Q&A on Obamacare in Georgia



On three occasions, AJC reporters Carrie Teegardin, Misty Williams and David Markiewicz fielded readers' questions about Obamacare during live online chats on MYAJC.com. Our reporters also consulted with Georgia State University’s Bill Custer – one of the state’s top experts on the health law and one of our go-to sources.

The following is a collection of the questions covered during those chats and the answers that our reporters provided. You may find the answer to your questions about the Affordable Care Act here. If not, email us at ajchealthcare@ajc.com.

Q: If I retire at 64 and have income from investments and Social Security of $70,000 can I get an Obama Care subsidy?

A: One of the key questions we are getting from readers relates to whether or not they can qualify for help paying for their coverage. Unless you are covering yourself and some dependents, Craig, then will not be able to qualify for a tax credit on the exchange. Generally, people whose incomes fall between 100 and 400 percent of the federal poverty line may qualify for some assistance. Here are those income ranges for 2013, which should give you and other consumers a sense of whether they may qualify for assistance on the Health Insurance Marketplace.
• $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

Q: What if you have been unemployed for 3 years and you presently have insurance through PCIP state plan which ends Dec 31. Can you get onto the ACA with absolutely no income? Cannot get Medicaid because of home ownership and other assets.

A: Yes, you will be able to shop on the new Health Insurance Marketplace starting on Oct. 1. However, you will probably not be eligible for a federal tax credit. You can already learn some basic information about the exchange by going to HealthCare.gov. Generally, people with incomes between 100 percent and 400 percent of the federal poverty level will be eligible for a tax credit. Below you’ll find the corresponding income ranges.
• $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

Q:  With multiple reports of healthcare premiums skyrocketing, employers reducing work force and trimming hours; is there any chance that the law can be reworked to cause less pain on the people it was intended to help?

A:  Employers with 50 or more full-time employees are required to offer affordable health insurance to their workers starting in 2015, or pay significant penalties. Originally, the law called for the requirement to take effect in 2014, but that was delayed. Businesses had complained that they did not have enough time to study their options and to provide affordable coverage to their employees. Some still say they have or will cut back on work force or hours to manage. It's always possible that other delays may happen, given what took place with this major element of the law.

Q:  Where will I locate a formula to calculate the Premium Tax Credit?

A:  We have set up a calculator to give you an estimate. Here's the link for that. http://www.myajc.com/news/aca-calculator/ . Once the exchange opens on Oct. 1, you can go to healthcare.gov to shop on the marketplace.

Q:  If all are insurable now, why should I buy coverage, instead of just pay the penalty, and wait until I get sick...

A:  Even though people with pre-existing conditions can no longer be turned down for coverage, you will not be able to buy coverage on the day you get a bad diagnosis or land in the ER. There will be enrollment periods, just like most companies have, during which you can decide to get a plan.

Q:  If I already own insurance can I get on the Affordable Health Care Act cheaper than what I am paying now?

A:  It depends on several factors. If you don’t get insurance through an employer and buy it for yourself, then there’s a good chance you could qualify for a federal tax credit on the Health Insurance Marketplace at HealthCare.gov if your income falls between 100 and 400 percent of the poverty level. That’s from $11,490 to $45,960 for a single person. The insurance marketplace will also include four level of plans to choose from – bronze, silver, gold and platinum. With a bronze plan, for instance, you would pay a lower monthly premium but a higher deductible. With a platinum, your monthly premium would be higher but yearly deductible much lower. If you get your insurance through your employer, there’s also a couple things you should know. You’ll need to ask your employer whether the insurance plan they offer is considered “grandfathered” under the ACA. If so, they may not have to provide certain preventive services and other AC A requirements. Also, check to see if the plan your employer offers is more than 9.5 percent of your income. If that’s the case, then you could be eligible for a tax credit through the new marketplace.

Q:  I was wondering how a person or couple's income for Obamacare is determined. I understand a person is eligible for certain subsidies if his income is below a certain level. Is this gross income or adjusted gross income? Is it W2 income only or all income including social security and investments? Does tax-free income such as with municipal bonds count? Is the income based on previous tax returns or current estimates which have to be compiled by the consumer? I have never seen the answers to these questions in any article I have read.

A:  Here is the answer to your question and it's a good one. Lots of consumers have asked us about this. The exchange will use “modified adjusted gross income.” That’s your household’s gross income, plus any tax-exempt Social Security, interest, and foreign income you have. Here are the types of income that will be included:
• Wages
• Salaries
• Tips
• Net income from any self-employment or business
• Unemployment compensation
• Social Security payments
• Rental income
• Interest, dividends, capital gains and annuities
• alimony, and some retirement and pensions.
You will have to estimate what you think your income will be in 2014 from various sources and The Health Insurance Marketplace will use that information to figure out if you qualify for any tax credits or other assistance. We’re told the system will do all the math for you. What you got in advance tax credits will be reconciled with your income when you do your 2014 tax return.

Q:  Can you tell me if my withdrawls from the IRA will be considered 'income' for purposes of qualifying for a subsidy?

