Q: What's the Exchange?
A: The Health Insurance Marketplace, sometimes called the Insurance Exchange, offers you a way to choose and purchase a plan if you don’t have health insurance through your employer. By filling out just one online application in the Marketplace, you can compare plans and find health care coverage that meets your needs.
When you fill out an application, you’ll also receive information about whether your income and family size qualify you for discounts on coverage.
Certain life events, like having a baby, switching jobs, or getting married, may qualify you for a temporary special enrollment period. Visitwww.healthcare.gov for more information.
Q: How is insurance coverage going to be different?
A: The ACA offers a few protections that didn’t exist with health care before. The following protections are in place now, whether you purchase a plan through the new Marketplace or you already have coverage:
- You’ll get a simple document that clearly explains your benefits and coverage.
- Your insurance provider can’t cancel your coverage just because you made a mistake on your application.
- Companies won’t be able to turn you down or raise your rates because of a pre-existing condition.
- Most children may stay on their parents’ medical plans until age 26.
Q: What will be staying the same?
A: Not everything is changing under the ACA. For instance, if you receive benefits under Medicare or Medicaid, you’ll keep the same coverage and you don’t need to do anything. In fact, even more people may have access to these programs.
Q: Am I required to have health insurance?
A: Yes. The Affordable Care Act requires almost everyone to have health insurance. There are a few exceptions, but beginning in January 2014 most individuals of all ages must have health insurance or pay a special tax. For 2015, that will cost either $325 or 2 percent of taxable income per adult, whichever is greater. The tax will increase each year as follows:
- 2016: $695 or 2.5 percent of taxable income, whichever is greater
- 2017 and beyond: the tax penalty will increase annually based on cost-of-living increases
The tax for a child is half the adult penalty.
Q: Will I be penalized if I don’t have insurance? How much is the penalty?
A: The short answer: Maybe. As of January 1, 2014, people who can afford health insurance but don’t have it may have to pay a fee.
You may be exempt from this fee if you meet any of the following criteria:
- You qualify for Medicaid, even if your state doesn’t offer it to you.
- You spend less than three months without coverage.
- You don’t make enough money to buy insurance or to file a tax return.
- You are a member of an American Indian tribe or a religious group that opposes health insurance or shared health care benefits.
During 2014, your fee for not having coverage was 1 percent of your household income or $95 per adult whichever costs more and half that for each child. You’ll pay these fees when you file your 2014 income tax form in 2015.
During 2015, your fee for not having coverage is $325 or 2 percent of your household income, whichever is greater.
Every year you don’t have coverage, the fees will increase.
Q: What if I already have coverage through my job?
A: You can still shop at the Marketplace during open enrollment periods. But keep in mind that your employer may not pay part of your premium if you select a different plan. And you may not qualify for the same savings you would if your job didn’t offer insurance.
Q: Will I be able to keep my current health insurance?
A: That depends. The Affordable Care Act requires insurers to sell plans with a number of required benefits that typically exceed the benefits many plans have traditionally included. The cutoff for insurers to meet the minimum number of benefits had been January 2014, but the deadline was extended by one year.
States have been given the option of extending the deadline even further to include certain catastrophic coverage plans that begin on or before October 1, 2016. This means that if you currently have a policy that does not meet the Affordable Care Act’s minimum guidelines for coverage, and if your insurance carrier decides to continue offering that policy, and if your state decides to extend the deadline, you may be able to keep your plan into the year 2017. To find out if your state has extended the deadline, contact your insurance company or your state’s Department of Health.
If you currently have health insurance through your employer you are covered and do not need to do anything. If you have individual insurance coverage you are now able to evaluate your coverage options on the health insurance marketplace. To learn more about your coverage options, visit GetCoveredIllinois.gov.
Q: How will the Affordable Care Act impact my health insurance premiums?
A: If you buy or are planning on buying individual insurance, the impact on your premiums depends on a lot of factors including where you live, your age, and your health status. For an estimate of these costs, please use the Health Insurance Subsidy Calculator.
Q: What can I do to reduce my health insurance costs?
A: In order to find out if you qualify for the Advance Premium Tax Credit, you will need to apply to your state’s Health Insurance Marketplace. This tax credit is based on your household income and family size. To find out whether you might qualify for lower premiums, visit https://www.healthcare.gov/lower-costs/qualifying-for-lower-costs/. The reduced costs would be handled through a federal tax credit that can be applied directly to your monthly premiums. It is important to keep in mind that not everyone can reduce costs by going to the health insurance market place. For many, the options provided through an employer will be more affordable.
Based on your income and family size, you might also be eligible for free or low-cost care through Medicaid. Alternatively, if you earn too much money to qualify for Medicaid, your children may be eligible for low-cost health coverage through the Children’s Health Insurance Program (CHIP). If you apply to your state’s Health Insurance Marketplace, you’ll be told if you also qualify for other such insurance programs.
