Frequently-asked questions about health insurance

ACA plan benefits

• Is pediatric dental coverage included in exchange plans?
• Do ACA-compliant health insurance plans cover abortion?
• Do health insurance policies cover maternity?
• How is vision care covered under the Affordable Care Act?
• How is autism covered under the Affordable Care Act?
• Are visits to the chiropractor or physical therapist covered under the Affordable Care Act?
• Does the ACA require infertility treatment to be covered by health insurance?
• Pediatric dental is one of the essential health benefits on new plans. Does that mean that my insurance will cover braces for my son?
• Is it true that Obamacare’s preventive-care mandates only help women?
• I’ve heard that Obamacare will help women who want to breastfeed buy a breast pump. Others say the law will only help you rent a pump. Who is right?
• Are dental benefits included in the health insurance exchange plans?
• What is a ‘new’ health plan? I’ve heard that only ‘new plans’ will cover preventive care without co-pays.
• I earn too much to qualify for a subsidy. Why should I buy through an exchange?

ACA plan options

• What type of health insurance exchange does my state have?
• What is the ACA’s catastrophic plan and who is eligible?
• Are child-only policies available through the exchanges?
• Which health insurance exchange plan is best for me?
• Do Gold exchange plans offer more generous coverage than Bronze or Silver plans?
• How is a federal-state partnership different from a federal or state exchange?
• If all Silver plans cover the same benefits and percentage of costs, why do premiums vary by carrier?
• What are Consumer Operated and Oriented Plans (CO-OPs)? How are they different from plans in the health insurance exchanges?
• My health insurance options from my employer are on an exchange. Is this part of Obamacare?
• We live in China right now but we don’t have health insurance for the times we come back to the states. What kind of insurance can we get?

choosing coverage

• When I compare health insurance plans in the exchange for our family, they all show total family deductibles. Does that mean we’d have to meet that full deductible even for just one person?
• With state health insurance exchanges in place, will I still be able to use a broker or get some personal help in choosing a plan?
• Will I be able to see next year’s health insurance rates on exchange sites before open enrollment?
• What are some signs that you are being drawn into a health insurance scam?
• Should I keep my grandmothered individual health policy or switch to an ACA-compliant plan?
• Who should consider a high-deductible health insurance plan?

fact or fiction

• I have heard that because of Obamacare, employers have been dropping spouses from their plans. Is this true?
• My doctor posted a sign saying she ‘doesn’t take Obamacare.’ What should I do?
• I’ve heard that Obamacare included a tax on real estate transactions. When I sell my house, will I get stuck with a big tax bill to pay for everyone else’s healthcare?
• I’ve heard the federal government pays for the Medicaid expansion but only for a few years. Then the state is on the hook for costs?
• To what extent is Obamacare actually a ‘job killer?’

plan costs

• I earn just $22,000 a year. How can I afford the out-of-pocket costs of health insurance?
• Is the IRS changing how much I’ll have to pay for my health insurance next year?
• Is it true that policies in the exchange only charge for a maximum of three children on a family plan?
• Why would Congress let insurers charge a 60-year-old three times as much has a 25-year-old?
• What is the difference between a medical FSA and an HSA?
• Under the ACA, can I still have an individual HDHP and an HSA?

eligibility

• Can I use my Medicaid coverage in any state?
• My eligibility for Medicaid depends on whether I’m 133 percent of the Federal Poverty Level. Can you spell out what that means in dollars?
• I have insurance through my husband’s employer, so I don’t need my employer’s coverage. But my company said I have to work fewer than 30 hours a week so that I’m not considered full time. Can I just waive my employer’s coverage if they let me work full time?
• My employer offers insurance but I think it’s too expensive. Can I apply for a subsidy to help me buy my own insurance?
• If I have insurance through my employer, can my spouse get coverage through the exchanges?
• If I have access to health insurance, can my husband’s company deny me coverage?
• My employer offers coverage to our whole family, but only pays the premiums for my coverage; my kids’ premium is payroll deducted in full. Can I buy individual policies for my children instead?
• If my income is less than expected this year, I might be eligible for Medicaid. What can I do to cover my bases?
• How can Native Americans get coverage under the ACA? Are there specific plan options for them?
• Is it true that I have to earn a minimum of $30,000 per year in order to purchase ACA insurance?
• Will my income count toward my boyfriend’s household income if he applies for exchange coverage?
• I’m leaving my job – and my insurance – on June 30. Do I qualify for open enrollment on July 1? or do I have to take COBRA?
• My parents are 68 but recently moved to the U.S., so they don’t qualify for Medicare. Can they buy insurance in the exchange?
• How does my access to employer-sponsored coverage impact my eligibility for subsidized coverage through the exchanges?
• Is Social Security considered income when I’m enrolling in a plan through the exchange?
• I am on Medicare and Social Security. My wife is self employed and needs insurance from the state exchange. How do we figure our household income?
• I’m a legal U.S. resident but not a citizen. My job doesn’t offer health benefits. Can the ACA help me?
• Is there any chance I will be turned down for coverage by a health insurance exchange?
• Are smokers unable to afford insurance under the ACA?
• I’m 60 and retired. I can get insurance from my former employer but it’s very expensive. Do I qualify for insurance under the exchanges?
• I’m enrolled in Medicare. Can I enroll my 14-year-old daughter in the exchange?
• We get health insurance through my job but the coverage isn’t very good. Can I enroll in an exchange plan instead and get a subsidy to help pay for it?
• I’m a low-income single adult but I’ve never qualified for Medicaid before. I’ve heard that I might qualify now. Is this true?
• How do I tell whether I’m eligible for Medicaid or subsidized coverage through my state’s exchange?
• Are Medicare-eligible individuals eligible for coverage within the ACA’s health insurance exchanges?
• I will be retiring from my job in August and moving to a new state. Do I have to establish residency there before I can apply for ACA coverage?
• If I don’t buy health insurance now, but decide to buy it later on, can I?