A:  Here is a general description of what is considered income for the purposes of the exchange: Here are the types of income that will be included: • Wages • Salaries • Tips • Net income from any self-employment or business • Unemployment compensation • Social Security payments • Rental income • Interest, dividends, capital gains and annuities • alimony, and some retirement and pensions. If you report it as income on your tax return, it should be included in the calculation. The Health Insurance Marketplace will do the math for you, according to the exchange web site.

Q:  I am a former school employee completing a masters program. My job ended and my coverage ends at the end of this month. I have a pre-condition (lupus) where do I start?

A:  Starting Oct. 1, you will be able to shop on the Health Insurance Marketplace at HealthCare.gov. You may be able to qualify for a federal tax credit through the marketplace if your income falls between $11,490 and $45,960. Another plus for your situation is that the ACA bars insurance companies from denying people coverage because of a pre-existing conditions or from charging them more because of a pre-existing condition or ongoing illness.

Q:  Does everyone with an income between 100 and 400% if federal poverty level receive the same subsidy? Why does it abruptly stop at 400% of federal poverty level?

A:  Whether someone in these income categories gets a tax credit depends on the cost of coverage. For some people, especially younger consumers, the cost of the plan might be less than what the law requires consumers to cover.

Q:  I'm an independent contractor. My salary can vary. Will they just look at my last year tax returns to see what my income is to see if I qualify for assistance?

A:  You will estimate your own income and for people like you, this may be tricky. But once you estimate your income, the tax credits will be set according to that estimate. If things change during the year, it will be up to you to alert the Health Insurance Exchange so that you advance tax credits can be adjusted. Otherwise, when tax time rolls around, you may end up paying some of the credit back if you end up making more money than you estimated.

Q:  What if you have a widow's pension as income of $14,000 a year, then can you get a federal tax credit?

A:  I think it's likely that you would. The range for someone who could qualify for a single-person house: $11,490 to $45,960. You will need to shop on the exchange when it opens to make sure this is considered income to be sure. If it is, you are not far above the poverty line and there's a good chance you will be able to get a significant tax credit to help pay for a plan.

Q:  And how much subsidy should we all expect?

A:  How much you get depends on your family income. Here are the range of people who may qualify:
• $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
Lower incomes can generally qualify for a larger tax credit. Some can also qualify for help covering co-pays and deductibles on top of assistance paying for premiums.

Q:  My son, wife, and 2 children live on about $23,000 per year. They would have to pay fully for their coverage?

A:  Assuming two adults over 21 and two children under 18, a family with $23,000 is at 98 percent of the federal poverty level and doesn’t qualify for any subsidy on the Health Insurance Marketplace. The law envisioned that people whose incomes are lower than 100 percent of poverty would be eligible for a newly expanded Medicaid. But Georgia has opted not to expand Medicaid. If the family income in this instance were just a little higher, say $24,000, the cost of insurance per year would be $4,581, with a subsidy or $4,101. Total bill to you: $480 per year. Since the income level is less than the poverty level, however, you wouldn’t qualify for any subsidy and would have to pay the full $4,581.

Q:  I am 71 years old on Humana Medicare. will it affect me?

A:  we have received a lot of questions about what the law will mean for people on Medicare. The short answer: Not much! The Health Insurance Marketplace that opens next week has nothing to do with Medicare. Consumers will continue to get through Medicare’s traditional fee-for-service program and Medicare Advantage plans. You will continue to shop for Medicare just as you always have and you will not have to go on the exchange to get a Medicare plan. The Affordable Care Act did give Medicare beneficiaries some new benefits: more preventative care services. Also, the law will close the gap in prescription drug coverage- - a gap usually referred to as the ‘doughnut hole” by 2020. While Medicare spending will continue to increase as more baby boomers join the program every year, the law does try to constrain future spending. Some of these plans are aimed at saving money by improving care. For example, there is a big push now for hospitals to cut back on the number of patients who are quickly readmitted to the hospital after treatment.

Q:  What if you are unemployed and would really be entitled to the Medicaid expansion, but can't get it thanks to Gov. Deal, will you be totally not benefit from the ACA?

A:  It depends on your income. If you make between 100 and 400 percent of the federal poverty level, then you should be eligible for a federal tax credit through the Health Insurance Marketplace, or exchange. Unfortunately, most people in Georgia who make under 100 percent of poverty, or under $11,490 for a single person, won’t be eligible for a tax credit. However, you will still be able to shop on the exchange.

Q:  Is a tax credit the same as a subsidy?

A:  Yes. “Subsidy” is the generic term. Officially, what you’d be getting on the Health Insurance Marketplace is an “advanced premium tax credit” that you can apply immediately to your payment. You may also choose to apply less of your tax credit to each month’s premium and then take the remainder of the credit off your taxes.

Q:  I'm young, healthy, and will be uninsured. If I'm trying to maximize my savings, is it cheaper just to pay the penalty and seek coverage when I get sick?

A:  If it were that simple everyone would probably try that. You could pay what’s a fairly small penalty (at least next year) and not buy insurance unless you got ill. It would save some money, for sure. Here’s the problem. You can only buy coverage or change it during a certain enrollment period. This year, it runs from Oct. 1 to March 31 of 2014, an unusually long period of time. (Next year it runs only from October to December). If you choose to pay the fine and go without coverage and then get sick, you can’t get coverage until the next open period. That means you’d have to pay your medical bills.

