Sunday, May 20, 2018
Health

Reader questions on Obamacare, Part 3: COBRA and more

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.

Comments
U.S. approves first drug developed to prevent chronic migraines

U.S. approves first drug developed to prevent chronic migraines

TRENTON, N.J. — U.S. regulators Thursday approved the first drug designed to prevent chronic migraines. The Food and Drug Administration’s action clears the monthly shot Aimovig (AIM’-oh-vig) for sale. It’s the first in a new class of long-acting dru...
Published: 05/18/18
Know your blood pressure numbers? Today (May 17) is World Hypertension Day

Know your blood pressure numbers? Today (May 17) is World Hypertension Day

Today (May 17) is World Hypertension Day, and the American Medical Association is encouraging people to monitor their blood pressure levels and get high blood pressure, or hypertension, under control. High blood pressure, sometimes referred to as the...
Published: 05/17/18
Study: Depression in men may lower chances for pregnancy

Study: Depression in men may lower chances for pregnancy

Women having trouble getting pregnant sometimes try yoga, meditation or mindfulness, and some research suggests that psychological stress may affect infertility. But what about men: Does their mental state affect a couple’s ability to conceive?The la...
Published: 05/17/18
Tampa General Hospital named among top 100 in U.S., second best in Florida

Tampa General Hospital named among top 100 in U.S., second best in Florida

TAMPA—Tampa General Hospital was named one of the top 100 hospitals in America for the fifth consecutive year, and second best in Florida, according to one health industry website.Tampa General is considered the best hospital in the Tampa area, accor...
Published: 05/16/18
Joe Redner asks Florida Supreme Court: Let me grow marijuana now

Joe Redner asks Florida Supreme Court: Let me grow marijuana now

Even though a circuit judge has ruled that Tampa strip club owner Joe Redner can grow and juice his own marijuana, he was barred from doing so until the appeals process is finished.So Redner’s lawyers filed a petition with the Florida Supreme Court o...
Published: 05/15/18
Heated chemo is the key as Tampa General doctor tackles ovarian cancer

Heated chemo is the key as Tampa General doctor tackles ovarian cancer

Over the span of three weeks, Brenda Gotlen watched as her abdomen got bigger. Her lower stomach felt bloated."It got to the point that I looked nine months pregnant," said Gotlen, a 62-year-old Seffner resident. She made an appointment to see her pr...
Published: 05/15/18
Some health premiums will go up next year. Which party should we blame this time?

Some health premiums will go up next year. Which party should we blame this time?

As some insurers angle for hefty premium hikes and concerns grow that more Americans will wind up uninsured, the federal health law is likely — once again — to play big in both parties’ strategies for the contentious 2018 election.Candidates are alre...
Published: 05/15/18
Blood donations from the ‘Man with the Golden Arm’ saved millions of babies

Blood donations from the ‘Man with the Golden Arm’ saved millions of babies

When he was 14, James Harrison needed surgery. And as he would come to find out, he would also need a significant amount ofstrangers’ blood to survive it.After he had recovered and as soon as he became an adult, Harrison felt compelled to pay it forw...
Published: 05/14/18
UN health agency aims to wipe out trans fats worldwide

UN health agency aims to wipe out trans fats worldwide

NEW YORK — The World Health Organization has released a plan to help countries wipe out trans fats from the global food supply in the next five years. The United Nations agency has in the past pushed to exterminate infectious diseases, but now it’s a...
Published: 05/14/18
Troubling link found between pollution exposure in pregnancy, high blood pressure in children

Troubling link found between pollution exposure in pregnancy, high blood pressure in children

High blood pressure typically occurs in adulthood, so when children develop the condition, it often means something is very wrong. A child might have kidney disease, hyperthyroidism or a heart problem. Obesity can also be a factor.But what about seem...
Published: 05/14/18