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Q&A: The Affordable Care Act In Kansas

KMUW hosted a live call-in show October 9. We took questions from callers, email and Twitter. Below are questions and answers from the hour. We received more questions than we could get to during the hour, but we followed up with our panelists and added those additional questions and answers below.

Our guests were:

  • Maggie Ward, Certified Marketplace Navigator through the U.S. Department of Health and Human Services, Oncology Nurse Navigator with Via Christi Health
  • Joel Rutledge, Licensed Insurance Agent and Broker, Benefits Specialist, and an approved Agent/Broker with both the Individual and the SHOP Marketplaces
  • Sheldon Weisgrau, director of the Health Reform Resource Project.

Websites mentioned throughout the hour: insureKS.org and healthcare.gov.

There are many imposter websites popping up that you will most likely want to avoid. Make sure you visit either one of the sites above to access the correct system.

Useful telephone numbers for further help: 1-800-318-2596 for individuals, 1-800-706-7893 for small businesses.


Q:  Is there any need to look into further insurance if you're retired and currently on Medicare? 

Weisgrau: Take a deep breath. If you're on Medicare, you're covered and the ACA has no effect on your plan. 

Q: I'm on Medicare but also want dental coverage, should I be using the healthcare.gov site for dental services?

Rutledge: This is a possible use for the exchange but I would recommend waiting to look. 

Q: What do you know about changes in mental health coverage for Kansans?

Rutledge:  ACA improves access to mental health coverage. There have been a lot of health policies with inadequate coverage for mental health. The ACA has this service as part of its basic service components. All policies will have to have this type of coverage, including grandfathered plans. Most insurance requirements have already adapted.

Q: Who has to pay penalties if they do not have health care?

Weisgrau: The penalty applies to people who choose not to buy insurance. The ACA establishes a new marketplace where some people will be able to buy. If you don't get coverage as of January 1 you will pay $95 or 1 percent of your income, and in year 3 and beyond it will be $695 or 2.5 percent of your income.

Q: If ACA is repealed, can insurance companies then refuse to cover pre-existing conditions?

Rutledge: It's unlikely it will be repealed. Nevertheless, if the law went away, all the protections would no longer exist and we'd be back to the system we had before.

Q: If I sign up and my plan costs $100 a month and I pay it month-to-month, do I get my money back as a tax credit on April 15?

Rutledge: There are two methods where the primary assistance kicks in, you can either take the rebate upfront on the exchanges or wait for a credit on April 15. 

Q: Can I pursue individual insurance through the ACA or do I have to stick to my plan from work?

Rutledge:  No, just because you're a business owner doesn't mean you can't avail yourself of the exchanges. If you have two employees you can do small group business coverage, it's not necessary to have 30+ employees to do that type of coverage.

Q: Using the ACA, will I be able to get assistance with a medical expense that happened this July? 

Weisgrau: NoThere are some circumstances if your income is low enough to qualify for Medicaid where Medicaid can apply to there previous expenses.

Ward: If there are residual effects, as of January 1, if you get insurance through the ACA it will be covered.

Q: I'm 29, haven't had insurance since 2002 and I'm a student, I don't think I need insurance and I'm poor. Is there any hope for me?

Weisgrau: You have choices. You can either buy insurance or pay the fine. If you choose to pay the fine that's okay,  but you'll remain uninsured. Warning: If you break your hand and end up going to the hospital, you will end up paying all the fees. If you can't pay that the rest of us do. The ACA is designed to enhance personal responsibility. You really should get insurance.

Rutledge: For people who are younger than 29, there are very basic plans available, just catastrophic plans. There is hope. 

Q: My wife's employer covers her insurance but not mine, how does that affect me going on the exchanges? 

Rutledge: Your income will be considered aggregate but the opportunities available to you because you don't have opportunities through an employer will increase. You do have a lot of options through the exchanges triggered because you don't have employer-sponsored care available.

Q: When is the deadline to sign up for insurance?

Rutledge:  You have until the end of March 2014 to enroll during the initial open enrollment period.  However, the sooner you sign up, the sooner you could be saving money on your health insurance coverage. 

Q: Why can't I continue with the insurance company/policy I already have? I have been told I cannot not be grandfathered in.

Rutledge: "Grandfathering" is a term that relates to group or workplace/business policies, not to individual policies.  If you are currently on a group plan, there could be many reasons why your current policy is ending, typically because of a decision by the employer.

Q: Can I call my insurance broker like I have for years to find a new policy?

Rutledge: Your current insurance broker may or may not be able to assist you, and may or may not have all options available for you.  Not all brokers or agents are approved and certified for assisting clients on the exchanges, so the options your current broker presents to you may be too limited if they are not certified. 

Q: How do I find a new policy for me?

Rutledge: You can get a new policy either on or off the exchange from many insurance agents, or an exchange policy, that could have financial assistance available: from agents, nonprofit navigators, online directly with the exchanges at www.healthcare.gov, by phone from the same website, or from certain state or federal agencies. 

