Beginning today October 1st, individuals will begin selecting health insurance plans that will become effective January 1, 2014. These are some questions and answers to clarify the process.
I already have health coverage at my job. What happens to me?
- Changes may not affect you much if you’re one of the 171 million Americans with coverage through your job or your spouse’s job. You might be able to use new health-insurance exchanges opening Tuesday, but you probably wouldn’t be eligible for a subsidy.
I heard some companies that offer health coverage are making changes—is that true?
- Yes. The law already mandates allowing people to keep children on their plans up to age 26. Plans with very limited benefits offered by some companies—particularly in retail, restaurants and agriculture—are generally being phased out. A few firms are giving workers a fixed sum and letting them choose their own plan from what’s called a private exchange. This isn’t the same as the health law’s exchange.
I’ve been buying my own health coverage. What now?
- On Tuesday, you’ll see new private insurance plans through insurance exchanges in most parts of the country. Singles making less than $46,000 a year, couples making less than $62,000 and families with slightly higher income levels may be eligible for subsidies to pay for coverage.
What kinds of policies are they selling on these exchanges?
- Policies must cover certain preventive care and can’t have lifetime caps. Also, your premium won’t be based on your medical history—good news if you’ve been sick. Healthy people who previously could buy inexpensive policies may pay more. Plans are labeled gold, silver or bronze depending on how much they cover.
Do I get to keep my doctor?
- If you’re buying a new policy on an exchange or switching insurers, you’ll likely find they have different networks of providers. Some of the lowest-priced policies are likely to have smaller networks.
What if I’ve been going without coverage?
- Some of the 46 million uninsured Americans may be subject to a penalty starting at $95 next year if they don’t have coverage starting Jan. 1. You can go to the new insurance exchanges to shop for plans, or if your income is below 138% of the federal poverty level, you may qualify for Medicaid, depending on your state.
Those of us on Medicare?
- If you’re one of 49 million in the Medicare program, with or without a supplemental insurance plan, you’ll continue to enroll the same way. The law cuts spending by billions of dollars over a decade—largely by reducing payments to hospitals and doctors and increasing incentives for more-efficient care—but it doesn’t directly affect benefits. Supporters say this will strengthen Medicare. Opponents say seniors will find it harder to access their benefits if providers are squeezed.
*Modified from a WSJ.com article