Illinois News

'Obamacare' exemptions, plans, other FAQs

Tuesday, October 01, 2013

Viewers had questions about the new Affordable Care Act, which goes into effect this week, and ABC7's Leah Hope provided the answers from Blue Cross and Blue Shield in the state of Illinois.

The state of Illinois' website and Help Desk will be available starting Tuesday, October 1 - www.getcoveredillinois.gov (866) 311-1119

CAN I FORGO HEALTH INSURANCE? ARE THERE EXEMPTIONS?
People will be asked to prove they have insurance or pay a fine when they fill out their 2014 federal income taxes in early 2015. If you're not insured by that time, you will pay a yearly penalty, which will start out low and then climb yearly. The first year, people with face the greater of $95 or 1 percent of 2014 household income, but that would increase over the next few years, to $325 per uninsured person or 2 percent of household income over the filing threshold for 2015 and $695 per person, or 2.5 percent of household income, in 2016. After that, the penalty will be assessed by a cost-of-living formula. Exemptions from the penalty include people whose income is below the federal income tax filing threshold, members of federally recognized American Indian tribes, and religious groups exempt from Social Security, like the Amish.

Uninsured people won't have to pay a fee if they:
-are uninsured less than 3 months of the year
-are determined to have very low income and coverage is considered unaffordable
-are not required to file tax returns because their income is too low
-would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
-are a member of a federally recognized Native America tribe
-participate in a health care sharing ministry
-are a member of a recognized religious sect with religious objections to health insurance

Also consumers avoid a penalty if they considered covered by *:
-any health marketplace plan or any individual insurance plan they already have
-any employer plan (including COBRA) including retiree plans
-Medicare v-Medicaid v-the Children's Health Insurance Program (CHIP) or All Kids
-TRICARE (for current service members and military retirees, their families and survivors)
-Veterans health care programs (including the Veterans Health Care Program , VA Civilian Health and Medical Program/CHAMPVA and Spina Bifida Health Care Benefits Program)
-Peace Corps Volunteer plans
*other plans may also qualify, ask a certified navigator

HOW MUCH WILL IS COST? HOW WILL THIS AFFECT PRESCRIPTIONS?
The cost will be based on age, household size, where a person lives, tobacco use, type of insurance you choose. Prescription coverage is included in the stated essential health benefits required of every eligible health plan offering.

WHAT COMPANIES ARE OFFERING COVERAGE THROUGH EXCHANGES? DO WE HAVE TO CHECK W DOCTORS/HOSPITAL TO SEE IF THEY ACCEPT THE PLANS?
Eight insurers are participating: Aetna Life Insurance, Coventry Health & Life Insurance, Coventry health Care of IL, Health Alliance Medical Plans, Health Care Service (Blue Cross), Humana Health Plan, Humana Insurance Company and Land of Lincoln Mutual health Insurance.

WHO ARE THE NAVIGATORS? WHAT ARE THEIR QUALIFICATIONS? WILL THEY TAKE PERSONAL INFORMATION? WILL ANYONE BE CALLING FOR PERSONAL INFORMATION?
Navigators are funded by the federal government. In-person counselors are another kind of assister that are funded by the state. Both must go through training and be certified in order to help enroll people on the Illinois Health Insurance Marketplace. Their role is to objectively assist people in determining which health insurance plans are the best fit for each individual's personal and financial circumstances. Enrolling can occur either by telephone or online.

IF I HAVE A PRE-EXISTING CONDITION, DO I PAY MORE OR SAME RATES?
A key component of health reform is called "guaranteed issue," meaning that individuals cannot be denied insurance coverage due to a pre-existing condition, nor will they have to pay more for the same coverage. The ability to deny or limit coverage due to a pre-existing condition goes away completely in 2014 on and off online marketplace - except for grandfathered individual plans.

HOW DOES THIS AFFECT VETERANS WHO GET CARE THROUGH THE VA?
Veterans' access to health coverage through the VA is not affected and they will still have access to VA doctors and hospitals. However, they are still able to purchase additional coverage if they choose on the Health Insurance Marketplace.

HOW DOES THIS IMPACT MEDICARE RECIPIENTS? HOW DOES THIS IMPACT RETIREES?
This does not affect those receiving Medicare benefits

IF I'M SELF EMPLOYED, HOW DOES IT WORK?
You may sign up for a health insurance plan offered on the Illinois Health Insurance Marketplace, beginning October 1st and concluding March 31st, 2014. If you want coverage to begin on 1/1/2014, however, you must enroll by December 15th this year. If you earn up to 400% of federal poverty - or $94,000 for a household family of four - you are eligible for a federal subsidy and tax credits to help pay for your coverage.

WHAT IF I CAN'T AFFORD THE PREMIUM?
There are several ways that the Affordable Care Act helps make getting health insurance more affordable. It expands access to Medicaid. It provides Federal tax credits to help pay for insurance premiums and offers cost-sharing subsidies for low-income individuals. To be eligible for a premium tax credit and/or subsidy, an individual must:
1. Be a U.S. citizen or legal resident .
2. Have household income between 100-400% of Federal Poverty Level.
3. Be enrolled in a marketplace plan.
4. Be included in tax filings to the IRS as an individual, or as a member of a married couple or family with dependents.
5. Not be eligible for other affordable coverage, such as Medicaid or Medicare or other types of "minimum essential coverage" (other than through the individual health insurance marketplace) .
6. Not have access to an affordable employer plan that meets minimum value requirements.

BASIC QUESTIONS ABOUT DATES  WHEN CAN I ENROLL&WHEN DOES IT START?
Enrollment in the state Health Insurance Marketplace is set to open on October 1st and run through March 31st, 2014. In order to have healthcare coverage on 1/1/2014, individuals must sign up for a plan by December 15th of this year.

EXCHANGES IN EVERY STATE?
Exchanges will be available in every state. Some states will operate their own. Others, like Illinois, will operate their exchange as a state and federal partnership for the first few years, and still others will be operated entirely by the federal government. On the exchanges you can compare the insurance policies of multiple insurance companies, enroll in a plan online or by phone, qualify for government subsidies to help pay for coverage, and in the end, it establishes a way for many U.S. citizens and legal residents to acquire affordable health insurance. Undocumented residents are not eligible.

WHEN WILL WE SEE REDUCTION IN COSTS DUE TO COMPETITION?
Insurance providers do not drive the cost of healthcare. Healthcare providers and pharmaceutical usage does that. One of the aims of the Affordable Care Act is to change the model of the U.S. healthcare industry, from one that is driven through financial incentives to doctors and hospitals to do more and drive greater patient volume, to one that rewards them for delivering higher quality care and value. One example is Medicare no longer paying hospitals for unnecessary re-admissions due to infections, medical errors or over-treatment.

Leah Hope wants to know your questions and concerns about the Affordable Care Act. Please CLICK HERE to post your questions or comments.

General information about the Affordable Care Act:
http://www.healthcare.gov

Great resource for small businesses and the ACA:
healthcoverageguide.org

The Associated Press contributed to this report.

(Copyright ©2014 WLS-TV/DT. All Rights Reserved.)

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