• WHATare the facts?
  • HOWdoes this affect me?
  • WHENis this happening?
  • WHEREdo I get more info?

What is health care reform?

What is health care reform?

"Health care reform" refers to a federal law called the Affordable Care Act, which was passed in March 2010.
Health care reform also includes laws passed in each state, including Pennsylvania, to support the Affordable Care Act.
To most people, health care reform means:

  • New and better ways to get affordable health care coverage
  • More options for receiving quality medical care
  • As of January 1, 2014, citizens are required to have health insurance or pay a penalty.

The only people who won't have to buy health insurance or pay a penalty are:

  • Those with certain religious beliefs
  • Members of Native American tribes
  • Undocumented immigrants
  • Those who are in prison
  • Those whose income is below a certain level

What do I need to do now?

What do I need to do now?

The first open enrollment period for the Health Insurance Marketplace ended on March 31, 2014. The second open enrollment period for the health Insurance Marketplace begins November 15, 2014 and lasts until February 15, 2015. The marketplace will show the different health insurance plans, what they cover and what they cost. Open enrollment begins November 15, 2014 for health care plans that begin coverage on January 1, 2015. Enrollment is required by December 15, 2014, in order for coverage to begin on January 1, 2015.

You won’t be able to purchase health insurance outside of open enrollment unless you qualify for a special enrollment period. Certain life events, like moving to a new state, losing or changing jobs, or a change in family size, will trigger a special enrollment period.

If you have health insurance but want a more affordable plan, start keeping basic records about your household income and spending. You may be able to receive discounts or financial help when buying coverage for next year. You will need to provide income information when you apply for coverage through the Health Insurance Marketplace.

If you do not have insurance now, ask your employer if they plan to offer health insurance starting in January.

Do you have a favorite doctor? Would you choose one hospital above all others, whether for routine testing, emergency care—or to deliver your baby? Do your research today for 2015 and the future. Then choose an insurance plan that will continue to cover care at the highest quality doctors and facilities.

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

Can I buy coverage outside of the open enrollment period?

Can I buy coverage outside of the open enrollment period?

Most individuals may only buy private health insurance doing open enrollment, which runs from November 15 through February 15. However, certain life events will qualify you for a special enrollment period, during which you can buy coverage through the Marketplace. Life events include losing job-based insurance, moving, or a change in family size. HealthCare.gov offers a screener to help determine if you qualify for a special enrollment period.

If you qualify for Medicaid or the Children’s Health Insurance Program, you may enroll at any time. There is no open enrollment period for these programs.

Will everyone be able to get health insurance?

Will everyone be able to get health insurance?

Yes. Insurance companies will be required to accept everyone, even people with medical conditions like diabetes, asthma or cancer.

This is a big change that will help people with “pre-existing conditions.” This means illnesses or injuries they had in the past or have when they sign up for health insurance.

You might get health insurance through your employer, a public program (such as Medicare or Medicaid, also called Medical Assistance) or a private insurance plan.

I have 15 employees. Can I get help paying for their coverage?

I have 15 employees. Can I get help paying for their coverage?

If your business meets certain conditions, you may qualify for a small business tax credit of up to 50% to offset the cost of health insurance.

To qualify, you must have fewer than 25 employees and pay average annual wages below $50,000.

I have a pre-existing condition. Can I get coverage?

I have a pre-existing condition. Can I get coverage?

Beginning January 1, 2014, you can get insurance coverage even if you have a pre-existing condition like asthma, cancer or diabetes. Under the new law, insurance coverage will not be denied to those who have serious illnesses or injuries, or who had them in past years.

This is a big change that will help many people who have tried to buy coverage and were rejected because they had a pre-existing condition.

Another important new law provides unlimited annual and lifetime coverage. Beginning in 2014, health plans are not allowed to put dollar limits on what they cover in one year or during your lifetime. So if you need a lot of health care treatment, you don’t have to worry about “running out” of insurance.

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

Will co-pays for preventive care be covered?

Will co-pays for preventive care be covered?

Yes, by most plans. Many people skip preventive care—for themselves or their family members—because they have to pay part or all of the costs. These payments, called “cost-sharing,” can include co-payments, co-insurance and deductibles.