subsidies

• Under what circumstances might I have to repay my ACA subsidy?
• What happens if my income changes and my premium subsidy is too big? Will I have to repay it?
• My premium subsidy is dependent on my AGI. But I’m self employed so my AGI is dependent on my premium. Help!
• With my income, I’m barely over the eligibility limit for a premium subsidy. Is there anything I can do to lower my income so I become eligible?
• We’re a family of four with an income of $47,000 a year. What kinds of subsidies are available to help us purchase insurance through the exchanges?
• My wife and I each make about $40,000 a year. If we file our taxes separately, can we each qualify for an exchange subsidy?
• If I get an Obamacare subsidy in the exchange, is the subsidy amount considered income?
• I thought subsidies were available for anyone with incomes up to 400 percent of poverty level but the calculators I’ve used say our family doesn’t qualify. Why?
• We claim our son but not our daughter on our taxes. How are premium subsidies calculated for families like ours?
• I understand that subsidies come in the form of tax credits. But I’m unemployed and probably won’t owe any taxes. How would the subsidy help me?
• Who ISN’T eligible for Obamacare’s premium subsidies?
• How does the government calculate the ACA’s premium subsidies?
• Can you explain the ACA cost-sharing subsidy that increases a policy’s actuarial value?
• Can I purchase a Platinum policy and also get a premium subsidy?
• Is everyone who makes too much for ACA subsidies going to see big premium increases?
• I work part-time. Am I eligible for a premium subsidy to help me buy insurance?
• Would my 21-year-old’s subsidy be based on his income – or mine?
• We’re in a same-sex civil union. Should we calculate our subsidy as a household of two or apply separately?
• I live in Boston where health care is really expensive. Are the subsidies large enough to help me buy insurance here?

coverage mandates

• Is it true that the government can’t really enforce the penalty for not having health insurance?
• If I say ‘No!’ to Obamacare and buy my coverage outside of the exchanges, will I have to pay a penalty if the benefits don’t meet Obamacare’s standards?
• If I owe income tax and the ACA penalty but don’t plan to pay the ACA penalty, will the IRS apply my payment to my penalty or to my income tax?
• What happens if I buy insurance but it doesn’t meet ACA’s minimum essential benefits standards?
• I know the individual mandate permits a gap in coverage up to three months per year. What if I’m uninsured for the last three months this year and first three months of next year?
• Does the president’s executive order mean the IRS won’t enforce the individual mandate penalty?
• If I decline my employer-sponsored plan and try to get a subsidized exchange plan, will the IRS know?
• I didn’t know I was eligible for Medicaid, so I didn’t enroll. Will I have to pay a penalty?
• If the IRS doesn’t owe me a refund, how does it enforce the individual mandate penalty?
• Is the Obamacare individual mandate just based on the honor system?
• When I file my taxes, my preparer asks me if I have health insurance. How is that any of their business?
• Is there a minimum age for Obamacare’s individual mandate?
• My health plan is being terminated on December 31. Does that mean I’m exempt from the ACA’s individual mandate?
• I can’t enroll in my employer-sponsored plan until July. Do I have to pay a penalty for the first half of the year?
• If I decide to gamble and go without insurance, isn’t that my business?
• Who is keeping track of whether I buy health insurance through the exchanges?
• Are employers required by the Affordable Care Act to purchase group insurance for their employees?
• Will every business with more than 50 employees pay a penalty if it doesn’t offer ‘affordable, comprehensive’ insurance?
• If I pay the tax for not purchasing health insurance, does that buy me an insurance policy?
• I’m self-employed and am hiring employees. Under Obamacare, am I obligated to provide health insurance for them?
• I work at a large corporation that offers health insurance but it’s expensive and I don’t feel I need it. Under Obamacare, will my company force me to sign up?
• I was laid off and don’t have any income. Am I still required to sign up during open enrollment?

