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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:   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:   What if I did not receive a form 1095-A or the information is incorrect?

 A:   Consumers who do not obtain the form 1095-A should contact their marketplace. Consumers should also contact their marketplace if the information included in the form is incorrect. This tip sheet from the Centers for Medicare and Medicaid Services and this newspaper article from the Chicago Tribune explain more on the form 1095-A.

 Q:   What is a form 1095-A?

 A:   All consumers who purchased insurance through the marketplace will receive a form 1095-A in the mail or electronically by the end of January, 2015. The form 1095-A will include the premium amount for each month and the total advanced premium tax credits received. When filing their taxes, marketplace consumers will use the form 1095-A to determine the amount of premium tax credits they qualified for, based on their reported income. Turbo Tax addresses common form-1095-A questions on their website.

 Q:   Will I owe money after doing tax reconciliation for premium tax credits?

 A:   It depends. In tax reconciliation, individuals filing their taxes complete a form to compare the amount of premium tax credits they received to the amount warranted by their reported income. Tax reconciliation only applies to those who receive advance premium tax credits, as opposed to collecting one lump sum with their annual tax refund. If tax reconciliation determines that an individual was eligible for a smaller tax credit, the person may have to pay the difference. Tax reconciliation could also show that consumers deserved a larger premium tax credit and people could get a refund. Consumers Union has created a fact sheet that explains more on the tax reconciliation process.

 Q:   Should I use my past year's income to determine premium tax credits?

 A:   No- you should estimate the amount of money you will make next year. For the 2015 coverage year, the actual premium tax credit will be based on your reported income in your 2016 tax return. If you underestimate how much you will make, you may owe money. This question and answer from the IRS explains more on how to claim your premium tax credit.

 Q:   Why should I avoid auto-enrolling in the same health plan?

 A:   Even if your current plan is still being offered by an insurance company for the 2015 enrollment period, important elements, including your monthly premiums and the hospitals and doctors that are in network, could have changed. This means that consumers who choose to auto-enroll could encounter higher medical costs and a different network that does not include doctors they had been seeing. Auto-enrolling can be particularly harmful for consumers receiving premium tax credits or subsidies that help pay for insurance. When consumers auto-enroll, the marketplace will apply the same premium tax credit amount toward 2015 coverage. Consumers whose income has not changed would actually be eligible to receive a higher premium tax credit. This is because their income would represent a smaller percentage of the federal poverty line, which increases annually to account for inflation. Consumers should return the marketplace, update their income information, and compare options to confirm that their current plan is still the best fit. The Center on Budget and Policy Priorities has provided an informative fact sheet that explains the downside of auto-enrollment in more detail.

 Q:   Why am I receiving letters saying I have to choose a plan and a primary care physician?

 A:   Illinois state law requires that 50% of Medicaid beneficiaries are enrolled into coordinated care by 2015. This means that a managed care organization (health insurance company) or provider group will be coordinating your physical and behavioral healthcare. A primary care physician will refer you to appropriate services and will typically be the first person you go to for healthcare. If you plan to enroll and have received letters in the mail you should go to or call the client enrollment broker at 1-877-912-8880 to pick a plan. If you want to learn more about coordinated care in Illinois please visit our Medicaid Care Coordination section.

 Q:   Can a health insurance policy be purchased on the marketplace at any time?  

 A:   No. You can purchase a plan at during open enrollment or if you qualify for a special enrollment period. The next open enrollment period starts November 15th. However, if you experience a qualifying life event like having a baby, getting married, or moving, you may qualify for a special enrollment period. To find out if you qualify for a special enrollment period answer the questions on the screening tool.

 Q:   What happens at tax time for consumers who have a reduction in income and are also receiving financial assistance from the Marketplace?

 A:   If someone were receiving a tax credit and later would have been eligible for Medicaid rather than a private plan based on actual income, s/he doesn't have to pay the IRS back for the tax credit.  HHS created this policy to protect low-income consumers.  In fact, the final tax credit will be calculated based on the individual's actual income, not the earlier estimate. So that person may actually get a larger refund at the end of the year due to the higher tax credit (and lower actual income). Projected incomes should be as accurate as possible and if something changes during the year, it should be reported to make sure the consumer is receiving the correct amount and enrolled in an appropriate health insurance plan. To learn more about when to report changes to the marketplace, see "How do I report life changes?"

 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:   Does the Affordable Care Act provide Medicaid to people in Illinois if they qualify based upon lack of income?

 A:   Yes. Illinois expanded Medicaid. As long as your yearly income is below 138% of the Federal Poverty Level (FPL) which is $15,900 for a single person or $32,500 for a family of four and you meet Illinois residency and US citizenship requirements, you will be eligible for a new Medicaid category called the ACA (Affordable Care Act) Adult Group. You can apply for Medicaid at any time throughout the year. To apply for Medicaid go here.  
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