Saturday, November 25, 2017
Health

As Oct. 1 approaches, answers to more questions about Obamacare

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Third in a series

The Obamacare marketplaces open for business Tuesday to start selling health insurance to people who don't have coverage through their work, Medicare or Medicaid. We've been answering our readers' most common questions about the marketplace; you can find these answers at www.tampabay.com/health.

Today, we dig into more issues, from subsidies to COBRA. Please keep sending your questions to [email protected]

I tried some different scenarios on an online marketplace calculator, and it showed qualifying for the subsidy at $62,000 income but not at $73,000. Why?

Subsidies disappear at 400 percent of the poverty level. For a single person, that means no subsidies on income above $45,960. For a couple, the cutoff is $62,040.

I have family health coverage through COBRA. Can I switch from COBRA to a marketplace plan? Will they cover my children, who are 23 and 25?

COBRA is the law that allows employees who have left the job to keep buying insurance through work for a limited time. These policies are expensive because you pay the entire premium plus a 2 percent administration fee. Your employer no longer subsidizes you. If you qualify for premium tax credits in the insurance marketplace, you could pay considerably less than you do under COBRA.

On Tuesday, you will be able to compare what you have now with the costs and benefits of the marketplace plans, and switch if you choose. If you exhaust your COBRA benefits, you will get a special enrollment period to get a marketplace policy, but if you just want to switch you need to do it during the regular enrollment periods (that's Oct. 1-March 31 in this first enrollment period, then Oct. 15-Dec. 7 in subsequent years). As for your adult children, the answer depends on the plan you select. If you sign up by Dec. 15 this year, your coverage is effective Jan. 1.

Will large employer insurance (over 50 employees) be required to offer the same benefits required under the Affordable Care Act?

If your plan existed as of March 23, 2010, and hasn't changed a great deal since, it may be "grandfathered." Check with your plan to find out.

Even if it is grandfathered, it still must offer: No lifetime limits on coverage, no arbitrary cancellations, coverage for adult children up to age 26, a summary of benefits and coverage (SBC), and it must hold insurance companies accountable to spend premiums on health care, not administration and bonuses.

But unlike new plans, grandfathered plans do not have to provide such things as free preventive care, a guaranteed right to appeal coverage decisions, and accountability for excessive premium increases. Still, some plans do offer these and other protections they're not required to.

Our family has insurance through a retiree program run by my former employer, which has entered bankruptcy. (None of us is on Medicare.) We worry we might lose this coverage in 2014. If so, when can we enroll in the marketplace?

Open enrollment in this initial sign-up lasts from Oct. 1 to March 31, 2014; in future years, it will be Oct. 15-Dec. 7. But you can enroll any time you have a "qualifying life event" such as losing your insurance, getting married or divorced, losing your job, or having a baby.

Your coverage will start on the first day of the month after you enroll.

I'm trying to help a friend who wants to enroll, but he doesn't have access to a computer. What can he do?

He can call the National Marketplace Toll-Free Call Center at 1-800-318-2596 (TTY 1-855-889-4325), 24 hours a day, seven days a week, for assistance in both English and Spanish. They also can find help for people who speak 150 other languages. Local advisers — called navigators — are being trained and will be able to help.

Plus, many independent, licensed insurance agents have had marketplace training and also can help you through the process. These agents have access to multiple insurance companies, and they are paid by insurers, not consumers.

Our health insurance policy is set for renewal on Oct. 1, but marketplace health care plans won't take effect until Jan. 1. Should we renew the current policy?

Check the details of your current policy carefully; find out what its provisions are for cancelling.

Ask if the plan can be canceled at any time, or only at specific times. Once you know that, and what marketplace insurance will cost, you can make an informed decision.

Other states seem to be doing a lot more to help residents enroll in their marketplaces than Florida is. Can I buy insurance from another state's marketplace?

No, insurance is regulated individually by each state, so you must buy in your home state.

How will part-time workers receive coverage?

There are no specific provisions for part-timers. Coverage is not based on how many hours you work. Most people who need insurance can shop in the marketplace. Subsidies for insurance are pegged to income, so the less you make, the greater your potential subsidy.

Sources: Healthcare.gov, U.S. Department of Health and Human Services, Kaiser Family Foundation, the Internal Revenue Service.

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