Getting preventive care is an important way to:

  • Stay healthy
  • Avoid or delay disease and illness
  • Stay active and productive
  • Reduce health care costs

Under health care reform, most insurance plans created after March 23, 2010, are required to cover all of the costs for wellness and prevention services delivered by in-network providers. That means if you are covered in one of these plans, you might not have to pay anything to receive these important services.

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

What if I don’t buy health care coverage?

What if I don’t buy health care coverage?

As of January 1, 2014, if you don’t buy health care coverage, you will pay a penalty. The IRS will add this penalty to your tax bill at the end of the year. For 2014, the adult fee is the greater of $95 or 1 percent of income. The fee for a child is half the adult amount.

There is no penalty for a gap in coverage of less than three months. Also, if you have health insurance coverage but drop it or lose it for three months or more, you will have to pay the penalty.

Why am I being forced to buy health insurance?

Why am I being forced to buy health insurance?

The health care reform laws were created to help everyone get health insurance they can afford—even if they have health problems.

That’s why the law requires both sick and healthy people have minimum coverage. With many more people buying health insurance, average costs are kept low.

If people are not required to buy insurance when they are healthy, many will wait until they are sick or injured. There would be few insurance plans available, and those choices would be more expensive for everyone.

Learn about the pros and cons of Obamacare.

What is health care reform?

What is health care reform?

"Health care reform" refers to a federal law called the Affordable Care Act, which was passed in March 2010.
Health care reform also includes laws passed in each state, including Pennsylvania, to support the Affordable Care Act.
To most people, health care reform means:

  • New and better ways to get affordable health care coverage
  • More options for receiving quality medical care
  • As of January 1, 2014, citizens are required to have health insurance or pay a penalty.

The only people who won't have to buy health insurance or pay a penalty are:

  • Those with certain religious beliefs
  • Members of Native American tribes
  • Undocumented immigrants
  • Those who are in prison
  • Those whose income is below a certain level

What do I need to do now?

What do I need to do now?

The first open enrollment period for the Health Insurance Marketplace ended on March 31, 2014. The second open enrollment period for the health Insurance Marketplace begins November 15, 2014 and lasts until February 15, 2015. The marketplace will show the different health insurance plans, what they cover and what they cost. Open enrollment begins November 15, 2014 for health care plans that begin coverage on January 1, 2015. Enrollment is required by December 15, 2014, in order for coverage to begin on January 1, 2015.

You won’t be able to purchase health insurance outside of open enrollment unless you qualify for a special enrollment period. Certain life events, like moving to a new state, losing or changing jobs, or a change in family size, will trigger a special enrollment period.

If you have health insurance but want a more affordable plan, start keeping basic records about your household income and spending. You may be able to receive discounts or financial help when buying coverage for next year. You will need to provide income information when you apply for coverage through the Health Insurance Marketplace.

If you do not have insurance now, ask your employer if they plan to offer health insurance starting in January.

Do you have a favorite doctor? Would you choose one hospital above all others, whether for routine testing, emergency care—or to deliver your baby? Do your research today for 2015 and the future. Then choose an insurance plan that will continue to cover care at the highest quality doctors and facilities.

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

Can I buy coverage outside of the open enrollment period?

Can I buy coverage outside of the open enrollment period?

Most individuals may only buy private health insurance doing open enrollment, which runs from November 15 through February 15. However, certain life events will qualify you for a special enrollment period, during which you can buy coverage through the Marketplace. Life events include losing job-based insurance, moving, or a change in family size. HealthCare.gov offers a screener to help determine if you qualify for a special enrollment period.

If you qualify for Medicaid or the Children’s Health Insurance Program, you may enroll at any time. There is no open enrollment period for these programs.

Will everyone be able to get health insurance?

Will everyone be able to get health insurance?

Yes. Insurance companies will be required to accept everyone, even people with medical conditions like diabetes, asthma or cancer.

This is a big change that will help people with “pre-existing conditions.” This means illnesses or injuries they had in the past or have when they sign up for health insurance.

You might get health insurance through your employer, a public program (such as Medicare or Medicaid, also called Medical Assistance) or a private insurance plan.

What if I don’t buy health care coverage?

What if I don’t buy health care coverage?

