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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:   Does employer health coverage affect eligibility for financial assistance through the Marketplace?  

 A:   Yes. If you have an offer of health coverage from your employer, you will not be eligible for a tax credit through the Marketplace unless that employer plan is unaffordable*.  If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. For more information on tax credits read our blog post here.

 Q:   If I don't have reportable income, how will the government know if I don't have health insurance?

 A:   Starting next year, most people will be required to have health insurance. But if you don't have to report your income because it is below the tax filing threshold -- $10,000 for individuals and $20,000 for families in 2013 -- you're exempt from that requirement and won't face any penalties for not having insurance. See more FAQs from Kaiser Health News.

 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:   I’ve heard that the Affordable Care Act (Obamacare) cuts $716 billion out of Medicare. Is this true?

 A:   It is true that the Affordable Care Act (ACA) calls for $716 billion in cuts to Medicare. However, none of those cuts will come from or affect the benefits Medicare participants receive.  In fact, the ACA takes steps to improve the medical care that seniors receive via Medicare. First, the majority of the cuts come from getting rid of overpayments to private insurers. Also, the ACA will provide seniors with more benefits—not a reduction in benefits. This includes a plan to close the Part D donut hole for prescription drug coverage, as well as more preventative care services offered without a co-pay (such as annual check-ups, prostrate exams, cervical cancer screenings, mammograms and flu shots). As for those seniors enrolled in the Medicare Advantage program, the new Medical Loss Ratio requirements mean that insurance companies have to spend a certain percentage of premium costs on customer’s medical care and improving the quality of care offered. If companies do not spend the required amount on providing care, they must refund the remainder to their customers. For more information about Medicare and the Affordable Care Act check out this blog post here.

 Q:   How is "domestic violence" defined under the ACA? Does this cover counseling for victims who are now safe but are recovering from past domestic violence?

 A:   The recommendation for new preventive health services for women beginning on 8/1/12, including interpersonal and domestic violence screening and counseling, was based on the Institute of Medicine’s (IOM) Report: Clinical Preventive Services for Women: Closing the Gaps. This report defines interpersonal and domestic violence, including intimate partner violence and childhood abuse, as "a pattern of coercive behaviors that may include progressive social isolation, deprivation, intimidation, psychological abuse, childhood physical abuse, childhood sexual abuse, sexual assault, and repeated battering and injury. These behaviors are perpetrated by someone who is or was involved in a familial or intimate relationship with the victim." The report also states that "screening and counseling involve elicitation of information from women and adolescents about current and past violence and abuse in a culturally sensitive and supportive manner to address current health concerns about safety and other current or future health problems." Here is a memo that summarizes this information and provides additional resources.

 Q:   Are non-citizen victims of domestic violence eligible for Medicaid under the Affordable Care Act?

 A:   Yes. Under the Violence Against Women Act (VAWA), certain non-citizens are eligible for Medicaid (providing they meet income guidelines) and are not subject to the 5 year bar. See #10 in the following Illinois Department of Human Services eligibility chart. If VAWA applicants are eligible now, they should remain eligible under ACA. They typically have to provide a receipt that their application has been filed with US Citizenship and Immigration Services, not that the application has been approved.

 Q:   Who will the Affordable Care Act benefit, anyway? Don’t most people have health insurance?

 A:   According to the U.S. Census Bureau, 49.9 million people were uninsured in 2010, about 16.3% of the population. The Census Bureau collects its information based on interviews conducted by the government every March as part of the Current Population Survey. According to Kaiser Family Foundation, nine in ten of the uninsured are in low- or moderate-income families, meaning they are below 400% of the federal poverty level. Many of the people without health insurance cannot afford to purchase individual coverage due to the high cost of premiums. Others may be barred from purchasing insurance due to a pre-existing condition. Being low income does not qualify someone for public benefits in Illinois and most other states, so going uninsured is often the only option. The Affordable Care Act will allow many people currently without insurance to obtain health coverage. Starting in 2014, Medicaid will expand to cover all Americans below 138% of the federal poverty level. Those without coverage who are between 138-400% of the federal poverty level will be eligible for tax credits to use towards purchasing insurance in the statewide health insurance exchanges. Historically, young adults make up a disproportionate share of the uninsured. Those aged 19 to 29 make up 29% of the uninsured and have the highest uninsured rate of any age group. Young adults are for the most part neither full-time students nor full-time employees, meaning they likely do not get coverage from their school or employer. Many are unwilling or unable to pay the high premium costs of private insurance. The Affordable Care Act already allows young adults to remain covered by a parent’s private insurance plan until age 26, and when the Medicaid expansion and the Health Benefit Exchanges are put into place, many more will gain new access to coverage. An estimated 11 million of those without health insurance are undocumented immigrants, but the exact number is not known. Neither the health benefits exchanges nor the Medicaid expansions will provide health insurance to undocumented non-citizens.

 Q:   Who can help me purchase health insurance on the health insurance marketplace?