Q:  Which insurance companies are on the exchange in Georgia?

A:  There are five companies offering plans in Georgia: Blue Cross and Blue Shield of Georgia, Humana, Alliant, PeachState Health Plan and Kaiser. However, it's important to note that only Blue Cross is offering plans statewide. The others are only offering in certain regions. Below is a link to a map showing who's selling plans in which regions. http://www.myajc.com/news/ga-insurance-exchange-regions/

Q:  I am self-employed. I went to Healthcare.gov, but I'm a bit confused. Since our governor and his cronies haven't expanded the Medicaid rolls, is my only option subsidies to obtain Bronze level coverage?

A:  The subsidies are actually geared toward silver plans. If you opted for a bronze plan then the subsidy would pay for more of the premium. But remember that your deductible would be higher than under a silver plan. Also, if you choose a silver plan and your income is between 100 and 250 percent of the federal poverty level then you would likely be eligible for additional financial assistance to help with co-pays, co-insurance and other out-of-pocket costs. The amount of the subsidy is set, but you could choose to apply it to a gold or platinum plan. That may be a valuable option to consider if you have a lot of health problems because the higher tier plans have lower deductibles. Just remember that the additional assistance for co-pays, etc., if you're eligible is for silver plans only.

Q:  I have insurance through my employer, my wife is uninsured, and my child is insured through Peachcare. Will I be able to see coverage for my wife through the exchange, or will i have to get her insured through my employer? Also, can the government subsidy go to pay for private insurance through an employer? According to the numbers listed below I would.

A:  Your wife will be able to shop for coverage through the exchange. However, she may or may not be eligible for a tax credit. That depends on whether the plan that your employer offers is considered "affordable" by the government. If the plan costs more than 9.5 percent of your income, then your wife would probably be eligible for a tax credit. If the plan costs less than that, then your wife could still shop on the exchange but just wouldn't be able to get a tax credit.

Q:  Single mom, with a 16 y.o. dependent. I have insurance through my employer. To add my dependent, would cost me almost $500.00 per month. I can not afford that! Last time I checked, 2012, a child only policy was not available in GA. Will the exchange provide me with any budget friendly plans?

A:  Child only plans are now available in Georgia and will be available on the exchange for much less than $500 per month, according to rates we have reviewed. Go to healthcare.gov starting on Oct. 1 and you should be able to start reviewing those rates at this time. Also, the site will let you know if your child qualifies for Medicaid or PeachCare for Kids.

Q:  My employer only offers a one health insurance plan option, a high deductible plan with a deductible of $2000. There is no coverage for prescriptions drugs or office visits until the deductible is met. Would I qualify for the exchange? The plan does cover preventative care such as annual physicals, mammograms, etc. We also receive $500 from our employer that is deposited into an HSA account and the employee portion of the premium is very low.

A:  From what you have told us, it's likely that your plan meets the minimum requirements for a plan. Whether or not you could get a tax credit on the exchange depends on your income. If your share of the cost of your employer-sponsored insurance totals more than 9.5 percent of your modified adjusted gross income, then the plan is not considered “affordable” under the law, and you may shop on the exchange. Unfortunately, the 9.5 percent threshold applies to your share of the premiums.

Q:  Since the subsidy is based on AGI then can I fully fund a SEP retirement account to reduce my income below the threshold and receive the subsidy and maximize my retirement account?

A:  Great question. That one is going to take a bit more research on our part. We'll try to get that answered by Thursday at 1 p.m. when we'll have another one of these chats. I appreciate the question.

Q:  Didn't the GA state government do something that opted us (collectively) out of the Exchange markets? If so, how does our current situation compare to states that DO have the Exchange markets?

A:  Georgia did choose not to build and run its own exchange, as did 33 other states. The exchanges in those states, including Georgia, are being run by the federal government. States that are running their own exchanges, such as Kentucky and New York, have received hundreds of millions of dollars form the feds to set up, run and market the exchanges. But as for the basics, people in Georgia will still be able to shop on the exchange and potentially be eligible for tax credits. The exchange opens on Oct. 1, but you can find out some basic information right now at HealthCare.gov. That's also the site Georgians will go to on Oct. 1 when shopping begins. Plans bought there will take effect on Jan. 1.

Q:  Will Peachcare for Kids still exist once Obamacare goes into effect?

A:  Yes. PeachCare for Kids will absolutely still exist, as will Medicaid, even though Georgia has decided not to expand Medicaid to include more people.

Q:  Can I make my insurance effective 1/1/14 and have my claims paid for then terminate the coverage on 2/1/14?

A:  Yes, but you will face a penalty if you do not have insurance. The first year the penalty for an individual is $95 or 1 percent of income, whichever is greater. That penalty increases to $695 or 2.5 percent of income by 2016.

Q:  I am working with Fed Quaified Health Clinic in Columbus Ga. How do these FQHC complement insurance coverage for the Working Poor in Georgia?

A:  Federally qualified health centers have received millions of dollars in additional federal funding under the law.

