Ask Emily: How health insurance exchanges will work
04/23/2013 2:38 PM
04/23/2013 3:01 PM
Three years after Congress passed the Affordable Care Act, the landmark law now known as Obamacare is finally nearing full implementation. This week, veteran health care writer Emily Bazar presents the second of her question-and-answer columns to help answer questions. "Ask Emily" runs twice a month.
Q: I work at a family-owned restaurant and my boss has cut back my insurance coverage. I have to pay a lot more out of pocket on top of my monthly premium. Can I find a better deal on insurance under health reform?
A: How’s this for a definitive answer: Possibly. You may be able to find a more affordable option later this year at a new state-run marketplace for health insurance called Covered California.
This marketplace, known as a “health insurance exchange” is a critical piece of President Obama’s health care overhaul.
It will offer a variety of health plans that cover at least a minimum set of benefits. And depending on how much money you make, you may qualify for sliding-scale tax credits to offset the cost of premiums.
But, and this is a big but, you’d only be eligible for a tax credit if you can show that your employer’s plan is “unaffordable.” The law defines unaffordable in two ways:
1. If your share of the insurance premium is more than 9.5 percent of your annual household income or
2. If your employer’s insurance plan covers, on average, less than 60 percent of your medical expenses, leaving you with expenses of 40 percent or more.
Sound like a lot of hoops? You may not have to jump through them after all.
Your boss may be able to offer more affordable coverage – and perhaps even more plan choices – to you and your coworkers.
Small businesses with 50 or fewer full-time workers in 2014 (and 100 or fewer in 2016 and beyond) will be able to shop the exchange for employee coverage.
Your boss may not find a better deal, but to finish off the way we started, it’s possible.
Q: I haven’t been eligible for Medi-Cal because I own two cars (one doesn’t even run). But I make hardly any money. Does Obamacare change my eligibility?
A: For those who aren’t sure, Medi-Cal is the state’s publicly funded health program for low-income and disabled residents. (It is California’s version of the federal Medicaid program.)
In California, Medi-Cal will broaden its enrollment requirements as a result of Obamacare. As a result, one million or more low-income Californians will become newly eligible for coverage.
Currently, a single applicant can’t have more than $2,000 in property or assets to qualify for the program. (Your home doesn’t count and one car may be exempt, along with other items.)
You’ll be happy to learn that starting Jan. 1, asset and property limits will go away for most new applicants. There are some exceptions, especially if you’re 65 or older or have a disability.
This change is expected to simplify the eligibility and application process, and it may mean that you can enroll.
There are other changes that also could affect your eligibility, including an increase in the limit you can earn to qualify and the acceptance of childless adults into the program for the first time.
Have a question for Emily: Send it to her at AskEmily@usc.edu.
The CHCF Center for Health Reporting partners with news organizations to cover California health policy. It is funded by the nonpartisan California HealthCare Foundation.
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