Answers to the Most Common Health Care Reform Questions
By Sana Hashmi
As submitted by EmblemHealth
Through the open enrollment period, more than 1 million New Yorkers are expected to sign up for health insurance online through NY State of Health, part of the national health care reform law known as the Affordable Care Act or Obamacare. But what do you need to do and how do you do it? To help New Yorkers choose an insurance plan, below are some of the most common questions and the answers.
Q. What is the Affordable Care Act or Obamacare?
In 2010, President Obama signed this law to make quality, affordable health care available to more Americans and offer financial assistance to those who need it most. It also requires most Americans to have health insurance starting in 2014 or pay a penalty.
Q. What happened October 1?
NY State of Health, the state’s health insurance marketplace, opened. You can learn all about it at www.nystateofhealth.ny.gov. Anyone who enrolls in a health plan between October 1 and December 15 will be eligible for health insurance starting January 1, 2014. The deadline for enrolling on the health plan marketplace in the first enrollment period is March 31, 2014.
Q. Do I need to sign up for health insurance?
Unless you already have health insurance, the answer may be yes. The federal law says that most people in the US (legal residents and “lawfully present” immigrants) must have health insurance starting in 2014 or pay a penalty. If you don’t have health insurance right now, the law is designed to help you get an affordable plan.
Q. How can I afford health insurance?
People who qualify will be eligible for tax credits and subsidies to help lower the cost of coverage. Household income and family size are used to decide who gets help with costs and how much help they can get. You may be eligible for this help if your income is between 100% and 400% of the Federal Poverty Level. The only way to know the exact dollar amount is to apply through the marketplace.
Q. Am I eligible for subsidies or tax credits?
Many people will be. Under the new law, you may get financial assistance when you apply for a plan on NY State of Health. You may get tax credits to lower monthly payments, subsidies to lower out-of-pocket costs when you go to the doctor, Medicaid (no-cost health coverage) or Child Health Plus (a low-cost health plan for young people up to age 19).
Q. I already have insurance but my spouse needs it. Will my salary affect her ability to receive a subsidy or a tax credit?
Yes. Eligibility for tax credits and subsidies is based on total household income.
Q. How do I sign up and what information do I need?
You can sign up for a health care plan online, in person, over the phone or by mail. You will need social security numbers for all family members you plan on enrolling, or document numbers for legal immigrants. Also, have employer information and income information at hand, and policy numbers for any health plans covering members of the household.
Q. Can I enroll my entire family?
Yes. The law requires most citizens and legal residents to have health insurance.
If you have health insurance through your employer, you may not need to sign up. To be sure, ask your employer’s health benefits administrator (the person who assists with health benefits) or someone in the human resources department.
Q. I heard the new employer mandate was delayed. How does this affect me?
The employer mandate was delayed until January 2015. Once it takes effect, employers with 50 or more full-time workers must provide adequate, affordable health care coverage to their full-time employees or pay a penalty. (Adequate, affordable coverage means the plan covers 60% of total health care expenses and costs employees no more than 9.5% of their household income.) If you have health insurance through your employer, you may not need to sign up. If you don’t have health insurance through your job, you can visit NY State of Health to look at your options. For more information, ask your employer’s health benefits administrator (the person who assists with health benefits) or someone in the human resources department.
Q. Can I still buy insurance directly from a health insurance company?
Yes, you can buy health insurance directly from a health insurer. But financial assistance is available only through NY State of Health.
Q. What are “metal” plans?
All health insurers participating on NY State of Health will offer four types of metal plans — Bronze, Silver, Gold and Platinum plans. They cover the same benefits but, between health insurers, differ in monthly costs and in the choice of doctors, hospitals and other health care providers. “Catastrophic” plans will be available for people under age 30 and others who qualify. This plan covers essential health benefits, routine preventive-care services and three annual visits to a primary care doctor at no out-of-pocket cost to you. It has similar benefits as the metal plans, but different costs.
Q. What will be covered?
All health insurance plans will be required to provide coverage for these essential benefits:
- Routine doctor visits
- Visits to the emergency room
- Hospital care
- Maternity and newborn care
- Mental health and substance-abuse treatment
- Prescription drugs
- Habilitative and rehabilitative services
- Laboratory tests
- Preventive and wellness services and chronic-disease management
- Pediatric services, including vision care
Certain preventive care services, like cholesterol tests, will be covered at 100% so that it’s easier to stay healthy.
Q. I don’t want health insurance. Will I be penalized?
If you don’t have health insurance in 2014, you may have to pay a penalty when you file your taxes. For 2014, the penalty is $95 per adult and $47.50 per child or 1% of taxable household income — whichever is higher. For example, if you are a single adult with $50,000 of taxable income, the penalty would be $500.
The penalty will go up each year until 2016, when it will be $695 per adult and $347.50 per child or 2.5% of taxable household income — whichever is higher. After 2016, the penalty will continue to go up with the cost of living.
It’s important to think about more than just cost when considering your options. Health insurance is essential to protecting both your physical and financial health, in case something happens.
Q. Where do we go for more information?
The NY State of Health website, nystateofhealth.ny.gov, is a good place to start. Customer service information is available at 1-855-355-5777. EmblemHealth also has extensive information at emblemhealthreform.com.
Sana Hashmi is Director of Health Care Reform and Product Design at EmblemHealth.