Q:  I own a small business with about 40 employees. Our group plan is due for renewal Nov.1. I am starting to believe that our employees will get better and cheaper coverage on their own than what we can provide through group coverage. I have also been told that they may not qualify for subsidies if we provide group coverage. Is this true? And is there a way we can still reimburse for coverage if they get it on their own without them having to pay income tax and us still being able to write it off?

A:  We need to do a bit of research. We'll be back to chat on Thursday at 1 p.m., and we'll get back to you then. Or please email ajchealthcare@ajc.com and we'll respond via email. Thanks!

Q:  How does the self employed manage to stay afloat and not get hit with the penalties of not being able to maintain health insurance? How truly affordable will this new insurance?

A:  Hard to answer this question without knowing a lot more about your situation. To avoid the penalties, of course, you’ll have to obtain health insurance by Jan. 1, as will most adults in America. Please check our online calculator – www.myajc.com -- which will give you an idea of the expense you’re facing and how much of a subsidy you might qualify for.

Q:  What if you have been unemployed for 3 years and you presently have insurance through PCIP state plan which ends Dec 31. Can you get onto the ACA with absolutely no income? Cannot get medicaid because of home ownership and other assets.

A:  You will still be able to shop on the Health Insurance Marketplace. Pricing may be a little higher than what you were paying under the Pre-Existing Conditions Insurance Plan. If you have zero income, you will not be able to qualify for a tax credit on the exchange. The law envisioned that the lowest-income Americans would be covered by an expanded Medicaid program. Since Georgia decided not to expand Medicaid, that will not be available for the state’s residents. Tax credits are reserved for people who can’t get an affordable plan at work and whose incomes fall between 100 percent and 400 percent of the federal poverty line.

Q:  I have an illustration of something to watch out for when shopping for insurance on the new exchanges. Suppose you have a Blue Cross/Blue Shield plan and you are looking on the exchange to see if you can find a plan that is cheaper. And you actually find a Blue Cross/Blue Shield plan with the same deductibles and co-pays which is significantly cheaper! But before you sign up, you need to check whether the doctors and hospitals you use accept this Blue Cross/ Blue Shield plan.

A:  You raise a really important point for our readers who will be shopping on the Health Insurance Marketplace and we hope to write more about this soon. Make sure, everyone, that you know what doctors are included in the network for your plan. It’s likely that you will have to call the insurer you are considering. We are expecting the networks to be smaller and more limited. Follow this advice, everyone! We have been told that there should be a screen on the exchange site allowing you to search for your doctor before signing up. So that feature should help.

Q:  If I see doctors on a cash only basis, can I be exempt from having to buy this worthless insurance?

A:  The following are the only exemptions to the ACA's individual mandate:
• You’re uninsured for less than 3 months of the year. The lowest-priced coverage available to you would cost more than 8% of your household income
• You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
• You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
• You’re a member of a recognized health care sharing ministry.
• You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
• You’re incarcerated, and not awaiting the disposition of charges against you
• You’re not lawfully present in the U.S. If you don't fall into any of these categories, then you'll face the penalty. The penalty for the first year is $95 or 1 percent of income, whichever is greater. That increases to $695 or 2.5 percent of income by 2016.

Q:  Free stuff is great. Preventive care is great. But who really pays for it?

A:  The Affordable Care Act requires most health plans, including those sold on the exchange to cover a list of preventive services at no cost to consumers. That means consumers are not charged copayments or coinsurance for these services, even if they have not yet met their deductibles. The list of services includes things like immunizations and cancer screenings. These screenings have been shown through research to lower the overall cost of health care over time by preventing illnesses or by allowing doctors to catch the illnesses early, when treatment is less costly.  Keep this in mind: many employer plans are still considered “grandfathered” and are NOT required to cover preventive care for free. When it comes to who pays for the cost of the tax credits and other subsidies, then that is coming from the tax dollars.

Q:  After reading today's article, have a question concerning Region 3 projected monthly expense of $288.29. How can an unemployed male over 55 with 0 income pay the $288.29 premium?

A:  The law envisioned that someone with no income or a very low income below the povery line would get Medicaid. And in more than half the states, that is what will happen. Georgia, however, has rejected the Medicaid expansion. That will leave the poorest Georgians out of luck for getting affordable health plans. If he can make enough money to get just over the poverty line, however, he will be eligible for tax credits that can cover a significant portion of premiums. The credits are available to households with incomes between 100 and 400 percent of the federal poverty line. For an individual that range is $11,490 to $45,960.

Q:  Will I need anything other than medicare at 67?

A:  No, nothing else. If you have Medicare you're all set.

Q:  Is there a deadline for enrolling?

A:  For 2014, the Open Enrollment Period is October 1, 2013–March 31, 2014. For 2015 and later years, the Open Enrollment Period is October 15 to December 7 of the previous year. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events – such as getting married or having a baby.

Q:  If an employer only offers healthcare insurance to its full time employees will they now have to offer it to their part time employees as a choice?

A:  No, employers do not have to offer a plan to part-timers. Those workers can shop for coverage on the exchange. Only relatively large employers -- those with 50 or more full-time workers face a penalty if they do not offer affordable coverage to their workers.

