Your Healthcare Reform questions answered…
In my many discussions with people recently regarding Healthcare reform, the following questions have popped up more than once so I thought I would put them together in a little Q&A format.
Q: My employer offers coverage for my dependents but it is very expensive. Can I get an individual policy for them through Covered California and get premium assistance?
A: If your health insurance as an employee is considered “affordable”, meaning the cost to you is not more than 9.5% of your income, than you would not qualify for any premium assistance for your dependents (but they could very well get a lower cost plan on the individual market).
Q: Does Covered California offer different plans than the carriers do for Individual & Family plans?
A: NO. They offer the same ACA compliant metal tiered plans as the carriers do outside the marketplace. The difference is Covered California is the only place you can get premium assistance based on your household income.
Q: What would my income have to be to qualify for premium assistance?
A: It is based on your modified gross income and the number of household members. You would qualify for some premium assistance if you make less than:
Family size:
- $44,680
- $60,520
- $76,360
- $92,200
- $108,040
Q: What if my income increases during the year and I am receiving premium assistance through Covered California?
A: You would notify Covered California by phone or signing in to your account and make the change of income when it occurs. This is your responsibility. If you forget to make the changes you could owe some assistance back when you file your income taxes at the end of the year.
Q: My insurance company is dropping my plan at the end of the year and I have to pick a new plan. Why? What should I do?
A: Aetna has decided to exit the market for Individual plans in California. These policyholders should first see if they qualify for premium assistance, and if so, should buy their 2014 plan on the marketplace. If not, they should check with an independent agent to look at all carriers to see who is the best.
Other carriers are simply cancelling your current plan and are asking you to move to one of their 2014 Affordable Care Act compliant plans. (Again, the metal tier plans: Bronze, Silver, Gold, and Platinum).
Q: If I am moving to an ACA compliant PPO with the same carrier at the beginning of the year can I assume that the doctors I have been seeing are covered on the new PPO plan?
A: Not Necessarily! This is where you have to be very careful. Carriers have made some big changes to networks on the 2014 plans. Not all PPOs will cover Scripps physicians and hospitals and that is very important in our area. If you want to be safe, do a provider search on the carrier’s website, call your agent to help, or call your doctor and ask if they will take your new plan in 2014.
Q: If I cannot afford to pay the new prices and I decide not to purchase a policy in January, can I purchase one later?
A: You will only be able to buy a plan during open enrollment each year (with a few exceptions). There are a handful of reasons that could be considered a “qualifying event” such as a marriage or the birth of a child. Open enrollment this year is the longest extending through March, but in other years it will be much shorter. Remember, there is a tax penalty for not purchasing a policy. Not much the first year, $95 or 1% of your income, whichever is greater, but it will jump up each year.
Q: Do I have to go online and do my own Covered California application? I have heard on the news that the websites are having troubles and I am not really good on computers.
A: No, you should contact your agent to assist you with the plan selection and application. You do not pay any extra to have an agent assist you and they can help you in person or over the phone. The process takes about 30-45 minutes and will hopefully get quicker as they make updates and improvements to the system.