enrollment

• What happens if I don’t make my premium payment by the end of the grace period?
• What’s the deadline to get coverage during Obamacare’s open enrollment period?
• What are the ACA’s enrollment periods and when can I enroll outside of the open enrollment period?
• If I don’t enroll in a plan by the open enrollment deadline, what are my options?
• If I already enrolled in a plan for new year, can I change my mind and pick a different plan?
• If I qualify for Medicaid, should I worry about the deadline for open enrollment?
• If I enroll in the exchanges, will that coverage take effect immediately?
• If someone decides not to buy health insurance and is injured in accident what happens?
• If I don’t make changes to my plan and just let it auto renew for January, am I stuck with it for the rest of the year?
• I’m not sure when health benefits will start at my new job. Can I drop ACA coverage when those benefits start?
• Are qualifying events and special enrollment periods the same as they were in prior years?
• We’re moving 50 miles but staying in the same state. Is that a qualifying event?
• Where can I find the list of Obamacare qualifying events?
• I enrolled through the exchange and I’m happy with my coverage. Do I have to go through that again or can I just let my plan renew?
• I purchased health insurance under the Affordable Care Act in Texas but I have moved to Colorado. How do I transfer my coverage?
• How long will it take me to enroll in the exchange?
• My son is covered on my employer’s policy through July 31. Can he enroll in a new plan starting on August 1 or did he need to have purchased a plan during open enrollment?
• If I turn down my employer’s offer of insurance and then am in an accident, don’t I have a right to sign up for coverage?
• Can I buy coverage in the exchange that starts January 1 and stop paying for my COBRA insurance at that point?
• My carrier is allowing me to renew my pre-2014 plan. Can I shop for a new plan instead?
• If my current coverage ends on December 31st, can I be confident that my coverage will be in force if I enroll by December 15?
• Should I be concerned about how much personal information is required for enrollment in the exchanges?
• If I sign up for a Bronze plan during open enrollment, can I bump my coverage up to a higher level several months later if I find out that I need surgery?

Medicare

• Can you explain the controversy around the IPAB and why it was repealed?

non-ACA coverage

• If I can’t buy a short-term plan and I don’t have a qualifying event, what are my coverage options?
• What’s the difference between dental insurance and dental discount plans?
• What’s the difference between prescription discount plans and prescription drug insurance?
• Should I be leery of short-term health insurance?
• How do the ACA’s health insurance exchanges interact with critical-illness plans?
• If I buy a dental insurance plan, what sort of out-of-pocket costs should I expect?
• Is it better for me to pay out of pocket for dental care and not worry about dental insurance?
• Do student health policies have to cover birth control without co-pays?
• Do I need special health insurance when traveling abroad?
• Do student health plans have to cover preventive care at no charge?
• We earn too much to qualify for a premium subsidy and our existing plan costs less than exchange plans. Can we keep it?

self-employed

• Does Obamacare make health coverage less expensive for the self employed?
• I’m self-employed. Is it better for me to buy health insurance through a broker, or through the exchange?
• How do the self-employed access health insurance through the health insurance exchanges? Does the subsidy apply to me?
• Can small businesses use the ACA’s health insurance marketplaces (exchanges)?
• I own a small business. Can I get a break on my taxes if I buy insurance for my employees?
• Are there programs that help the self-employed pay for health insurance?

tax-related

• Where do I find my 1095 tax form?
• Can I deduct my exchange premiums when I file taxes next year?
• If an individual pays for an exchange plan, how do they pay for the premium pre-tax as would someone with an employer plan?
• I’m self-employed. Can my husband deduct his Medicare premiums?

consumer protections

• Is it true that under the ACA, insurers can’t cap how much they’ll pay out over the course of your lifetime?
• Does the Affordable Care Act make it easier to get individual health insurance?
• Can health insurance policies still have lifetime benefit maximums? What about annual benefit maximums?
• I already have great employer-sponsored health insurance that covers my pre-existing conditions. So how does Obamacare help me?
• How do the health insurance exchanges affect me if I already have insurance from my employer?

under 26

• Does Obamacare make my student health plan offer better benefits?
• Should I buy the health plan my college offers? or buy through an ACA exchange?
• I’m 24. How do I choose between coverage from my father’s plan and an exchange plan?
• The ACA allowed young adults to remain on their parents’ health plans until age 26. Has that changed?
• My college offers health insurance. Can I purchase coverage through the exchange instead?
• I am a 21-year-old dependent living with my parents. I have no wife or kids, so do I apply for health insurance as a household of one and list only my own income? Or do I have to be on my parents’ insurance?