Q:  If you choose an ObamaCare plan, and your income does not change, will the premium cost be locked in place for at least 12 months?

A:  The premium will be locked in for the year. You will have a new enrollment period at the end of next year that is expected to run from October 15 to December 7 of next year for 2015 coverage. For coverage that kicks in on Jan 1, 2014, you can start shopping on Oct.1. The enrollment period is extra long, tho, for this first year and goes through March 31.

Q:  Can you go from a Silver Plan to a Gold Plan in your 12 month window?

A:  It depends on your situation. Generally speaking, people will only be able to enroll during an open enrollment period. That's Oct. 1 to March 31 for this first open enrollment period. The goal of this is to make sure people just don't wait until they get sick to purchase coverage. However, there will be some exceptions if someone experiences a major life change. That could be losing insurance coverage through work or Medicaid. Or it may be a marriage, divorce, birth of a child, adoption, etc. Even in those instances, however, you would probably have to shift to another plan in the same medal category. However, if you experience a change in your eligibility for premium or cost-sharing subsidies, you may be able to jump to a different medla category.

Q:  My insurance premium is a family plan with Blue Cross Blue shield. It is through the School system, as I am a teacher. Should I expect my premium to rise? Also, should I expect to have less options with my plan. I guess my fear is that Obamacare will indirectly cost me even though I will not be a part of the exchange?

A:  The Department of Community Health, which runs the State Health Benefit Plan, said last year that they estimate 2 percent of the premium increases state employees experienced this year were related to new requirements under the Affordable Care Act, such as offering free preventive care and allowing parents keep their children on their insurance until age 26. Private companies have quoted similar percentages related to ACA costs. As for options, you shouldn't have fewer options, at least because of the ACA. The health care law actually requires businesses both inside and outside of the exchange to offer coverage that includes 10 essential benefits, including maternity and emergency care. The State Health Benefit Plan’s costs went up 9.5 percent this year, in part because the cost of health care keeps rising. The Department of Community Health told state workers that a portion of the increase is a result of Obamacare provisions requiring insurers to offer more comprehensive coverage. The State Health Benefit Plan also started charging more this year for covering employees’ spouses.  The plan is switching its administrator in 2014, from UnitedHealthcare and Cigna to Blue Cross and Blue Shield of Georgia. Employees’ costs are expected to go up again next year, but employees may not find out for sure until open enrollment begins in late October.

Q:  A reader wrote in with this question in our last chat session: I own a small business with about 40 employees. Our group plan is due for renewal Nov.1. I am starting to believe that our employees will get better and cheaper coverage on their own than what we can provide through group coverage. I have also been told that they may not qualify for subsidies if we provide group coverage. Is this true? And is there a way we can still reimburse for coverage if they get it on their own without them having to pay income tax and us still being able to write it off?

A:  Employees who have access to minimum essential and affordable coverage will not have access to government premium subsidies, but their dependents could potentially qualify to get their coverage with the benefit of subsidies if their household income is less than 400 percent of the federal poverty level. But the only way to receive tax preferential premium treatment is within the framework of an employer-sponsored benefits program under a Section 125 Plan.

Q:  My parents are currently uninsured. My dad works but his employer currently does not offer health insurance and my mom does not work. Their annual income is about $54,000 and my 21 year sister still lives at home, will they qualify for the government assistance to help pay their monthly premium?

A:  Yes, your parents should be able to get help paying for at least a portion of a plan with that income. Exactly how much would depend on whether your sister is a dependent.

Q:  1. Where can people go online to see the different plans/exchanges that are available? 2. I have the lowest Blue Cross, and I really still can't afford it. Can I get off of that and go on an Affordable Health Care Act plan? Is there an income cut-off for who qualifies for the Affordable plan?

A:  On Oct. 1, you'll be able to go to HealthCare.gov to find out which plans you may be eligible for. There are four levels of plans -- bronze, silver, gold and premium. The bronze is less expensive each month but has a higher deductible. While, the monthly premium for a platinum plan is more expensive and the deductible is lower. So it really depends on your needs. Anyone can shop for coverage on the Health Insurance Marketplace. However, you may be eligible for a federal tax credit to help make your coverage more affordable. It depends on your situation. If you have insurance through your job and that coverage is considered by the government to be "affordable" or less than 9.5 percent of your income, then you wouldn't be eligible for tax credits through the exchange. However, if you don't get coverage through work or it's unaffordable then you may qualify for a credit depending on your income. If you make under 250 percent of the federal poverty level, then you may also qualify for financial help with co-pays, co-insurance and other out-of-pocket costs. I'll post the income ranges below:
• $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

Q:  Will there be HSA eligible health plans offered on the exchanges? We currently have a HDHP that is going away at the end of the year, and would like to still be able to utilize our HSA's to manage out of pocket expenses.

A:  Yes, there will be HSA eligible plans on the exchange. Blue Cross Blue Shield of Georgia says On the individual side, there are two silver and one of the bronze plans with HSAs.

Q:  How do the copays and deductibles look for the Silver and Gold plans? Will hospitalization clean out your wallet?

