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Affordable Care Act Q&A

     

The AARP Daily News Alert will feature answers to a health care law “question of the day” throughout the month of December. Be sure to tune in throughout the month for more answers to frequently asked questions about the health care law.

Does AARP have an online resource where I can go to learn more about the health care law?
Yes. Learn how the health care law works for you and your family through the AARP online tool HealthLawAnswers.org

What are the 10 essential health benefits?
The law sets certain standards that all insurers must meet, and requires that all health plans offered to those who buy health insurance on their own or in small groups include a set of "essential health benefits."

Where can I get in-person assistance to walk me through the Health Insurance Marketplace application process?
The marketplace will offer different ways to help you apply of coverage and choose a plan.  Assistance will be available online, by phone or in person.  To find help in your state, visit HealthLawAnswers.org

 

What will my discounts be if I fall into the Medicare Part D prescription drug doughnut hole in 2014?
If you fall into the doughnut hole in 2014 you will get a 52.5% discount on your brand-name prescription drugs and a 28% discount on your generic prescription drugs while you are in the doughnut hole.  Learn more.

 

I have a pre-existing condition, can I be denied coverage?
The health care law makes sure health plans can’t deny you coverage due to health problems you had before your insurance started. Learn More.

 

Will small businesses be required to shop through the marketplace or can they shop outside of the marketplace?
Small business can buy insurance through the marketplace, through a broker registered with the SHOP, or from an insurance company. Tax credits will only be available to employers who purchase insurance through the small business marketplace.  Learn more.

 

I have health coverage through my job.  Can I get financial help with the cost of my coverage?
Most people who have health coverage through their employer are not eligible for the premium tax credits in the Health Insurance Marketplace.  In certain circumstances you may be able to get a premium tax credit if your employer is neither “affordable” nor “adequate,” as defined by the law, and you meet specific income levels. To see if you qualify find the marketplace in your state by visiting HealthLawAnswers.org

How do I find local help about enrolling in the Health Insurance Marketplace?
In all states, there will be people trained and certified to help you understand your health coverage options and enroll in a plan. They will be known by different names depending on who provides the service and where they are located. All will provide similar kinds of help and include:

  1. Navigators
  2. Application assisters
  3. Certified application counselors
  4. Government agencies such as state Medicaid and Children’s Health Insurance Program (CHIP) offices
  5. Insurance agents and brokers


To find help in your area, visit HealthLawAnswers.org.

 

I have Medicare.  Will I have to pay a penalty for not having health insurance?
No.  Your Medicare coverage meets the health care law requirement to have health coverage.  To learn more about Medicare and the health care law visit HealthLawFacts.org

 

I’m self-employed and want to buy coverage. Where should I go to buy my plan?

You can shop for health insurance on your own, through a broker or through the Health Insurance Marketplace.  To find the marketplace in your state visit HealthLawAnswers.org

 

How long after I enroll in a plan in the Marketplace will coverage take effect?
If you enroll any time between October 1, 2013 and December 23, 2013 and make your first premium payment, your new health coverage can start as early as January 1, 2014.  After that if you enroll between the 1st and 15th day of the month and pay your premium by the due date your coverage begins the first day of the next month. But if you enroll between the 16th and the last day of the month your effective day of coverage will be the first day of the second following month (e.g.:  you enroll February 16, 2014 your coverage starts on April 1, 2014.)

 

Is there a toll-free number I can call to get assistance and find the Health Insurance Marketplace in my state?
Yes.  You can call the Health Insurance Marketplace toll free number at 800-318-2596 to get your questions answered and to get information about the marketplace in your state.

 

I’m not a U.S. Citizen.  Can I buy health coverage through the Health Insurance Marketplace?
Only noncitizens living in the U.S. legally can buy coverage through a Health Insurance Marketplace.  Undocumented immigrants are not able buy coverage in a Health Insurance Marketplace.  To learn more about the law, visit HealthLawFacts.org.