Q: Does the ACA have anything in place that will help people who have high deductible plans to start some sort of payment plan if there's a catastrophic event?

Weisgrau: The ACA has some provisions to protect consumers from very high out-of-pocket costs.  First, out-of-pocket costs are capped at $6,350 for individuals and $12,700 for families.  Second, some consumers will qualify for subsidies to help cover out-of-pocket costs. 

Q: What is this "medical device tax" Congress keeps talking about? If Republicans are able to repeal it, what will that mean?

Weisgrau: The medical device tax is one of many ways that the law is financed. Under this provision, medical device manufacturers will pay an excise tax of 2.4% on all devices they sell.

If it is repealed, Congress will have to come up with an equivalent amount in revenue or budget cuts to make up the difference.

Q: Can people still lose their entire life savings, home, and car because they had to be admitted to a hospital?

Rutledge: Presumably, more Americans will have health insurance due to the PPACA, and that should reduce the likelihood of someone being financially wiped out.  Hopefully, that alone will help to prevent the scary scene you paint.

The secret is to set the [hospital bill] payment amount low enough that you can always afford it, and not to miss any payments.

Q: How can I get info about options for my mom, who is under 65?

Rutledge: Your under 65 aged mom can access the exchange like anyone else (via the internet, phone, or through certain state and federal agencies). 

Q: Do Medicare users still need supplemental coverage?  

Rutledge: The PPACA did not change the Medicare benefits, so yes, it is wise for Medicare users to look into Medicare supplement plans.

Q: Will ASIFlex or HCS reimbursements change in any way?

Rutledge: Flex accounts, or FSAs, are changing and further changes are expected.  Annual contribution limits are going lower and the eligible expenditures (such as over the counter drugs, etc) are being restricted for FSAs, HSAs and HRAs alike.

Q: A transfer of funds from a traditional IRA to a Roth IRA is taxable income on a tax return. Is this considered income in determining income levels for ACA?

Ward: Yes, according to the Modified Adjusted Gross Income for the Affordable Care Act any IRA distributions are considered income.

Q: I work with low income clients who do not qualify for Medicaid. Can you please explain who will fall in the donut hole and if they must pay a penalty for not being insured?

Weisgrau: Under the Affordable Care Act, those with income between 100-400 percent of the Federal Poverty Level (FPL) qualify for tax credits to help them purchase private insurance coverage in the new Marketplace. 

These income levels are as follows:
$11,490 to $45,960 for individuals
$15,510 to $62,040 for a family of 2
$19,530 to $78,120 for a family of 3
$23,550 to $94,200 for a family of 4
$27,570 to $110,280 for a family of 5
$31,590 to $126,360 for a family of 6
$35,610 to $142,440 for a family of 7
$39,630 to $158,520 for a family of 8

Those with income below 100% of FPL were to be covered by an expanded Medicaid program.

Q: I have insurance through my employer and my wife doesn't. She would qualify for a tax credit based on her salary alone, but not ours together. Is the tax credit based on the ACA insured party's single income or is it based on our joint income?

Rutledge: It depends on how you file your taxes.  In most cases, both incomes are taken into account, but that is not a hard and fast rule.

Q: What happens when one's income changes drastically during the year following enrollment?

Ward: If the income changes by more than 10%, this must be reported to the marketplace immediately for an adjustments in allotted tax credits. If an individual makes more than estimated and does not report the change, this will be reflected in the next year's income tax filing and a portion of the provided tax credits will have to be paid back.

Q: How does one estimate anticipated income for 2014 when unemployed and anticipating a part-time contracting job beginning mid-year (income unknown)? Is there a mechanism in place to report changes in income - either less or more than estimated?

Ward: Unfortunately, as of now, there is no method in place for estimating this, as it would differ greatly from situation to situation.

Q: My income is not much above 100% of the federal poverty level, so I'm eligible for a subsidy.  But it's not much above, and some misfortune could push me below.  What would happen to my ACA insurance  if that happened?

Weisgrau: Your income determines your eligibility for tax credits to help pay your premiums and subsidies to help cover out-of-pocket costs.  It does not determine your eligibility to purchase an insurance plan in the marketplace. Any citizen or legal resident of the U.S. is eligible to purchase a plan in the marketplace. If your income changes during the course of the year, it may affect both your eligibility for a tax credit and the amount of that credit.

Q: If an individual has health insurance via a single policy, is this considered self-insured?

Weisgrau: Individuals who have health insurance via a single policy are not considered self-insured.  They have insurance. Self-insurance refers to businesses that do not purchase traditional insurance plans to cover their employees.

Q: If I work for a company that is self-insured, is there an exemption for covering pre-existing conditions?

Weisgrau: The plans offered by self-insured businesses are subject to regulation by the U.S. Department of Labor.  As in all group health plans, they cannot discriminate based on health status or pre-existing condition.