A:  There are LOTS and LOTS of different plans and I have looked at most of them! The copays and deductibles vary but here is a general idea. I'm seeing gold plans with deductible around $750 or$1,000, silver plans around $2,000 and bronze around $5,000. The copays and coinsurance really vary but there is an out of pocket limit for each year. Total patient out-of-pocket costs would be capped at $6,350.

Q:  I used your calculator. There is no way my husband and I can pay slightly more than 10,000 in premiums with no subsidies for our approx 70,000 income.

A:  Are you a two person household? Our calculator displays estimated costs for a silver plan, but there will be a cheaper bronze option as well.

Q:  2 person

A:  You do make too much to earn a tax credit. If you give me your ages, I could estimate what some of the lower-cost plans might cost. You could also shop for a plan outside of the exchange.

Q:  57 male 53 female

A:  You should be able to get a bronze plan that would cover both of you for about $800 a month. Email me and I might be able to get you more info. cteegardin@ajc.com

Q:  I am in a union with a union plan. Will I be able to use a plan from the exchange if I prefer, or do I have to stick with my union plan?

A:  Anybody can shop on the exchange, but the big question is: can you qualify for a tax credit to help pay for the plan. If the plan you have is “affordable,” as defined by the law, you cannot get a tax credit. If not, you are free to shop on the Health Insurance Marketplace to find a better deal and possibly qualify for the credit. (Affordable means your premiums – not your family’s, but just yours – do not cost you more than 9.5 percent of your income.) Your current plan also must offer a minimal level of coverage, also defined by law.

Q:  I don't plan to get it, what will the penalty be?

A:  The penalty for the first year is $95 or 1 percent of income, whichever is greater. That will increase to $695 or 2.5 percent of income, whichever is greater, by 2016. The penalty will be assessed when you file your federal taxes, meaning it could be deducted from any refund you qualify for, or added to the tax bill you owe.

Q:  I work 4 days a week at a small 60 employee company. The insurance premium I pay as a single insured is over 9% of my income. They do offer a less expensive plan but that plan does not cover much. Can I discontinue my plan and get on the exchange?

A:  First of all, anyone is allowed to shop on the exchange. But whether you would qualify for a federal tax credit depends on a few factors. If the less expensive plan your company offers does not meet minimum value requirements, the plan share of the total cost of covered services is at least 60 percent, then you would be able to qualify for a tax credit. You must also be considered a full-time employee.

Q:  I keep reading that the law requires employers to offer “affordable coverage.” What exactly is considered affordable?

A:  The law defines affordable this way: your share of the premium cost does not exceed 9.5 percent of your income. If your employer-sponsored insurance does cost more than that, you are free to shop for a better deal on the Health Insurance Marketplace, which opens on Tuesday. Bear in mind that the 9.5 percent threshold applies only to your plan and your income. If your plan costs 8 percent of your income, it’s affordable – even if you have to then spend another $10,000 on coverage for your family.

Q:  Do Medicare recipients still need a supplemental policy?

A:  The Affordable Care Act does not affect Medicare in any meaningful way. So yes, if you pay for Medicare Advantage or some other supplement now, you probably will want to keep doing so.

Q:  Will all medical staff (doctors, hospitals, etc.) HAVE to accept the plans available under Obamacare? What if they choose to only accept private plans or employer plans?

A:  No health care providers do not have to join particular networks for plans offered through the exchange just like they don't have to now in the current insurance market. We've been told my insurance companies that will offer plans on the exchange that there will be a way to find out if a provider is included in the network for a plan during the sign up process through HealthCare.gov. Remember too that the insurance being offered on the exchange is not being provided by the federal government. These plans are being offered by PRIVATE insurance companies. Georgia that's Blue Cross Blue Shield, Peach State, Kaiser, Humana and Alliant. If someone qualifies for Medicaid or another government proram then they will be shifted to that program.

Q:  I have been accepted into a non profit, mission organization that provides sliding scale or free healthcare to unemployed or low income people. What is going to happen to my healthcare once it is required for me to purchase a health insurance plan? Will the fact that I am covered by a charity organization meet the requirement of being covered, or will I still be required to purchase a plan?

A:  While the healthcare you've qualified for isn't insurance, it doesn't necessarily mean you'll have to pay the penalty. There is a hardship exemption for people who don't make enough money to file a tax return. Here is a link to more information about exemptions from the individual mandate: https://www.healthcare.gov/exemptions/

Q:  Will we still have Flexible Spending Accounts (FSAs) as offered by my employer?

A:  You can still use a Flexible Spending Account (FSA) to pay for copayments, deductibles, some drugs, and other health care costs. But FSAs are now limited to $2500 per year.

Q:  OK, it was $2,500 last year, so no effect from Obamacare.

A:  The law actually imposed the limit in a previous year.

Q:  How is the subsidy determined for a husband and wife if one is on Medicare and the other is using exchange. Also is the income used net income or gross.

A:  The income used is modified adjusted gross income. We're still working on the first part of your question, which is a little trickier to answer. Your household income, as reported on your taxes, will be determined to set the tax credit amount. That is most likely your combined income. If you use our calculator that should give you an idea of whether you can qualify for a tax credit.

Q:  I don't exactly understand the silver plans $6,350 annual out of pocket expense. Say I visit my doctors office, how much will I have to pay?