 

I received a notice saying I lost my coverage.  What can I do?
The Health Insurance Marketplace allows you to look at a number of different coverage options and different price points so that you can choose the best health coverage for you and your family.  To find the marketplace in your state visit HealthLawAnswers.org

 

Will I be able to buy my Medicare prescription drug plan through the Marketplace?
No. The Health Insurance Marketplace is not for people who have Medicare. You will continue to shop for your Medicare and prescription drug coverage as you always have.  To learn more about your Medicare benefits visit HealthLawFacts.org

 

What preventive care services are covered under the health care law?
The health care law requires all plans to cover important preventive care services for the whole family. Learn more.

 

Can I get financial help with the costs of my health coverage if I buy it through the Health Insurance Marketplace?
Depending on your income, you may be able to get financial help to pay for your premiums and copayments if you purchase your insurance through the Health Insurance Marketplace. For more information or to find the marketplace in your state, visit HealthLawAnswers.org.

 

Will I have to pay a penalty if I don’t have health coverage?
If you don’t have health coverage that meets the minimum requirements, you may have to pay a penalty. Learn More.

Why is December 23, 2013 a critical date when it comes to the Health Insurance Marketplace?
Coverage through the Marketplace starts as early as January 1, 2014.  In order to have health coverage by January 1, 2014 you must sign up by December 23, 2013.  Find the Marketplace in your state.

Do I need to buy my coverage through the Health Insurance Marketplace or can I go through an insurance broker?
You can shop for health insurance on your own, through a broker or through the Health Insurance Marketplace. But financial help is only available with plans bought through the Health Insurance Marketplace.  Find your Health Insurance Marketplace.

 

Can I get coverage after the Marketplace Open Enrollment period ends?
Generally, there is only one Marketplace enrollment period.  In certain circumstances you may qualify for a “special enrollment period,” which will allow you to enroll in a plan at a time that is not the official open enrollment period.  For example a relocation out of the area or state, or a loss of another type of health coverage.

When will insurance plans be required to cover adults with pre-existing conditions?
In 2014, all insurance plans will be required to provide coverage to adults with pre-existing conditions. Learn More.

Can I add my grandchild to my health insurance plan?
If you are their legal guardian, you might be able to add them to your family policy. Check with your employer or your insurance company for details about adding your grandchildren to your policy.

 

I heard that my Part D premiums will increase because of my income. Is that true?
The income levels for higher premiums start at $85,000 for a single person or $170,000 for married couples filing joint tax returns. If your income level is higher than those threshold numbers, your Part D prescription drug premiums are scheduled to increase.

 

How long can my child remain on my family health plan?
You may be able to keep your children on your family health plan until they turn age 26, even if they don’t live at home, are married or attend school. It is important to remember that employers are not required to offer family plans. Check with your employer for the details about adding your adult child to your family plan.

Does AARP have a resource on where I can go to learn more about the Health Care Law?
Yes. Learn how the health care law works for you and your family through the AARP online tool HealthLawAnswers.org »

 

I have Medicare. Do I also have to buy extra coverage when the Health Insurance Marketplace opens?
There are no changes in what you need to do to sign up for Medicare. If you have Medicare, you do not need to purchase additional health insurance through the Health Insurance Marketplace.

 

Where can I go to get health coverage if I’m retired, uninsured and not eligible for Medicare?
If you retire before you’re 65 and don’t have health coverage, you may use the Health Insurance Marketplace to buy a plan. Depending on your income you may be eligible for financial help. When you apply for coverage in the marketplace, you’ll also find out if you’re eligible for Medicaid. Visit HealthLawAnswers.org for more information.

 

How do I find local help about enrolling in the Health Insurance Marketplace?
In all states, there will be people trained and certified to help you understand your health coverage options and enroll in a plan. They will be known by different names depending on who provides the service and where they are located. All will provide similar kinds of help and include:

  1. Navigators
  2. Application assisters
  3. Certified application counselors
  4. Government agencies such as state Medicaid and Children’s Health Insurance Program (CHIP) offices
  5. Insurance agents and brokers


To find help in your area, visit HealthLawAnswers.org.

