SOME Q AND A ABOUT OBAMACARE
Below is an article that may help answer some of the questions that many Americans have about Obamacare.
Obamacare: Your Questions Answered
By Lisa Scherzer
November 22, 2013 2:48 PM
It should come as no surprise that the troubles bedeviling Obamacare’s exchanges have sunk the law’s popularity.
But according to a Kaiser Family Foundation poll released Friday, the gap between positive and negative views of the law is almost the largest it’s been since Kaiser began tracking consumer sentiment about Obamacare in April 2010. Nearly half (49%) of Americans have an unfavorable view of the law and a third have a favorable view, a 16-percentage-point difference. The only time it was bigger (17 points) was in October 2011 – in the midst of the 2012 presidential campaign – when Republican candidates amped up their critique of the law. What’s more, favorable views of Obamacare dropped most among Democrats, after rebounding in September and October.
The past few weeks have brought a mix of news as the Obama administration works to fix HealthCare.gov’s technical snags in time for the promised end-of-November deadline. The administration said Friday it would give consumers until Dec. 23 – an additional eight days – to sign up for coverage that takes effect Jan. 1. The move allows more time for people to compare and shop for plans on the notoriously glitch-filled federally run exchange.
On Tuesday Health and Human Services Secretary Kathleen Sebelius told people at an event in Florida that the federal marketplace site is “far faster” than it was when first launched, and “the error rate is down to less than 1% and the volume capacity is continuing to be added to.”
House Speaker John Boehner on Thursday described his frustration attempting to sign up for Obamacare in the D.C. exchange on his blog: “After putting in my personal information, I received an error message. I was able to work past that, but when I went to actually sign up for coverage, I got this ‘internal server error’ screen,” Boehner wrote. (He succeeded after several tries.)
Earlier this month President Obama apologized for the rollout’s missteps and announced that he would give insurance companies (at each state’s discretion) the option to keep offering consumers plans that would otherwise be canceled because they do not meet the new minimum requirements of the law.
Now a major question is whether the hundreds of thousands of people who filled out applications on the exchanges – but didn’t actually enroll – will come back to do so. Cost was the most common reason among consumers who visited the marketplaces but didn’t enroll in a plan, according to a survey by Commonwealth Fund, with 48% saying they were uncertain they could afford coverage. Meanwhile, 46% of respondents said they were still trying to decide which plan they wanted, and 37% of those who didn’t enroll cited technical difficulties as the reason.
No doubt the steady trickle of hiccups and delays made to parts of the law since the exchanges launched on Oct. 1 are hard to keep up with. We’ve been answering readers’ questions about the ACA here. If you have questions about buying coverage on your state’s exchange or the federal marketplace, send them to email@example.com. And check Yahoo Finance on Monday, Dec. 2, at 2 p.m. EST for a live chat about Obamacare.
Here are answers to some of our latest questions from readers:
Q: Are the subsidies paid out monthly? If we can’t afford to pay the insurance premiums monthly, how do we even get coverage? Having this reimbursed at the end of the year doesn’t exactly work. Where are the subsidies monies coming from?
A: You can choose to receive the credits in advance because, as you note, many people won’t be able to afford paying their entire premiums upfront and wait until they file taxes to get reimbursed. Consumers also have the option to get a partial credit in advance or get reimbursed when they file their federal taxes. HealthCare.gov describes how this works here.
If you decide to get advance payments of the credit, you’ll need to file taxes for the year in which you receive them. For example, someone who got advance payments of the credit for the 2014 calendar year will need to file a tax return for 2014 before the April 2015 deadline, according to the Center on Budget and Policy Priorities’ Beyond the Basics of Health Reform.
Q: My job is seasonal, lasting from 6-8 months per year. During the season, my employer provides health care for myself and my spouse. During the off-season, my coverage lapses and I do not have insurance. Cobra coverage is too expensive with no income so we generally go without insurance until eligible for the next season. Will we be able to continue with this arrangement or will we be required to buy coverage?
A: The ACA requires everyone to have health insurance coverage, or else pay a tax penalty, unless they qualify for an exemption. You’re not at risk of incurring the penalty if you’re without coverage for less than three months. But it sounds like you and your spouse would be without employer-based insurance for longer, in which case you’re required to buy coverage. You can check to see if you’d be eligible for a subsidy through the exchange here.
Q: For my 7-year-old son who has a preexisting disability, my company’s health insurance won’t cover a specific therapy. On the exchange, the plan will cover the therapy. If I purchased both insurances [for] my son, one from the exchange and one from my company, how would that work?
A: You can’t get insurance through both an exchange and your employer – individuals and families must choose one or the other, says Janet Coffman, associate professor at UCSF School of Medicine.
If your employer offers family coverage, you can choose to purchase a plan through an exchange instead but you won’t be eligible for subsidies unless the employer-sponsored plan is deemed “unaffordable” or does not meet minimum value. As explained previously, a job-based plan is considered unaffordable if the individual employee’s share of premiums for the lowest-cost coverage that meets the law’s requirements is more than 9.5% of your family’s income. You and your spouse may want to compare total costs (premiums plus out-of-pocket expenses) for the employer plan and plans available on the exchange. Your employer should be able to tell you what the lowest cost of self-only coverage is and whether the plan meets minimum value, Coffman says.
Q: I am single, self employed, and my adjusted gross income last year was $32,000. I currently have a PPO with Blue Cross that also has an HSA (health savings account). If I decide to go on the exchange, can I keep my HSA to help cover my co-pays? Will I qualify for a subsidy?
A: Once you’ve established a health savings account, you can continue to make withdrawals for health expenses even if you’re no longer enrolled in an HSA-eligible plan, says Karen Pollitz of the Kaiser Family Foundation. You just can’t make new tax-free contributions to the account when you’re in a non-HSA-eligible plan. Many of the plans offered on the exchange will also be HSA-eligible plans, so you should check to see what’s offered, she says.
Q: If one member of the household is on Medicare, is the cost paid for the Medicare taken into consideration to determine the subsidy for the remaining family members?
No. One’s eligibility for subsidies and the amount of the subsidy will be based on family income. The amount your spouse pays for his or her Medicare, Medicare Part D and supplemental insurance premium costs will not be taken into account, according to the Kaiser Family Foundation.
Q: My wife will need Obamacare in 2014 and 2015 until she gets on Medicare. I want to know how much maximum out-of-pocket expenses will there be on the different plans in Obamacare.
A: The maximum out-of-pocket costs for any marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan. Those totals include copayments and deductibles, but not premiums, and they apply only to plans that are not grandfathered under the law.
Q: In response to one of the questions to you, you had indicated the subsidy amount on the ACA premiums would be based on “MAGI,” or Modified Adjusted Gross Income. Why would it be based on “MAGI” & not “Taxable Income”? It would seem to me like “Taxable Income” would be a fairer & better number to use. Also, how would capital gains, capital gains distributions be considered in the calculations?
A: Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service, says the tax credit rules are based on MAGI, which is simply AGI (on line 37 of your 1040) with three “add backs” (i.e., nontaxable Social Security income + foreign earnings + tax-exempt interest income). So MAGI is actually higher than AGI. Capital gains and cap gains distributions are included in MAGI (but long-term capital gains are subject to rules separate from those governing ordinary income, Haile says).