By Warren Vieth
WETUMKA, Okla. —
Where do I go for information?
The federal government’s marketplace website is www.healthcare.gov. The toll-free help line is 1-800-318-2596. Spanish-language information is available at www.cuidadodesalud.gov. Information in Vietnamese, Korean, French, Chinese and other languages is available at 1-800-318-2596. The Kaiser Family Foundation has a tax credit estimator at kff.org/interactive/subsidy-calculator.
Is the online marketplace part of Obamacare?
Yes. The health insurance marketplace, or exchange, is one component of the Affordable Care Act passed by Congress and signed into law in 2010.
Is this government insurance?
No. The policies offered on the marketplace will be issued by private insurance companies. The federal government is creating the marketplace and providing tax credit subsidies and cost-sharing payments to individuals.
Who can participate?
Anyone can use www.healthcare.gov. to compare plans, determine their tax credit eligibility and apply for coverage. But if you qualify for Medicaid and Medicare or can get affordable and adequate health coverage from your employer, you will not be eligible for tax credits or cost-sharing.
When does it start?
Pre-registration has already begun at www.healthcare.gov. Open enrollment begins Oct. 1 and ends March 31. You must choose a plan and make a first payment by Dec. 15 for coverage to start on Jan. 1. You can enroll later if you lose insurance because of a job change or other qualifying life event.
Which insurance companies are offering plans?
The official list of companies, policies and premium rates won’t be announced until mid-September. Officials have confirmed that four companies have applied to provide coverage in Oklahoma: Coventry Health Care Inc., BlueCross Blue Shield of Oklahoma, GlobalHealth Inc. and CommunityCare.
What kinds of plans are being offered?
The insurance companies must offer two plan levels: silver and gold, designed to cover 70 percent and 80 percent of average health care costs, respectively. They also may offer bronze and platinum plans providing 60 percent and 90 percent coverage.
Will the government pay the premiums, or will I?
You will pay the monthly premiums to the insurance company. If you qualify for a federal tax credit, the government will pay that amount directly to the insurance company, and your payment will be lower. Or you can pay the full premium amount and claim the credit on your federal tax return.
Who gets the tax credits?
Eligibility is based on income and family size. Credits will be provided to single people with income between $11,490 and $45,960 a year, two people with income between $15,510 and $62,040, three people with income between $19,530 and $78,120, and four people with income between $23,440 and $94,200. Starting Oct. 1, you can determine where you stand on www.healthcare.gov.
What if my income is less than that?
You can still shop for policies on the exchange. But if your income falls below the federal poverty level, you are not eligible for tax credits or cost-sharing. The poverty level is $11,490 for a single person, $15,510 for two people, plus $4,020 for each additional person. Because the state of Oklahoma rejected an Obama administration proposal to expand Medicaid, you won’t receive any government help unless you already qualify for SoonerCare.
How much will the policies cost?
Oklahoma premium rates won’t be posted until September. Hypothetical examples provided by the Center for Budget and Policy Priorities include a 24-year-old single worker whose policy costs $5,000 a year and a four-person family whose plan costs $15,000. Those figures reflect the full cost of the policies before tax credits.
How big are the tax credits?
It depends on income level and the number of people on the plan. In the previous examples, the single worker earned $22,980 a year and would get $3,552 in tax credits. That means his discounted cost was $1,448, or about $120 a month. The four-person family had income of $52,988 and would get $11,198 in credits. That means its discounted cost was $3,802, or about $320 a month.
What if I have pre-existing conditions?
Policies offered on the online marketplace can’t exclude people with pre-existing conditions. Common pre-existing conditions in Oklahoma include diabetes, obesity, high cholesterol and tobacco use.
Will I pay more for insurance if I smoke?
Yes. Insurance companies can post different premium rates based on four criteria: age, family size, geographic region and tobacco use.
What if I make too much money to qualify for tax credits?
You can still purchase a policy on the marketplace, which might make sense if you don’t qualify for employer coverage and have been rejected for private insurance because of pre-existing conditions.
What if I’m on Medicaid?
You’ll stay there.
My kids are covered by SoonerCare, but I’m not. Will they lose their coverage?
No. But you can purchase a policy for yourself on the marketplace.
I’m retired and enrolled in Medicare. Will I be affected?
No. The Affordable Care Act has no direct effect on Medicare beneficiaries.
I’m retired from the military and receive TriCare. Will I be affected?
No. The Affordable Care Act has no direct effect on TriCare beneficiaries or veterans benefits.
What if I’m covered by Insure Oklahoma?
Because the state of Oklahoma declined to change Insure Oklahoma to comply with new federal requirements, the program is scheduled to end on Dec. 31. You can shop for a new policy on the marketplace.
Can the government force me to buy health insurance?
No. But you will be subject to a fine, starting at $95 next year and rising to $695 in 2016. Some people will be exempt from the fine, including Native Americans and people whose policies would cost more than 8 percent of their annual income.
What if I get my health insurance from my employer?
You won’t be affected.
What if I already have a private insurance plan?
You can keep it. But it might make sense to compare your plan’s cost and coverage to the policies offered on the marketplace. You can do this starting Oct. 1.
I operate a small business. Does the marketplace affect my firm?
Employers with fewer than 50 full-time workers are not required to provide health coverage. But the health insurance marketplace includes a Small Business Health Options Program with plans designed for people like you. The SHOP program might provide a tax credit for your business.
Why isn’t state government involved?
Oklahoma is one of 27 states that declined to participate in setting up health insurance marketplaces. In 2010, Oklahoma voters approved a constitutional amendment banning mandatory participation in health insurance plans.