 

Can I get dental coverage in the Health Insurance Marketplace?
In the Health Insurance Marketplace, dental coverage will be included in some health plans. You’ll be able to see which plans include dental coverage when you compare them. Under the health care law, dental insurance is treated differently for adults and children 18 and under. Dental coverage is an essential health benefit for children, but not for adults so insurers don’t have to offer it.

 

Will there be categories of health plans available in the Health Insurance Marketplace?
Yes. Plans are offered in four tiers so it’s easier for you to make “apples-to-apples” comparisons among plans. The tiers – bronze, silver, gold and platinum – are based on how generous the plan is for the benefits and services covered.

Will I be able to buy my Medigap supplemental insurance in the Health Insurance Marketplace? No. The Health Insurance Marketplace is not for people who have Medicare. Medicare plans are not sold through the Health Insurance Marketplace. So, you will continue to shop for Medigap supplemental coverage as you always have. Learn more »

 

Will I have to pay federal income tax on my Medicare benefits because of the health care law? No. There is nothing in the health care law that requires you to pay federal income tax on your Medicare benefits. Learn more about how the law works with Medicare at HealthLawAnswers.org »

Is there a toll-free phone number I can call to get assistance and find the Health Insurance Marketplace in my state?
Yes. You can call the Health Insurance Marketplace toll free number at 800-318-2596 to get your questions answered and to get information about the marketplace in your state.

 

Does my health plan have to cover certain benefits?
Starting in 2014, all new plans sold to individuals and small employers must cover a core set of important health care services known as essential health benefits.

 

How is the Medicare Part D doughnut hole going to close? You will get discounts on brand-name and generic prescription drugs while you are in the doughnut hole. These discounts will continue to increase until 2020, when the doughnut hole will disappear. Learn more »

 

Does the health care law expand the preventive benefits under Medicare?

Yes. Medicare now covers more preventive care, such as a yearly wellness visit and screenings for diabetes and certain cancers.

Who are health care navigators and what is their role?

Navigators have a vital role in helping consumers prepare their application to establish eligibility and enroll in coverage through the Health Insurance Marketplace. They also provide outreach and education to raise awareness about the marketplace and refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Navigators are funded through state and federal grant programs and must complete comprehensive training.

Will I have to go through the Health Insurance Marketplace if I want to get Medicare or if I want to make changes to my Medicare plan?
If you are new to Medicare or if you have Medicare and want to make changes, you do not go through the Health Insurance Marketplace. As before, you will continue to have an annual Medicare open enrollment period from Oct. 15 to Dec. 7. Learn More »

What premiums will be charged in the Health Insurance Marketplace?

Insurers will offer plans with a set of core benefits at a range of prices. The law makes clear that insurers won’t be able to charge more based on your gender or your health status and there will be limits to how much premiums can vary based on your age. Learn more »

When can I shop for insurance in the Health Insurance Marketplace?
The open enrollment period for 2014 began Oct. 1, 2013, and will run through March 31, 2014. Coverage bought in the Health Insurance Marketplace won’t begin before Jan. 1, 2014, and could be later, depending on when you sign up. To find the Health Insurance Marketplace in your state, visit HealthLawAnswers.org.

How do I get help enrolling in the Health Insurance Marketplace?
The marketplace will offer different ways to help you apply for coverage and choose a plan. Assistance will be available online, by phone and in person. To find help in your state, visit HealthLawAnswers.org.

Does everyone have to buy their health coverage in the Health Insurance Marketplace?
No. If you have insurance through Medicare or Medicaid, a military program or, in most cases, employer coverage, that coverage is separate from the marketplace. Learn More »

What is the Health Insurance Marketplace?
The Health Insurance Marketplace is a new way to shop for health coverage that allows you to compare plans and costs on an “apples-to-apples” basis. Through the marketplace, you can shop online and get help by phone or in person. Open enrollment begins Oct. 1, 2013, and will run through March 31, 2014. To find the Health Insurance Marketplace in your state, visit HealthLawAnswers.org.

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