Frequently asked questions on the Affordable Care Act

Have more questions or need help applying for a plan under the health exchange? Here are some places that can help (CLICK)

To apply for healthcare go to: https://www.healthcare.gov/

What does Marketplace health insurance cover?: https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/

Marketplace open enrollment ends March 31, 2014. If you enroll by December 15, 2013, coverage can begin as soon as January 1, 2014.

Subsidy Calculator produced by Kaiser Family Foundation to help shoppers find out if they're eligible for subsidized insurance coverage or Medicaid: http://kff.org/interactive/subsidy-calculator/

(WEAU) – As millions get onto the health exchange and apply for healthcare under the Affordable Care Act, questions still remain.

That’s why we turned to insurance expert and agent Karen Hebert for some answers.

Q: What about people that can’t afford the Affordable Care Act insurance policies, but do not qualify for Badger Care or Medicare? What can I do?

A: “There's always the option to go uninsured and of course the point of the Affordable Care Act is to have that happen less and less,” said Hebert. But if a person goes uninsured, they will have to pay a penalty. “They can get emergency care which is the worst way to receive healthcare. So I’m guessing it’s very possible that question came from an idea of whether or not it was affordable because the subsidies are very very generous.” Those subsidies are based on a percentage of your income as well so the cost of insurance really depends on your circumstance.

Q: With the mandate of being required to purchase insurance knowing that most individuals will only be able to afford the Bronze plan that only covers 60% of their medical bills how will this lessen the amount of overall medical debt?

A: “There are many people who doubt whether the Affordable Care Act will change the number of uninsured in the United States. It will certainly have a change but the amount of impact is questionable. But the premise of the question assumes that it will still be quite unaffordable and I again encourage people to look very carefully at the subsidies afforded to them and I also question whether or not folks will only be able to afford the bronze plan,” said Hebert.

Hebert said people may be confused on what percentage of healthcare each plan will cover.

“The bronze, silver, gold, platinum plans are pegged at percentages. 60, 70, 80, 90 -- the idea here is that they cover 60 percent of a basket of services, not 60 percent of every bill,” said Hebert.

She said tt may be easy for people to assume if they get the bronze plan, they’ll have to pay for 40 percent of the bill and insurance will cover 60. That’s not the case however. For instance, if you are getting preventative care or a regular office checkup, that could very-well be covered up to 100 percent. But another “basket” of care like cancer treatment could be covered up to only a certain percentage.

Q: I have excellent health care at my work. Do I have to pay a penalty to keep my coverage and how much?

A: “The only penalty that would ever be placed on an individual is if they have no coverage. So anybody who has coverage through work can certainly keep it. The Affordable Care Act goes one step further and invites somebody who has coverage at work which is unaffordable or of insufficient quality to come to the exchange and that person could get subsidized. But for the vast majority of Americans with coverage through work it will not make sense to buy an individual plan through the exchange. It will almost always be a better offer to use the employer's plan,” said Hebert.

Q: Will the plans fill up?

A: “The question is whether or not there’s a quota or a maximum that can enroll -- no there isn't. Once an insurer puts a plan on the exchange, they take all comers,” said Hebert.

Q: Will there be prescription benefits available?

A: “Every plan on the exchange has to cover the same basket of services the essential benefits and prescription drugs is one of them so you will not be able to buy a plan on the exchange or an individual plan off the exchange without prescription drug benefits,” said Hebert.

Q: How much is the penalty for having no insurance?

A: “The first year its 95 dollars or 1 percent of (household) income and then it goes up exponentially from there as the percentage of income or dollar amount, whichever is greater,” said Hebert.

Q: What is the biggest problem right now people are seeing with applying for healthcare on the exchange?

A: “The biggest problem right now is that the information systems that are supposed to be allowing people to enroll and shop and allowing in our state the federal exchange to check eligibility and income -- they're not working. So a lot of people feel frustrated and they're certainly delayed in enrolling. But i would say eventually they’ll work it out and again we have until December 15th (for January 1st coverage),” said Hebert. “It’s a big big undertaking so there’s still time. The very good news now for all January 1st enrollments either on or off the exchange is there’s no underwriting. So the moment someone’s ready to choose a plan, they can buy that plan.”

Hebert said it’s good to pick a professional agent who knows the Affordable Care Act well to walk you through the process of applying for insurance on or off the health exchange.


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