A:  That depends on the plan you select. The $6,350 is the maximum out of pocket for the year. The deductibles vary for a silver plan with $2,000 being pretty typical. But remember, preventive care is often carried with no out of pocket expenses. We will offer you some help understanding these terms in upcoming coverage. Answering this question just reinforces the point: insurance is complicated. Understanding co-pays, deductibles and coinsurance is important before buying a plan.

Q:  Let's say you drop (or are dropped by) your employers insurance and buy on the open market. You are going to loose out on the tax benefit. The premium you pay is pretax. That amount reduces your salary and the taxes paid on it. And let's say you don't itemize expenses (which is my case), you still lose out. I want to know if there has been any talk about changing any of the IRS rules. The tax credits -from what I heard- were only good for incomes below $46,000. I think the health care premiums paid that are not pre taxed should be made into some kind of credit if you can't itemize. My medical expenses last year didn't exceed the 7.5% of income.

A:  We haven't learned of any impending changes to those IRS rules. You don't get the same advantage of using pre-tax dollars on the exchange as you do through an employer.

Q:  Why were so many exempted from this? why are the congressional staffers being subsidized by the taxpayers when it was originally written in the bill, congress would be treated like the rest of the Nation?

A:  We have done a couple of stories recently about how this works for Congress. Here is a link to one recent AJC news story: http://www.myajc.com/news/news/local-govt-politics/healthcare-law-hits-home-for-congress/nZzSS/  And here is a link to a recent PolitiFact story we did on the topic too: http://www.myajc.com/news/news/politifact-claim-about-congressional-deal-on-obama/nZ6QQ/

Q:  What happens to the people who are unemployed?

A:  The law envisioned two solutions for the unemployed. First is the Health Insurance Marketplace: if your income is between 100 percent and 400 percent of the federal poverty level, you probably will qualify for a federal tax credit to help pay for your insurance. Second was the expansion of Medicaid for people whose income is less than 138 percent of the poverty threshold. Georgia, however, decided not to expand Medicaid. So if your income is below 100 percent of poverty, you may not qualify for any assistance with health coverage. People whose incomes are, say, 101 percent of poverty, likely will qualify for a large subsidy. But not people who earn say, 99 percent of poverty.

Q:  What happens to the tax deduction for small business that provide health insurance to their empoyees?

A:  Here is a link that should answer the question: https://www.healthcare.gov/will-i-qualify-for-small-business-health-care-tax-credits/  There is a lot of info about the tax credits for small businesses in this link.

Q:  If the IRS is going to be the enforcement arm of Obamacare, and they are going to have open access to our medical records, does this not violate our HIPAA rights?

A:  The IRS will not have access to your medical records. They will only have access to your financial information to determine if you qualify for a tax credit and if so, how much that credit should be. They will know whether you've purchased a plan but no specifics about your claims. Check out this PolitiFact for greater detail on the issue. http://www.politifact.com/virginia/statements/2013/aug/19/eric-cantor/cantor-says-obamacare-gives-irs-access-personal-he/

Q:  How will the AFCA impact an employer that offers no health insurance?

A:  Businesses with more than 50 full-time employees are required under the law to provide health coverage for their workers. This “employer mandate” was supposed to take effect Oct. 1, but earlier this summer the government delayed it for a full year.  After next Oct. 1, if an employee goes onto the Health Insurance Marketplace and qualifies for a federal tax credit, his employer will be fined at least $2,000 for not offering affordable coverage. (Speaking of delays, it just developed today that the opening of the SHOP exchanges for small businesses will be delayed a month, until Nov. 1.)

Q:  If you buy on the open market (either through the private insurance of the government market place exchanges (ie bronze, silver, gold, and platinum plans) how to you acquire the full written policies that show what is and what is not covered? Usually when you sign up it's just a generalization of services covered. I want the fine print versions which define specifically what will be covered. I don't want to have some kind of surgery only to find out some portion of the surgical team or operation wasn't covered and now I have to pay full price. I want the big written policy to read or download. Even employers don't give you these. They do a generalization. It's only when you have a service do you find out what wasn't covered when the bills come in.

A:  The fine print details of any policy you purchase should be provided to you by the insurer, even if bought on a government exchange.

Q:  If I have healthcare through Blue Cross/ Blue Shield, can I drop this coverage and sign up for Obama care plan?

A:  Yes, you could drop your plan, but I would suggest shopping on the Health Insurance Marketplace first. It's possible that plans sold on the exchange may have fewer in-network choices for doctors and hospitals than individual plans on the exchange. So it's worth checking on that. But if you would qualify for a tax credit, then chances are you will get a better deal on the exchange. Shop around and see what plan offers you more value.

Q:  I am currently uninsured. My employer does provide health insurance, but my contributions would be roughly 25% of my monthly pay. My annual household income is low enough to qualify for the expanded Medicaid coverage. Would I be able to purchase subsidized coverage through the exchanges, or must I enroll in Medicaid?

