MANHATTAN, Kan. -- The U.S. government’s deadline for Americans to purchase health insurance is March 31. And while many of those previously uninsured in Kansas and across the country have already purchased a health plan, there are still those who don’t quite understand how the Affordable Care Act (ACA) affects them.
Roberta Riportella, the Kansas Health Foundation professor of community health at Kansas State University, has spent much of the past six months helping consumers understand how ACA – also called ObamaCare – affects them.
Riportella’s work includes training K-State Research and Extension agents across the state. While their work is helping to educate thousands of Kansans, it’s also helping them get a pulse on consumer’s concerns.
Recently, Riportella and Debra Wood, a family resource management agent in the Central Kansas Extension District, answered several questions they’ve been hearing from consumers.
What is the ‘Health Insurance Marketplace’ and where do I find it?
The Health Insurance Marketplace is a place for people to go to shop for health insurance. Applying and enrolling through the marketplace, by phone at 1-800-318-251-800-318-2596 or at Healthcare.gov, consumers also can find out if they qualify for a premium tax credit or cost sharing reduction. The tax credits help pay the health insurance premiums for a plan purchased through the marketplace. The cost sharing reductions help to lower out-of-pocket costs.
All new plans offered, including those in the marketplace, cover essential health benefits, pre-existing conditions, and preventive care. No one can be denied coverage by any insurance plan due to a pre-existing condition.
What if I refuse to buy insurance?
Unless their income is too low, most people must have health coverage in 2014 or pay a fee. You will need to provide proof of health insurance in your 2014 tax return. If you don’t have coverage in 2014, and don’t qualify for an exemption, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1 percent of your income, whichever is higher. There is a family maximum of $275. Exemptions from the individual responsibility payment are available in certain situations.
Where can I find help to determine if I qualify for premium tax credits?
The Kansas Insurance Department website can help you see what plans are offered in Kansas and if you qualify for tax credits. Another useful website is from Consumer Reports.
In addition to the health insurance literacy information on the Healthcare.gov website, your local extension office has educational resources available, as does the Kansas Insurance Department site at www.insureks.org. This site also includes a list of navigators and assistors in addition to plan information, and a list of locally scheduled presentations.
Many people who do not have other coverage are eligible for help with paying for health insurance premiums, but only if they enroll through the new Health Insurance marketplace.
I have Medicare. Am I already covered?
Yes. You’re already covered if you have Medicare, Kan-Care (formerly Medicaid and Healthwave for children), any job-based health plan, COBRA, retiree coverage, Tri-Care, VA health coverage, or some other types of health coverage.
It is especially important for those on Medicare to understand the marketplace will have no effect on their Medicare coverage. In fact, it is illegal for someone to sell you a marketplace policy if they know you have Medicare.
I have heard that many policies sold recently have been cancelled. Why did this happen?
All policies sold needed to meet minimum standards. Some didn’t meet those standards and were cancelled. They were really substandard policies that left folks underinsured. However, because the healthcare.gov website got off to such a rocky start, the White House gave state insurance commissioners permission to allow those minimal policies to be offered first for one more year, and now for another two, until December, 2015.
Kansas Insurance Commissioner Sandy Praeger has allowed the continued sale of those policies. So people can renew that policy if they choose to go that route rather than shopping in the marketplace. By January, 2016 all people should be insured in more comprehensive plans.
The advantage to the marketplace is that many will qualify for assistance to pay premiums, called tax credits. That makes those comprehensive policies much more affordable both in terms of premiums and in terms of out of pocket costs. Those who receive premium tax credits are likely to qualify for a better plan at a lower cost.
How has Medicare been affected by ACA?
Medicare is not affected. Almost all eligible folks sign up, and eligibility remains based on age and social security eligibility. There are no Medicare supplemental policies offered on the marketplace. People on Medicare now get preventive screenings and an annual wellness exam. And the donut hole -- that place where the beneficiary has to pay for prescription drugs with no assistance -- is being minimized every year and will be gone by 2020.
Can I sign up after March 31 and still meet the law’s requirements?
The March 31 deadline for this year is solid, in terms of avoiding the tax penalty, but people can apply anytime if there are special qualifying events, such as a change in family status (new family member), employment, or citizenship.