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Health Care Reform FAQs

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 including cost sharing reductions and premium tax credits.

Certain 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 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: No. The Affordable Care Act required almost everyone to have health insurance up until 2019. 

Q: Will I be penalized if I don’t have insurance? How much is the penalty?
A: No.  The penalty is eliminated for the 2019 coverage year and you will NOT be penalized for not having health insurance that is considered “minimum essential coverage”.  For lack of coverage during 2018, you pay the higher amount of either:

  • 2.5 percent of your household income or
  • $695 per adult and $347.50 per child under 18 (up to $2,085 per family) 

There are some situations in which you might not have to pay the fee for being uninsured in 2018. For example, if you:

  • were uninsured for less than three consecutive months
  • don’t file taxes because your income is below the tax filing threshold

     
  • weren’t able to find a health plan that costs less than 8 percent of your household income 
  • are American Indian
  • had religious reasons for not purchasing insurance
  • had financial hardship
  • are a member of a Health Care Sharing Ministry

Q: What if I am offered coverage through my job?
A: If you have job-based coverage, you might be able to change to a Marketplace plan. But you probably won’t qualify for a premium tax credit or other savings. As long as the job-based plan is considered affordable and meets minimum standards, you won’t qualify for savings. Most job-based plans meet these standards.

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: Open Enrollment for 2018 is now closed. You can enroll or change plans only if you qualify for a Special Enrollment Period, visit www.healthcare.gov for more information. Open Enrollment for 2019 coverage runs from November 1st, 2018 through December 15th, 2018. 

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 needs. 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: Some employers with 50 or more FTE employees who don’t offer insurance, or whose offer of coverage is not affordable or doesn’t meet certain minimum standards, are subject to Employer Shared Responsibility provisions. They may owe a payment if at least one of their full-time employees enrolls in a plan through the Health Insurance Marketplace and receives a premium tax credit.

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 am Medicare eligible?
A: If you are eligible to enroll in Medicare, please visit Medicare.gov for more information. Please note that if you are looking to enroll in a Medicare Advantage plan, the enrollment period starts October 15, 2018 and ends December 7, 2018 for 2019 coverage. Plans accepted by NorthShore are listed on our website.

Medicaid and CHIP coverage:

When you fill out a Marketplace application, you may learn that you qualify for for free or low-cost care through Medicaid based on income and family size. Please visit HealthCare.gov for more information.

Q: Where can I get additional information?
A: Visit the following links for further information about Health Care Reform:

Last updated: October 2018