A:  It sounds as if you would likely benefit from a tax credit if you bought coverage through the exchange. Employers are required to offer affordable coverage, or no more than 9.5 percent of a workers' income. People who make between 100 and 400 percent of the federal poverty level, or about $11,500 to $46,000, can potentially qualify for a tax credit to help cover the cost of premiums. On Medicaid, Georgia has actually rejected the Medicaid expansion, which would have extended coverage to adults with incomes up to 138 percent of the poverty level.

Q:  What is the difference between gold, silver and bronze?

A:  Premiums typically will be higher for plans that pay more of your out-of-pocket medical expenses. So, with a Gold plan, you'll probably pay a higher premium, but you could have lower costs for doctor’s visits or other medical services. By contrast, with a Bronze plan, you typically will pay a lower premium, but would pay a larger portion of the costs when you get care. Platinum plans likely would have the highest monthly premiums and lowest out-of-pocket costs. All the plans would provide the same essential benefits, however. And there is no difference in the quality of care in the plans.

Q:  I have insurance through my employer, so I’m good. However, my boyfriend, who also lives in Georgia, has no job and no income. Obviously, he can’t buy health care. However, from what I’ve seen of the Georgia Medicaid program, he isn’t eligible for that, either. I understand that this is because GA declined to broaden that coverage to include households without children or pregnant females. Are there plans in the works in N. GA for people in this circumstance? I’m pretty certain that there are a lot of people that are falling through the cracks between the two systems.

A:  It sounds like you’re correct that your boyfriend is likely one of the thousands of Georgians who will not qualify for Medicaid or for a federal tax credit through the exchange. That is if he makes less than 100 percent of the federal poverty level, or about $11,600. Unfortunately, there is nothing in the works to right now to help give people in this circumstance access to coverage. If he makes more than 100 percent of poverty, he would likely qualify for a tax credit.

Q:  Would Medicaid help him?

A:  Probably not. Eligibility for Georgia's Medicaid program is extremely restrictive. It mostly covers children, pregnant women, the disabled and the elderly. It does NOT cover single adults. And that will remain the case since Georgia has decided not to move forward with the Medicaid expansion.

Q:  My son is a college student in graduate school. He has no income; he is living off of student loans. Would he qualify for any subsidy/tax credits?

A:  Probably not. Income is the first test for deciding whether a person qualifies for a tax credit and, at least in Georgia, no income generally means no tax credit. Here’s how the law was intended to work: People who earn less than the federal poverty level (about $11,600 for a single adult) would be enrolled in an expanded Medicaid program. People whose incomes fall between 100 percent and 400 percent of the poverty level generally would be eligible for a tax credit when they buy an individual policy on the Health Insurance Marketplace. When Georgia decided not to expand Medicaid, the people below the poverty line lost out. So you can get a subsidy if your income exceeds the poverty level, but you can’t get a tax credit if it falls below the poverty level.

Q:  I am a teacher and have had United Health Care through the GA school system. It has varied from year to year, especially with prescription drugs. They (GA school systems) have switched from United Health Care to Blue Cross Blue Shield. Will those premiums (generally speaking) e.g. prescription drugs, doctor visits, tests, surgery be lower than the premiums in the ACA exchanges?

A:  The premiums that you pay as a member would be less than the total premium of a plan sold on the Health Insurance Marketplace. That's mainly because the SHBP covers most of the cost of the plan. Since you are offered a plan at work, you cannot qualify for a tax credit on the Health Insurance Marketplace. All that said, we know that the costs you have been paying out of pocket have gone up a lot in recent years, mostly due to increases in health costs. However, the state has said that costs associated with the Health Care law are also driving up the plan's costs.


Reader Comments


Next Up in News

Shocking video shows police stopping armed robbery in broad daylight
Shocking video shows police stopping armed robbery in broad daylight
Plainclothes police in San Francisco were in the right place at the right time to thwart a brazen daylight armed robbery Saturday.
Florida home to America's two deadliest highways, study says
Florida home to America's two deadliest highways, study says
Surviving Florida is challenging enough considering the shark bites, alligator attacks and myriad other ways the state can take a life.
Trump foes try to create a ballot spot for a challenger-to-be-named
The so-called #NeverTrump movement has not come up with a candidate to stop Donald Trump’s run for the White House, but a new group is trying...
British politics in disarray as 'Brexit' fallout continues
  LONDON — Parliament meets Monday for the first time since the United Kingdom's surprise vote to exit the European Union,...
Obama’s national monuments are about more than conservation
Using his authority under the 1906 Antiquities Act more frequently than any president in history, President Obama has set aside more than 3.
More Stories

You have reached your limit of free articles this month.

Enjoy unlimited access to myAJC.com.

Starting at just 99¢ for 8 weeks.

GREAT REASONS TO SUBSCRIBE TODAY!

  • IN-DEPTH REPORTING
  • INTERACTIVE STORYTELLING
  • NEW TOPICS & COVERAGE
  • ePAPER
X

You have read of free premium articles.

Get unlimited access to all of our breaking news, in-depth coverage and bonus content- exclusively for subscribers. Starting at just 99¢ for 8 weeks.

X

Welcome to myAJC.com

This subscriber-only site gives you exclusive access to breaking news, in-depth coverage, exclusive interactives and bonus content.

You can read free articles of your choice a month that are only available on myAJC.com.