Affordable Care Act (Obamacare)FAQs

Question: What if I want help getting set up?

Answer: Many of our clients call with regards to the Affordable Care Act or “Obamacare” as is often called. The annual open enrollment begins November 1st and continues through December 15th for policies to begin January 1st of the next year.

When you successfully enter the Federally Facilitated Marketplace or “The Marketplace” at www.healthcare.gov you will see a question that asks if someone will be helping with your application.  Will you please do our agency a favor?  Please find and select “agent or broker” so that we may follow up for you and be your advocate with the insurance company. The service your agent provides costs you nothing extra.  The website will ask for an agent’s name and NPN or National Producer Number.  This Information is identified below:

Agent Name = Lowell (no middle name ) Lyon

NPN = 5452273 (National Producer Number)

As you shop and apply for coverage through the federal marketplace, you may qualify for a Federal Income Tax Credit plus a cost-sharing reduction when you apply for a “silver” plan.  You may find this website of interest to help you calculate your costs: https://www.kff.org/interactive/subsidy-calculator/

If you are not eligible or just don’t want financial assistance with the monthly insurance premiums, we can help you shop outside of the federal marketplace by sending you quotes and plan information directly to your email.  We look forward to helping you choose a health insurance policy that makes sense for your situation.  We’re happy to meet with you in-person at your home, office, other location or over the telephone.

Question:  Am I eligible for a Federal Tax Credit plus a cost-sharing reduction to help pay the monthly insurance premium and health care costs?

Answer: If your family size and adjusted gross household income are within the range of values in the latest spreadsheet on the blog page, you may qualify for financial assistance in the form of a Federal Income Tax Credit plus a cost-sharing reduction if you choose a “Silver” plan.  This financial assistance is only available if you choose to apply for coverage through the Federally Facilitated Marketplace at www.healthcare.gov  To give you an idea of how much financial assistance you may receive, here’s a helpful website: https://www.kff.org/interactive/subsidy-calculator/

What’s the next step?  Please see “What if I want help getting set up?” above.

Question: Do I have to be insured?

Answer: For most of us the answer is yes.  You may recall that the Supreme Court upheld the “individual mandate,” which requires everyone to have health insurance.  A tax penalty for not having health insurance may be eliminated.  More than 80 percent of Americans already have insurance through Medicaid, Medicare, employer-based insurance, private insurance policies or other sources.  Only those who would have to pay more than 9.5 percent of their income on health insurance, those whose income falls below income tax thresholds and ex-pats are exempt from the mandate tax.”

Question: What do the new Federal Health Care Reform health insurance plans cover?

Answer: There are 10 Essential Health Benefits all plans must cover as part of the Affordable Care Act and Federal Health Care Reforms.

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventative and wellness services and chorionic disease management
• Pediatric services including oral and vision care

Question: What do I need on hand before I start?

Answer: Whether through your employer, an insurance agency or a marketplace (www.healthcare.gov for individuals, Avenue H for small businesses), what you need to know before buying a plan:

• Social Security numbers for everyone you want on your insurance policy.
• Gross salary for you or your family
• A list of doctors and providers you want.  Note the copayments for in-network providers and for this out-of-network.
• A list of medication your family needs.  Check the drug formulary for any plan you’re considering and note copays for each prescription.
• A summary of benefits for any health plan you’re considering.  Look for services you need, such as infertility treatment of gastric-bypass surgery.
• Know how much you can afford for monthly premiums.

You can get an estimate of how much you can spend on a health plan and what kind of subsidies you could be eligible for by using this outline calculator: https://www.kff.org/interactive/subsidy-calculator/

Question: How will the individual mandate affect families?

1. Those with income up to 138% of FPL ($33,465) for a family of four will be eligible for Medicaid.
2. Those with incomes between 138% and 400% of FPL ($97,000) for a family of four will be able to get financial assistance from the government to buy health care coverage on the federal exchange in Utah.
3. Those with incomes above 400% of FPL will still be able to get coverage through the federal exchange yet will be ineligible for government financial assistance.
4. The penalty for not purchasing health insurance
   • Flat fee in 2016 will be $695 or 2.5% of your income up to a maximum of $2,085 whichever is higher in your case.
   • The fee will continue to increase in future years based on inflation.

Question: Will “Obamacare” rules apply to my Current Health Insurance Plan?

Answer: Employers may decide if it wants grandfathered status.  Any changes to the plan will remove grandfathered status.

Question: What is “Obamacare” hoping to accomplish?

Answer: The law has four main goals in mind:

• Give Americans greater access to healthcare
  • 37 million Americans with no health insurance at all
  • Expand Medicaid
  • Subsidized health insurance through federal exchanges
• Rein in (and ideally reduce) out of control health care costs
  • Mainly by encouraging movement away from the current fee-for-service system.
  • Rewards doctors for increasing quality of their care.
    • Encourages often unnecessary tests and procedures rather than quality.
  • Add more consumer benefits and protections
    • Insurance companies cannot drop you because of illness or bookkeeping errors.
    • No pre-existing condition exclusions or charge a higher premium due to health and usage.
    • No annual or lifetime limits.
  • Address other nagging issues (praiseworthy but difficult to achieve)
    • Emphasizing prevention and wellness programs.
    • New ways of delivering and paying for healthcare with the goal of improving efficiency and reducing cost on the system.

For more information, go to www.healthcare.gov