As of January 1, 2014, if you don’t buy health care coverage, you will pay a penalty. The IRS will add this penalty to your tax bill at the end of the year. For 2014, the adult fee is the greater of $95 or 1 percent of income. The fee for a child is half the adult amount.

There is no penalty for a gap in coverage of less than three months. Also, if you have health insurance coverage but drop it or lose it for three months or more, you will have to pay the penalty.

Why am I being forced to buy health insurance?

Why am I being forced to buy health insurance?

The health care reform laws were created to help everyone get health insurance they can afford—even if they have health problems.

That’s why the law requires both sick and healthy people have minimum coverage. With many more people buying health insurance, average costs are kept low.

If people are not required to buy insurance when they are healthy, many will wait until they are sick or injured. There would be few insurance plans available, and those choices would be more expensive for everyone.

Learn about the pros and cons of Obamacare.

What is health care reform?

What is health care reform?

"Health care reform" refers to a federal law called the Affordable Care Act, which was passed in March 2010.
Health care reform also includes laws passed in each state, including Pennsylvania, to support the Affordable Care Act.
To most people, health care reform means:

  • New and better ways to get affordable health care coverage
  • More options for receiving quality medical care
  • As of January 1, 2014, citizens are required to have health insurance or pay a penalty.

The only people who won't have to buy health insurance or pay a penalty are:

  • Those with certain religious beliefs
  • Members of Native American tribes
  • Undocumented immigrants
  • Those who are in prison
  • Those whose income is below a certain level

Will everyone be able to get health insurance?

Will everyone be able to get health insurance?

Yes. Insurance companies will be required to accept everyone, even people with medical conditions like diabetes, asthma or cancer.

This is a big change that will help people with “pre-existing conditions.” This means illnesses or injuries they had in the past or have when they sign up for health insurance.

You might get health insurance through your employer, a public program (such as Medicare or Medicaid, also called Medical Assistance) or a private insurance plan.

I have 15 employees. Can I get help paying for their coverage?

I have 15 employees. Can I get help paying for their coverage?

If your business meets certain conditions, you may qualify for a small business tax credit of up to 50% to offset the cost of health insurance.

To qualify, you must have fewer than 25 employees and pay average annual wages below $50,000.

What if I don’t offer health care coverage?

What if I don’t offer health care coverage?

The Affordable Care Act does not require employers to provide health insurance for their employees.

However, beginning in 2015, large businesses (those with 100 or more full-time equivalent employees) must offer coverage to at least 70 percent of employees or pay a penalty if at least one employee receives a government subsidy, or tax credit, to buy coverage on the Health Insurance Marketplace. In 2016 and beyond, the definition of large business is expanded to include those with 50 or more full-time equivalent employees, and they must offer coverage to 95 percent of employees or pay a penalty.

How does the law define “small business?”

How does the law define “small business?”

Under the health reform law, a small business is defined as one with up to 49 employees.

What are the penalties?

What are the penalties?

Beginning in 2015, large employers with 100 or more employees that don’t offer coverage to 70 percent of employees face a penalty of $2,000 per full-time employee (excluding the first 80) if at least one employee receives a government subsidy, or tax credit, to buy coverage on the Health Insurance Marketplace. In 2016 and beyond, this penalty applies to large employers with 50 or more employees who don't offer coverage to 95 percent of their employees.

If you offer coverage to employees but their share of the premium is considered unaffordable, you may also pay a penalty.

I have 75 employees. Am I required to provide insurance?

I have 75 employees. Am I required to provide insurance?

The law does not require employers to provide health insurance. However, beginning in 2016, businesses with 50 or more full-time equivalent employees will pay a penalty, or assessment, if they do not offer insurance or if their insurance is considered unaffordable and their employees receive tax credits to help offset the cost of buying their own insurance.

What is the Small Business Health Options Program (SHOP)?

What is the Small Business Health Options Program (SHOP)?

If your business has 50 or fewer employees, you might be able to research and purchase health care insurance through the Small Business Health Options Program (SHOP).

On average, small businesses spend 18% more than big businesses to purchase health insurance. SHOP will allow small businesses to pool their risk and gain increased purchasing power. Many will be able to offer employees high-quality coverage at a lower cost.

To enroll, eligible employers must have an office within the service area of the SHOP and offer SHOP coverage to all full-time employees.

Will my Medicare benefits change under health care reform?

Will my Medicare Health Insurance benefits change under health care reform?

If you are a senior citizen on Medicare, your coverage and your benefits will not be taken away under the new health insurance plan for seniors. You can continue to see your own doctor. Once ObamaCare goes into effect, if you have Medicare, you will still be able to continue seeing your own doctor.

Also, your Medicare health insurance will allow you to receive preventive health services at no cost. This includes vaccinations, and many cancer screenings. You are also now eligible to receive a free annual “Wellness Visit” from your provider (like the "Welcome Visit" you received when you first joined Medicare).

Since 2010, some Medicare changes have already been phasing in. People with Medicare Part D prescription drug coverage began to pay less if they reached the coverage gap known as the “donut hole.” In 2010, they also received a one-time $250 rebate if they reached the coverage gap. The new law requires the complete closing of the Part D coverage gap by 2020.

There may be changes, over time, to Medicare Advantage (MA) Plans. But the changes will vary, based on the Medicare Advantage Plan you have–because not all Medicare Advantage Plans are the same. The new law rewards the ones that have the best outcomes but may cut reimbursements to others. However, your guaranteed Medicare coverage will not change and you will always be able to reevaluate your plans during yearly open enrollment.

Can I buy coverage outside of the open enrollment period?

Can I buy coverage outside of the open enrollment period?

Most individuals may only buy private health insurance doing open enrollment, which runs from November 15 through February 15. However, certain life events will qualify you for a special enrollment period, during which you can buy coverage through the Marketplace. Life events include losing job-based insurance, moving, or a change in family size. HealthCare.gov offers a screener to help determine if you qualify for a special enrollment period.

If you qualify for Medicaid or the Children’s Health Insurance Program, you may enroll at any time. There is no open enrollment period for these programs.

What will health care reform mean for Medicare Advantage (MA) Plans?

What will health care reform mean for Medicare Advantage (MA) Plans?

Medicare Advantage plans are not going away under the health care reform law.

These popular plans provide health care coverage and value-added wellness and prevention programs to one in four seniors over 65. However, over the next few years, the law will change the way health plans like UPMC that offer Medicare Advantage are reimbursed.

Initially the health care reform law said the government would reduce reimbursements to all insurers who offer Medicare Advantage. In April 2013, the government reversed its position and will now initially freeze payments to insurers, followed by cuts to some Medicare Advantage plans but bonuses to others, depending on their track record of keeping people healthier.

UPMC will continue to deliver the highest quality of care in our Medicare Advantage Plans. Have questions? Call UPMC Health Plan at 1-877-539-3080.

Is the donut hole going away, and if so, when?

Is the donut hole going away, and if so, when?

Yes, but it's going to be a gradual process. When you’re in the coverage gap (also called the “donut hole”) in your Medicare prescription drug coverage, you can expect to see the following:

  • A discount on covered brand-name drugs when you buy them at a pharmacy or order them through the mail
  • Some coverage for generic and brand-name drugs
  • Additional savings on your brand- name and generic drugs during the coverage gap over the next several years until it’s closed in 2020
  • The coverage gap closes by maintaining the 50% discount the manufacturers offer and increasing what Medicare drug plans cover

What is health care reform?

What is health care reform?

"Health care reform" refers to a federal law called the Affordable Care Act, which was passed in March 2010.
Health care reform also includes laws passed in each state, including Pennsylvania, to support the Affordable Care Act.
To most people, health care reform means:

  • New and better ways to get affordable health care coverage
  • More options for receiving quality medical care
  • As of January 1, 2014, citizens are required to have health insurance or pay a penalty.

The only people who won't have to buy health insurance or pay a penalty are:

  • Those with certain religious beliefs
  • Members of Native American tribes
  • Undocumented immigrants
  • Those who are in prison
  • Those whose income is below a certain level

What if I can’t afford family coverage?

What if I can’t afford family coverage?

You might be able to get financial help. This is true even if your income was too high to qualify for help in the past. Many employers may begin to offer insurance in 2015 due to requirements of the Affordable Care Act. You also might be able to enroll your family in a free or low-cost plan. Another type of help for families is a new kind of tax credit that lowers your monthly premiums (insurance payments) right away. If you qualify for tax credits, the amount you pay will depend on:

  • your income level
  • the insurance plan you choose in the Health Insurance Exchange
  • the cost for insurance coverage in your state or region

The tables below give you an idea of how much you might pay each month and year for health care premiums for an individual and family of four. Your Health Insurance Marketplace, which you may find at www.healthcare.gov, will make the final determination regarding any financial help for which you may qualify.  These approximate costs are based on buying a "silver plan" on the Health Insurance Marketplace. For example, if you are buying individual coverage and your income is $16,245 per year, you would pay $650 per year or $54 per month for health insurance premiums.


Maximum Premium Contribution (MPC) for Individual Coverage

INCOME:
MPC:   
Poverty %
Dollars
Annual
Monthly
100%
$10,830
$217
$18
150%
$16,245
$650
$54
200%
$21,660
$1,365
$114
250%
$27,075
$2,180
$182
300%
$32,490
$3,087
$257
350%
$37,905
$3,601
$300
400%
$43,320
$4,115
$343

Maximum Premium Contribution (MPC) for Coverage for a Family of 4

INCOME:
MPC:   
Poverty %
Dollars
Annual
Monthly
100%
$22,050
$441
$37
150%
$33,075
$1,323
$110
200%
$44,100
$2,778
$232
250%
$55,125
$4,438
$370
300%
$66,150
$6,284
$524
350%
$77,175
$7,332
$611
400%
$88,200
$8,379
$698

 

Source: familiesusa.org

Can I buy coverage outside of the open enrollment period?

Can I buy coverage outside of the open enrollment period?

Most individuals may only buy private health insurance doing open enrollment, which runs from November 15 through February 15. However, certain life events will qualify you for a special enrollment period, during which you can buy coverage through the Marketplace. Life events include losing job-based insurance, moving, or a change in family size. HealthCare.gov offers a screener to help determine if you qualify for a special enrollment period.

If you qualify for Medicaid or the Children’s Health Insurance Program, you may enroll at any time. There is no open enrollment period for these programs.

Will everyone be able to get health insurance?

Will everyone be able to get health insurance?

Yes. Insurance companies will be required to accept everyone, even people with medical conditions like diabetes, asthma or cancer.

This is a big change that will help people with “pre-existing conditions.” This means illnesses or injuries they had in the past or have when they sign up for health insurance.

You might get health insurance through your employer, a public program (such as Medicare or Medicaid, also called Medical Assistance) or a private insurance plan.

What if I don’t buy health care coverage?

What if I don’t buy health care coverage?

As of January 1, 2014, if you don’t buy health care coverage, you will pay a penalty. The IRS will add this penalty to your tax bill at the end of the year. For 2014, the adult fee is the greater of $95 or 1 percent of income. The fee for a child is half the adult amount.

There is no penalty for a gap in coverage of less than three months. Also, if you have health insurance coverage but drop it or lose it for three months or more, you will have to pay the penalty.

Can I add my 21-year-old to my plan?

Can I add my 21-year-old to my plan?

Maybe. If your health insurance plan includes dependent coverage, your children may be covered until they turn 26 years old.

You may add these adult children to your plan even if:

  • They do not live with you
  • They are not enrolled in college
  • They are not financially dependent on you
  • They are married (however, plans are not required to cover their spouses)

My family income is $40,000. We can't afford coverage. Can we get help?

My family income is $40,000. We cannot afford coverage. Can we get help?

Yes. The health reform law includes many financial programs to help low- and moderate-income families to buy health insurance.

You can learn about financial assistance for your family by visiting the Marketplace website, healthcare.gov or calling the toll-free number, 1-800-318-2596.

Some of this financial help includes free or low-cost insurance plans through Medicaid.

Another type of help for families is a new kind of tax credit that lowers your monthly premiums (insurance payments) right away.

If you qualify for tax credits, the amount you pay will depend on:

  • Your income level
  • The insurance plan you choose in the Health Insurance Marketplace
  • The cost for insurance coverage in your state or region

The tables below give you an idea of how much you might pay each month and year for health care premiums for an individual and family of four.

These approximate costs are based on buying a "silver plan" on the Health Insurance Marketplace.

For example, if you are buying individual coverage and your income is $16,245 per year, you would pay $650 per year or $54 per month for health insurance premiums.


Maximum Premium Contribution (MPC) for Individual Coverage

INCOME:
MPC:
Poverty %
Dollars
Annual
Monthly
100%
$10,830
$217
$18
150%
$16,245
$650
$54
200%
$21,660
$1,365
$114
250%
$27,075
$2,180
$182
300%
$32,490
$3,087
$257
350%
$37,905
$3,601
$300
400%
$43,320
$4,115
$343

Maximum Premium Contribution (MPC) for Coverage for a Family of 4

INCOME:
MPC:
Poverty %
Dollars
Annual
Monthly
100%
$22,050
$441
$37
150%
$33,075
$1,323
$110
200%
$44,100
$2,778
$232
250%
$55,125
$4,438
$370
300%
$66,150
$6,284
$524
350%
$77,175
$7,332
$611
400%
$88,200
$8,379
$698

 

Source: familiesusa.org

 

What do I need to do now?

What do I need to do now?

The first open enrollment period for the Health Insurance Marketplace ended on March 31, 2014. The second open enrollment period for the health Insurance Marketplace begins November 15, 2014 and lasts until February 15, 2015. The marketplace will show the different health insurance plans, what they cover and what they cost. Open enrollment begins November 15, 2014 for health care plans that begin coverage on January 1, 2015. Enrollment is required by December 15, 2014, in order for coverage to begin on January 1, 2015.

You won’t be able to purchase health insurance outside of open enrollment unless you qualify for a special enrollment period. Certain life events, like moving to a new state, losing or changing jobs, or a change in family size, will trigger a special enrollment period.

If you have health insurance but want a more affordable plan, start keeping basic records about your household income and spending. You may be able to receive discounts or financial help when buying coverage for next year. You will need to provide income information when you apply for coverage through the Health Insurance Marketplace.

If you do not have insurance now, ask your employer if they plan to offer health insurance starting in January.

Do you have a favorite doctor? Would you choose one hospital above all others, whether for routine testing, emergency care—or to deliver your baby? Do your research today for 2015 and the future. Then choose an insurance plan that will continue to cover care at the highest quality doctors and facilities.

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

Can I buy coverage outside of the open enrollment period?

Can I buy coverage outside of the open enrollment period?

Most individuals may only buy private health insurance doing open enrollment, which runs from November 15 through February 15. However, certain life events will qualify you for a special enrollment period, during which you can buy coverage through the Marketplace. Life events include losing job-based insurance, moving, or a change in family size. HealthCare.gov offers a screener to help determine if you qualify for a special enrollment period.

If you qualify for Medicaid or the Children’s Health Insurance Program, you may enroll at any time. There is no open enrollment period for these programs.

I’m young and healthy. Why should I buy health insurance?

I’m young and healthy. Why should I buy health insurance?

People become seriously ill and injured at all ages. Health insurance protects your financial as well as your physical health. If you need medical treatment, from emergency services to hospital care to rehabilitation, your bills could become overwhelming very quickly.

Another good reason to buy health insurance for young adults: it is the law as of March 31, 2014.

As of March 31, 2014, you should have health care coverage. If you don’t, you will pay a penalty. The IRS will add this penalty to your tax bill at the end of the year.

The Affordable Care Act gives you many more options to find health insurance that fits your needs and your budget.

How will I know what plan to buy?

How will I know what plan to buy?

Plenty of help is available. A main goal of health reform is to make health insurance a lot easier to understand. More choices and less confusion will mean better health care.

You can compare insurance plans from different companies online at the Health Insurance Marketplace. You can also get help over the phone. In some communities, you can get in-person help.

The Marketplace will help you to learn about:

  • What services the plans cover
  • How much the insurance will cost you each month
  • Whether or not you can get financial help

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

I’m not in college. Can my parents' insurance cover me?

I’m not in college. Can my parents' insurance cover me?

Probably, if you are younger than 26 and your parents' plans include dependent coverage, though some plans are exempt from this requirement.

Before the Affordable Care Act became law in 2010, insurance companies could stop covering dependent children, usually at age 19. Sometimes they would continue to cover young adult children if they were enrolled in school full-time.

Now, most plans that offer dependent coverage must continue to cover children until their 26th birthdays.

These new rules help to make health insurance more affordable for you—and all young adults.

I don't live with my parents. Will their insurance cover me?

I don't live with my parents. Will their insurance cover me?

Probably. If you are 25 years old or younger, you can usually be covered as a dependent.

Keep in mind that if you have access to affordable health insurance through your employer you will not be able to be added to a parent's plan.

Was the Affordable Care Act passed in Pennsylvania?

Was the Affordable Care Act passed in Pennsylvania?

It is the law in Pennsylvania and all 50 states.

Health reform was passed on the federal, or national, level. A few parts of the law are different from state to state but, overall, the vast majority of United States citizens are affected.

Does Pennsylvania have a Health Insurance Marketplace?

Does Pennsylvania have a Health Insurance Marketplace?

Yes. Pennsylvania will use the federal exchange, but before purchasing health insurance find out everything you need to know about the health insurance marketplace.

Under the Affordable Care Act, states had three options:

  • Build a fully state-based exchange.
  • Create a state-federal partnership exchange.
  • Use a federally-facilitated exchange.

Pennsylvania uses the federal exchange.

Is Medicaid affected by the Affordable Care Act?

Is Medicaid affected by the Affordable Care Act?

Not in Pennsylvania at this time. The law calls for Medicaid, also called Medical Assistance, to be expanded to more residents. However, state leaders were allowed to opt out of this expansion, and many chose to do so.

What do I need to do now?

What do I need to do now?

The first open enrollment period for the Health Insurance Marketplace ended on March 31, 2014. The second open enrollment period for the health Insurance Marketplace begins November 15, 2014 and lasts until February 15, 2015. The marketplace will show the different health insurance plans, what they cover and what they cost. Open enrollment begins November 15, 2014 for health care plans that begin coverage on January 1, 2015. Enrollment is required by December 15, 2014, in order for coverage to begin on January 1, 2015.

You won’t be able to purchase health insurance outside of open enrollment unless you qualify for a special enrollment period. Certain life events, like moving to a new state, losing or changing jobs, or a change in family size, will trigger a special enrollment period.

If you have health insurance but want a more affordable plan, start keeping basic records about your household income and spending. You may be able to receive discounts or financial help when buying coverage for next year. You will need to provide income information when you apply for coverage through the Health Insurance Marketplace.

If you do not have insurance now, ask your employer if they plan to offer health insurance starting in January.

Do you have a favorite doctor? Would you choose one hospital above all others, whether for routine testing, emergency care—or to deliver your baby? Do your research today for 2015 and the future. Then choose an insurance plan that will continue to cover care at the highest quality doctors and facilities.

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

How will I know what plan to buy?

How will I know what plan to buy?

Plenty of help is available. A main goal of health reform is to make health insurance a lot easier to understand. More choices and less confusion will mean better health care.

You can compare insurance plans from different companies online at the Health Insurance Marketplace. You can also get help over the phone. In some communities, you can get in-person help.

The Marketplace will help you to learn about:

  • What services the plans cover
  • How much the insurance will cost you each month
  • Whether or not you can get financial help

Want to learn about coverage from UPMC Health Plan? Call 1-877-563-0292 or visit www.upmchealthplan.com.

What if I can’t afford it?

What if I can’t afford it?

If you're worried about being unable to afford health care insurance in 2014, you're not alone. The good news is you might be able to get financial help to help you pay for coverage. One benefit of the Affordable Care Act (ACA), also known as ObamaCare, is the availability of health care tax credits for Americans in certain income ranges. This premium tax credit is available to citizens who make between 100% - 400% of the federal poverty level. In 2013, the federal poverty level was $11,490 for an individual or $23,550 for a family of four. For information on various household sizes and income levels, the Healthcare.gov Quick Check Chart is very helpful.

In addition to a health coverage tax credit to help reduce the premium costs, individuals who make between 100%-250% of the federal poverty level may also qualify for additional support with cost-sharing, making deductibles and copayments for services more affordable. This helps lower-income Americans have more affordable choices for health insurance than was previously available.

Here’s how it works:

  1. Choose how to apply. You can either apply with a paper application, online, in person with a helper, or by calling 1-800-318-2596.
  2. If you are applying online, you can create an account on the Marketplace page, you will then fill out the online application. With a paper application, you will write your information on the form. Over the phone, a trained assister will help you enter your answers.
  3. Submit your application. If you submit online or over the phone you may know your rates and tax credits right away. Otherwise, your information may come to you in the mail.

Once your application is completed, you will find out if you qualify for a tax credit. If yes, you will see the estimated amount. It’s that easy. These tax credits reduce your monthly payments immediately. Usually, you have to wait until you file your taxes to get credit funds. The tax credit is sent directly to your insurance company to help pay your premiums, so you pay less each month. If you qualify for tax credits, the remaining amount you pay will depend on:

  • Your income level, which determines the size of your tax credit
  • The insurance plan you choose in the Health Insurance Marketplace
  • The cost for insurance coverage in your state or region

Estimating Your Income

It’s important to keep in mind that the income levels for health insurance tax credits are for the upcoming year. For instance, for coverage that will be in effect for 2014, you will want to use your expected 2014 income. Healthcare.gov has a site that will help you understand what income should and shouldn’t be included in your estimate.

If you have a regular job that doesn’t offer insurance, it may be easy to estimate this income. However, if you are self-employed, unemployed, or looking for work, it can be challenging to estimate your income. It’s important to make your best estimate, however keep in mind that if you end up making less than expected and you would have qualified for an additional credit, you will get a refund when you file your federal taxes. Conversely, if you make more than expected and got too much of a credit, you will need to pay back the extra credit received.

The table below gives you an idea of how much you might pay for health care premiums for an individual. This amount shows the cost for premiums after they are discounted with tax credits.


Maximum Premium Contribution (MPC) for Individual Coverage

INCOME:
MPC:
Poverty %
Dollars
Annual
Monthly
100%
$10,830
$217
$18
150%
$16,245
$650
$54
200%
$21,660
$1,365
$114
250%
$27,075
$2,180
$182
300%
$32,490
$3,087
$257
350%
$37,905
$3,601
$300
400%
$43,320
$4,115
$343

 

Source: familiesusa.org

These approximate costs are based on buying a "silver plan" on the Health Insurance Marketplace. However it is important to note that even within the categories there are variations in premium charges based on many variables.

Getting an Estimate of Cost Savings

While you won’t know exactly what your costs and savings will be until you fill out your actual application in the health insurance marketplace, you can get an estimate through the Kaiser Family Foundation health insurance cost and savings calculator. There are a few important points to keep in mind:

  • Prices will be based on the Silver level plan. Silver plans provide a mid-range of cost-sharing compared to other tiers, so your actual premiums and cost-sharing may vary.
  • The calculator only provides a rough estimate of costs for insurance. It shows what someone in your situation could pay for marketplace insurance for 2014.
  • Individual plans may weigh the rating factors of location, family size and ages, and tobacco use differently than the calculator does.
  • The prices from the calculator are not guaranteed by the government or any insurance plan. They are intended as a general estimate only. The government did not participate in the creation of the calculator, which is provided by the Kaiser Family Foundation for use by the general public.

Another way to get an idea of whether you and your family will qualify for cost and premium savings is to view the Healthcare.gov Quick Check Chart. Based on the number of people in your household and the income the family makes, this chart will help you understand if you are likely to qualify for premium health coverage tax credits, cost sharing reduction tax credits, or Medicaid. If you don’t qualify for any of these options, there is a link that will help you find low-cost or no-cost health care at community centers in your area.

The ACA health care tax credits are designed to help lower-income Americans purchase and maintain affordable health insurance. Depending on your income, you can qualify for premium tax credits and/or cost sharing reduction credits. Knowing the full range of options available and choosing the best one for you and your family is the first step to a happier, healthier life.

 

Sources:

https://www.healthcare.gov/what-income-and-household-information-do-i-provide-when-i-apply-for-marketplace-coverage/

https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/

https://www.healthcare.gov/how-can-i-get-an-estimate-of-costs-and-savings-on-marketplace-health-insurance/

https://www.healthcare.gov/how-can-i-save-money-on-marketplace-coverage/

https://www.healthcare.gov/where-can-i-get-free-or-low-cost-care/

https://www.healthcare.gov/will-i-qualify-to-save-on-out-of-pocket-costs/

https://www.healthcare.gov/how-do-i-apply-for-marketplace-coverage/