6,000 for individual and $12,000 for families. These limits will be increased in future years at the same rate of average premium growth. 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 related to average premium growth in future years.

Q Will insurers be able to charge me more because of my age?

A Yes, though they may not charge older individuals a premium that is more than three (3) times the premium charged to a younger individual. Currently, rates can vary by age as much as seven (7) times in some cases. In addition, insurers may not vary rates based on health, claims history, 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.

Q What if I make too much money for Medicaid but still can’t afford insurance?

A The Federal government has some financial assistance programs in place to make insurance more affordable. You might be eligible for financial assistance from the Federal government to help you pay for private insurance sold in the Health Insurance Marketplace.

Q Will it be easier for me to get coverage even if I have health problems?

A Yes. You will not be denied coverage because of a pre-existing or chronic health condition. Starting in 2014, insurers cannot reject applicants based on health status.

Q Can I still have a Health Savings Account (HSA)?

A Yes, nothing in the law would prevent an individual from contributing to a Health Savings Account (HSA).

Q What benefits are covered in my plan selected in the Marketplace?

A Review the Summary of Benefits and Coverage (SBC) in each plan offered to find out coverage details for your insurance plan.

Q Is my doctor in the network?

A You will need to look at the health plans on the Health Insurance Marketplace to see if your doctor participates in that plan’s network. The plans sold are required to have an adequate network of providers.

Q What are out-of-network services and do I have any coverage for them?

A Out-of-network services are services provided by a doctor, hospital or other provider that does not have a contractual relationship with your health plan. Not all plans cover out-of-network services, but when they do, your share of the cost is usually higher. In addition, deductibles are often higher for out-ofnetwork services.

Q I have coverage but need to buy a separate policy for my child. Can I do this in the Marketplace?

A Yes. You may obtain a policy for your child through the Health Insurance Marketplace. You may also be eligible for financial assistance to reduce the cost of your premiums.

Q I’m over 65. How does the legislation affect seniors?

A Seniors’ existing, guaranteed Medicare-covered benefits will not be reduced or taken away. In 2010, seniors in the Medicare Prescription Drug Coverage “donut hole” received a one-time, tax-free $250 rebate. Going forward, seniors in the “donut hole” will receive a 50% discount on covered brand-name drugs, and the “donut hole” will be closed completely by 2020. Also, seniors will receive coverage of certain preventive services (such as cardiovascular and cancer screenings) without being charged the Part B coinsurance or deductible, and will receive a free wellness exam each year.

Q Where do I go for more information?

A Please visit www.healthcare.gov for more information about the health care reform law.