Q: What are the key dates for purchasing health insurance through my state’s Health Insurance Marketplace?
A: The 2016 open enrollment period began November 1, 2015. Coverage can start as soon as January 1, 2016. The last day to enroll in a plan or change plans for coverage to start on January 1, 2016 is December 15, 2015.
Life events, like having a baby, switching jobs, or getting married, may qualify you for a temporary special enrollment period. Visit www.healthcare.gov for more information.
Q: How do I know if I can go to the Health Insurance Marketplace to buy insurance? Where can I buy it?
A: Most people are eligible for health coverage through the Marketplace. You must live in the United States, be a U.S. citizen or national and cannot currently be incarcerated for eligibility.
You can buy health insurance by applying online, over the phone, in person or on paper. Counselors are available to help you select the best plan for your healthcare. For more information about purchasing insurance, visit healthcare.gov.
Q: What if I have a pre-existing condition? Will I be denied coverage?
A: No, health insurance plans cannot refuse to cover you, deny treatment coverage, or charge you more because you have a pre-existing condition.
Q: How are small business affected by health care reform?
A: Although employers do not have to provide health insurance, in 2015 businesses with 50 or fewer full-time employees can get health insurance through the Health Insurance Marketplace’s Small Business Health Options Program (SHOP) Marketplace. This is also true of nonprofit organizations. If a business has fewer than 25 full-time employees who earn an average of about $50,000 a year or less, they may qualify for a tax credit worth up to 50 percent of their share of their employees’ premium costs and up to 35 percent for nonprofits.
Insurance plans cannot reject a small employer based on the health status of its employees or dependents, cannot charge higher premiums for women, and cannot increase the group’s premium for employees with high medical costs.
Q: What about larger businesses?
A: The mandate that businesses with more than 50 full-time employees either provide affordable, minimal health coverage or else pay an assessment has been delayed until 2015.
Q: What if I am self-employed?
A: If you are self-employed and have no employees, you can purchase insurance through the individual Health Insurance Marketplace or continue to buy an individual plan during open enrollment periods. If you have a Qualifying Life Event, such as the birth of a child, a change in income, get married, or get divorced, you may be eligible for a special enrollment period.
Q: What if I have Medicare do I need to do anything?
A: No. Anyone with Medicare is already covered. Medicare has nothing to do with the Health Insurance Marketplace and there will be no changes to your benefits. So stay on Medicare. If you're already on Medicare, don't let anyone try to sell you a Marketplace insurance plan. It's illegal for them to do so, and you don't need it.
Q: I'm on Medicare but my spouse isn't because he's under 65. How does that affect our access to health insurance coverage?
A: Let's start with you. You're on Medicare, so you're covered. There's nothing you need to do. Your spouse, however, may want to take action.
The Affordable Care Act (ACA) requires that most people have health care insurance in 2014. If they don't, they must pay a penalty. The fee is either 2% of the person's yearly household income or $325 per person per year. (The fee will increase each year.) This is paid on the federal income tax form.
If your spouse doesn't have coverage, he or she can receive it from an employer or through the Health Insurance Marketplace. Or, he or she can buy an individual policy on his or her own ñ through a health insurance company that is not on the Marketplace. To use the Marketplace, your spouse must be a United States citizen or national. He or she also must live (unincarcerated) in the United States.
Does your spouse already have health insurance through an employer, or on his or her own? If so, and your spouse is happy with it, no need to do anything. But if the insurance costs too much for your spouse, he or she can look for other coverage ñ either on the Marketplace or on his or her own.
If your spouse buys insurance through the Marketplace, he or she might be able to receive financial help to pay for it. This is called a subsidy, in the form of a tax credit. The credit is applied to monthly premiums, so you'd both see the savings right away. To receive this help, your spouse's total household income must be under 400% of the Federal Poverty Level. For a family of two, that comes out to $62,040. He or she also must meet other eligibility criteria.
For more information about the Affordable Care Act, visit www.healthcare.gov. There, you can also find information about Medicare, or visit www.medicare.gov.
Q: I already have Medicaid. Should I do anything?
A: No, if you already have Medicaid your benefits will not change and you do not need to do anything.
Q: How do I find out if I qualify for Medicaid?
A: Medicaid will now be available to all low-income individuals regardless of parenting or health status. This includes expanding care to former foster children (ages 18-25) who were on Medicaid and exited foster care, and to adults (ages 19-64) without dependent children that are at or below 138% of the federal poverty level.
Those who qualify for Medicaid can complete an online application at Get Covered Illinois.
Q: Where can I get additional information?
A: Visit the following links for further information about Health Care Reform:
Last updated: November 2015