Your Source for Health Reform




Many questions about how health reform is affecting us have already been answered. Perhaps yours is one of them. If you do not find the answer you need below, please send us your own question.


 Q:   I underestimated my 2014 income for premium tax credits. I'm not able to pay the IRS back by April 15. Will I have an additional penalty?

 A:   No.  You will not have to pay a fine if you don't already owe the IRS money and report the amount of premium tax credits owed in your 2014 tax return.You can file for an extension to pay back the IRS. This release from the IRS explains who will be waived from the penalty and this article from Forbes clarifies the information.

 Q:   Can people with SHOP coverage delay Medicare Part B enrollment without the penalty?

 A:   Yes. A person with SHOP coverage is the viewed the same as a person with an employer group health plan. The same enrollment rules apply. People must enroll in Medicare Part B within 8 months of retirement or their SHOP coverage ending, whatever comes first. This question and answer from addresses concerns Medicare beneficiaries may have about the marketplace.

 Q:   I went to fill a prescription but found out I was dropped from Medicaid. How could this have happened?

 A:   You may have been dropped for not responding to your redetermination notice sent by mail. Keeping your healthcare is not automatic. The State approves your eligibility every year through redeterminations. If you do not respond to the redetermination forms sent in the mail, you will be dropped from coverage. This fact sheet from Illinois Health Matters shows who to call with questions about your redetermination. This FAQ from the state answers questions about the redetermination process.

 Q:   I just lost my job and now I don't have insurance. Can I get a plan through the marketplace?

 A:   Yes. Losing a job is a "qualifying life event" that makes you eligible to purchase a plan through the marketplace. This special enrollment period lasts 60 days. You must purchase a plan within this time. has more information on who qualifies and how to get covered during your special enrollment period.

 Q:   I'm filing my taxes for 2014 and realized I should have enrolled in a healthcare plan. Is it too late?

 A:   There is a special enrollment period for people who didn't have health insurance in 2014 and didn't enroll in a plan for 2015. For a person to qualify for this special enrollment period, they must say they became aware of the requirement to purchase insurance only when they filed their 2014 taxes. The special enrollment period is from March 15 to April 30, 2015. This news release from the Centers for Medicare & Medicaid Services gives detail on who qualifies.

 Q:   If I overestimate my income, will I have to pay back the cost-sharing reductions I received?

 A:   No. During tax time, marketplace consumers who received cost-sharing reductions will not determine if their reported income disqualified them for this assistance. Consumers will only reconcile their projected income with their reported income for premium tax credits. The Center on Policy and Budget Priorities has more information on cost-sharing reductions.

 Q:   How can someone sign up for CountyCare?

 A:   In order to enroll in CountyCare, an adult must be eligible and enroll in Medicaid for ACA Adults first (ages 19-64 and below 138% FPL). After successful enrollment into Medicaid through ABE or a local DHS office, that individual  will receive a letter with Medicaid health plans options. CountyCare, which started out as a pilot program, could be one of those options, depending on the area where the individual lives. The letter will instruct the individual to call the client enrollment broker to choose a Medicaid Health Plan. If CountyCare is an option for that individual, they may sign up through the client enrollment broker.

 Q:   Are immigrants eligible for financial assistance in the Marketplace?

 A:   Yes! Many immigrants that are legally present in the US remain subject to a five-year wait/bar before they may enroll in Medicaid. However, they may purchase Marketplace coverage and receive tax credits on the same basis as citizens. Individuals who are ineligible for Medicaid based on immigration status may purchase marketplace coverage and receive tax credits and cost sharing reduction subsidies. Find more information regarding immigrants and health insurance coverage.

 Q:   How does the Affordable Care Act (ACA) affect people on Medicare including the Medicare Supplement Plans?  

 A:   The ACA will not impact Medicare Supplement Plans. The Medicare changes included in the ACA are primarily physician and hospital rate changes. The biggest consumer changes include free preventative care services and the gradual closing of the Medicare Part D (prescription drug) donut hole by 2020. See here for more information on how the ACA impacts Medicare.

 Q:   What are monthly costs for plans sold on the Marketplace?  

 A:   According to a report from HHS, the average premium (monthly costs) after tax credits(financial assistance) for the most popular type of plan, Silver, was $69 per month for an individual in 2013-2014. Consumers with income below 400% of the Federal Poverty Level (about $88,000 per year for a family of four) who are buying insurance for themselves or their family will get tax credits that cover a large part of their costs. Premium costs vary based on the level of coverage a plan provides and the number of people a plan serves. For example, a family plan will likely have a higher premium cost than an individual plan. 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.

 Q:   When is the increase in Medicaid payments to primary care physicians?

 A:   On March 4, 2013, the Illinois Department of Health & Family Services (HFS)  published this notice about the increase in fees for primary care physicians. It says, "For dates of service January 1, 2013 through December 31, 2014, the department will apply an increased payment rate to enrolled practitioners for primary care services delivered by a primary care physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine. The increased payments will apply to services reimbursed by Medicaid fee-for-service, Voluntary Managed Care Organizations and Integrated Care Program Health Plans."  In order to receive the increased payments, physicians must self attest that they meet certain criteria. Interested primary care providers should read the notice for more information.

 Q:   How can Illinois state legislators help uninsured constituents?

 A:   Many consumers need individualized help to figure out if there is a public health or private insurance program that might fit their specific needs. There are options such as Medicaid and Medicare which require that consumers meet very specific requirements on income level, family status, disability and age. There are also new options -- such as for people with special health care needs to buy insurance through a high risk insurance pool, young adults under age 26 (even if they are not in college) and others. You can refer an individual constituent for assistance finding coverage to:; the Illinois Department of Insurance, Office of Consumer Health Insurance (877) 527-9431; or the Campaign for Better Health Care's toll-free hotline at 1-888-544-8271.

 Q:   How might health care reform affect Illinois Supportive Living Facilities?

 A:   Health care reform includes provisions to encourage states to provide home and community based long term care through several different opportunities. One of these is the State Balancing Incentive Payments Program; through this opportunity states can receive increased Medicaid reimbursement for home and community based service expenditures (more info here). Additionally, there are other long-term care provisions that support the growth of Supportive Living Facilities(more info). Check out this fact sheet put together by the Laubacher Company specifically on how the Affordable Care Act will affect Illinois' Supportive Living Facilities for more information.

 Q:   Do patient Navigators in the new health insurance exchanges have to be insurance brokers?

 A:   Patient navigators help individuals and small businesses choose the best insurance option for themselves or their employees through the health insurance marketplace. Insurance brokers can be navigators under the federal law; however, other professionals can also be navigators. The Affordable Care Act specifies that any individual or entity serving in this role must be independent of any health insurance issuer. Therefore, if brokers act as navigators they will not have their traditional role as being employed or directly compensated by health insurance companies. Read the Congressional Research Service report on "Health Insurance Agents and Brokers in the Reformed Health Insurance Market".

 Q:   Do physicians have to accept Medicaid patients?

 A:   There is no requirement in the Affordable Care Act that physicians or other medical providers must accept Medicaid patients in 2014. However, incentives in the ACA are designed to encourage providers to accept more Medicaid patients like a temporary payment rate increase for primary care in 2013 and 2014. Learn more about provider incentives here.
1 2

Have more general questions? Ask us your own question or check out these FAQs: