Mark Bellman, president of the Texas Association of Health Underwriters, expressed concern that many consumers will be making major decisions that will affect their future and financial viability without the insight needed to make informed choices. “Health insurance is a complex and sometimes overwhelming topic. Many will face coverage options for the first time without fully understanding and weighing the impact of their decisions. If someone is not sure about the best choice for themselves, their families or businesses, they should seek the advice of a professional.”
An August 2013 Kaiser Family Foundation study reported that 51 percent of consumers say they do not have enough information about the ACA to understand how it will impact them and their families, a percentage that has remained consistent since 2010. The proportion of people who feel they do not have enough information remains particularly high among Hispanics, the uninsured, young adults and those with lower incomes.
The Kaiser Foundation poll also found that a large percentage of the population remains confused about the law’s status, with 44 percent either thinking the law has been repealed (8 percent), overturned by the Supreme Court (5 percent), or unsure whether it remains the law or not (31 percent).
Highlighting the basic questions about the new law, the Texas Association of Health Underwriters has compiled five of the top questions being asked by consumers and employers.
“We hope this list will provide a starting point for a conversation about the best type of coverage for families and employers,” said Bellman.
Am I affected by the individual mandate for health insurance coverage? Almost everyone is affected by the individual mandate for health insurance coverage, particularly if someone does not currently have health insurance coverage. If consumers can afford health insurance and do not have coverage in 2014, they may have to pay a penalty. They may also have to pay for all of their health care. The Congressional www.tahu.org
Budget Office estimates that in 2016, 24 million people will be exempted from the mandate’s penalties. Individuals are exempt from the coverage mandate if the premium costs exceed 8 percent of their household income, or their household incomes are below the minimum threshold for filing a tax return. Exemption categories also include individuals eligible for Medicaid under the health law’s new rules but whose states chose not to expand their programs, prisoners, Native Americans eligible for care through the Indian Health Care service, immigrants who are in the country illegally, religious objectors to insurance coverage, health care sharing ministry members, and individuals experiencing coverage gaps of less than three consecutive months.
Do I have to buy my insurance from one of the new Health Insurance Exchanges? Health insurance coverage choices will still remain outside the Exchange. However, if consumers want a subsidy or employers want a tax credit, then they will need to purchase coverage within the Exchange. Both will need to weigh the pros and cons of whether purchasing through an Exchange is best for them.
How do I know if I qualify for a subsidy? Federal subsidies will be available on a sliding-scale basis for individuals and families purchasing their coverage through an Exchange and whose income falls between 100 and 400 percent of the federal poverty level. For a family of four this range is $23,500-94,200. In general, employees who are offered insurance through work are not eligible for subsidized exchange coverage unless the coverage fails to meet certain federal criteria. Individuals offered coverage from their employer will be eligible for a subsidy if the cost of that coverage exceeds 9.5 percent of their household income or does not have an actuarial value of 60 percent.
Are college students required to have health insurance? College students who have insurance through their college or university will meet the law’s coverage requirement. If a student cannot afford the insurance offered by the school, and they do not earn enough to trigger the income requirement of the legislation, then they will not be required to carry health insurance. If a student wants health insurance and he or she is under 26, then the legislation allows parents to include their children on their health plans.
I’m a small business owner and am unclear what part of the Affordable Care Act will affect me and when. Small businesses with fewer than 50 employees are not required to provide health insurance coverage for employees.
“There are a lot of moving parts to the new law, and those purchasing coverage will be well-served to ensure they have the full picture of their options and the consequences of their decisions. Their choices could determine their ability to afford the care needed to remain healthy, manage an unexpected injury or deal with a life-altering illness,” added Bellman.
“They don’t have to make these decisions in the dark. There’s help nearby.”
Consumers interested in locating a professional benefit adviser in their community who can assist with questions about the Affordable Care Act may go to ACA Questions.
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Texas Association of Health Underwriters (TAHU) is a state trade association representing licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers seeking health insurance coverage. TAHU is a state chapter of the National Association of Health Underwriters.