 A:   Federal law requires the exchange to establish “Navigators,” who will help guide exchange customers through the insurance-purchasing process. Navigators will also be able to determine if a person using the exchange is eligible for public benefits, such as Medicaid or Medicare. Navigators will assist people in learning about insurance options and any financial assistance a customer may be eligible for, as well as enrolling in a plan. They will also be responsible to refer those who have problems with their plans or other elements of the exchange to the agency that can assist them with that problem. Navigators will be required to provide information in a way that is fair and impartial, in order to help consumers to choose the insurance plan that best fits their needs. Navigators are required to serve Illinois' diverse population adequately, including those with low income, single parents, homeless, those with HIV/AIDS or other chronic health conditions, currently or formerly incarcerated people, and immigrants. For more info on navigators, check out this blog post here. Find a navigator near you.

 Q:   What happens if I don't buy health insurance in 2014?

 A:   Now people have to have health insurance. If an individual does not buy health insurance they are subject to a penalty unless they qualify for an exemption. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater by 2016 and beyond. The requirement to have coverage, known as the individual mandate, can be waived for several reasons, including financial hardship or religious beliefs. Learn more about the penalty and exemptions here.

 Q:   What does the health care law do for legal international students? Are they subject to the individual mandate?

 A:   The Individual mandate is the piece in the Affordable Care Act that requires citizens and legal immigrants to have health insurance coverage, or else pay an annual fine. An exchange student living legally in the U.S. is considered a “nonimmigrant” by the U.S. government. According to the Individual Mandate, nonimmigrants are not required to purchase insurance if they will not be in the country for the full enrollment period of the insurance plan. Until the state-run health insurance exchanges are functioning, it is unclear what the length of the shortest period of enrollment will be. However, it seems safe to assume that if you will be in the U.S. for longer than 6 months, you will need to comply with the individual mandate. The good news is that most colleges and universities offer student insurance plans that fulfill the requirements of the individual mandate. If a student will be living in the U.S. for a period of time long enough to be subject to the individual mandate, but her college does not offer an insurance plan, she will be able to purchase insurance through the state health insurance exchanges. For more information on lawfully present non-immigrant students click here.

 Q:   Under the ACA, can young adults can be insured as dependents?

 A:   Yes! Under the ACA, children can be covered by their parents’ private insurance until age 26. This applies for children regardless of their marital status, living situation, student status, or financial situation. However, there are some situations where they might not be covered: (1) The ACA rule only applies to those with private insurance, not to government programs. So, if someone is currently insured by a state insurance program for kids, (e.g., All Kids in Illinois), then they will ONLY be insured by that program until they age out of it. For example, All Kids insures children up until age 18. That will remain unchanged, and children under that program will only be insured through age 18, not 26. Likewise, if the parents receive care through Medicare, their children will not become insured. (2) Until 2014, if a child has insurance through her own employer, then her parents’ insurance plan is not required to cover that child. However, in 2014, all insurance plans will be required to cover dependents whether they have access to an employee-provided insurance plan or not. (3) Insurance plans that have grandfathered status are not required to provide insurance for children under age 26. However, many insurance companies have voluntarily offered to provide coverage for children up to age 26, and others have created a stop-gap coverage plan until the law comes into full effect in 2014. You will need to contact your insurance company to find out your options. (4) If a parent’s insurance plan does not offer dependent coverage, then the plan will not cover their children whatsoever, regardless of their age, as this rule does not apply to those plans. (5) The young adult rule does not apply to any children of the children receiving coverage through their parents’ plans. To learn more about coverage for young adults click here.

 Q:   I recently learned that healthcare reform affects “Grandfathered” plans differently than other health care plans. What does this mean?

 A:   The provision in the Affordable Care Act (ACA) for “Grandfathered” plans was made so that Americans who like their current health insurance plan can keep it, by allowing plans that existed on March 23, 2010 (the date that the health care reform bill was signed into a law) to remain more or less the same. Those who choose to stick with their current health care plan will still benefit from the ACA. All health care plans, whether they have grandfather status or not, must adopt some of the ACA’s major changes, such as regulations that make it difficult for providers to revoke care in the case of an illness and ban providers from creating lifetime limits on care. Also, all plans must allow children to remain covered by parents’ health care until age 26. All grandfathered plans are exempt from certain requirements, such as not having to offer a benefits package in the competitive health care marketplace, provide free preventative care, or offer access to emergency, ob-gyn, or pediatric services. Some of the provisions for grandfathered plans, however, only apply to employer group plans. Individual market plans must abide by ACA rule that employer group plans are exempt from, such as a ban on refusing to insure children with preexisting conditions or unreasonable annual coverage limits. Insurance companies are allowed to make routine changes to health care plans that adjust or add benefits, or increase costs in accordance with inflation. However, plans will lose grandfather status if changes are made that either significantly raise the costs to consumers or limit the benefits provided by the plan. Examples of these types of changes are changes in co-pay or coinsurance costs that are greater than 15%, after inflation is factored in, or if the plan is changed over to a different provider. If a plan loses grandfathered status, then it must adopt the consumer protection regulations outlined for non-grandfathered plans in the ACA.
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