Answering your questions today are health care reporters Carrie Teegardin and Misty Williams. We’re also consulting with Georgia State University’s Bill Custer – he’s one of the state’s top experts on the health law and one of our go-to sources.
There’s no question that the law is complicated and far-reaching. Our team of health care reporters has devoted countless hours to understanding how the law is designed to work. Check our page for more ACA coverage and follow this week’s six-part series on how the law will be affecting Georgians.
For our first question, let's take this one from Craig.
If I retire at 64 and have income from investments and Social Security of $70,000
can I get an Obama Care subsidy ?
Thanks for your question, Craig. One of the key questions we are getting from readers relates to whether or not they can qualify for help paying for their coverage.
Unless you are covering yourself and some dependents, Craig, then will not be able to qualify for a tax credit on the exchange.
Generally, people whose incomes fall between 100 and 400 percent of the federal poverty line may qualify for some assistance. Here are those income ranges for 2013, which should give you and other consumers a sense of whether they may qualify for assistance on the Health Insurance Marketplace.
• $11,490 to $45,960 for individuals
• $15,510 to $62,040 for a family of 2
• $19,530 to $78,120 for a family of 3
• $23,550 to $94,200 for a family of 4
• $27,570 to $110,280 for a family of 5
• $31,590 to $126,360 for a family of 6
• $35,610 to $142,440 for a family of 7
• $39,630 to $158,520 for a family of 8
From Andrea
What if you have been unemployed for 3 years and you presently have insurance through PCIP state plan which ends Dec 31. Can you get onto the ACA with absolutely no income? Cannot get Medicaid because of home ownership and other assets.
Hi Andrea,
Thanks for your question. Yes, you will be able to shop on the new Health Insurance Marketplace starting on Oct. 1. However, you will probably not be eligible for a federal tax credit. You can already learn some basic information about the exchange by going to HealthCare.gov.
Generally, people with incomes between 100 percent and 400 percent of the federal poverty level will be eligible for a tax credit. Below you’ll find the corresponding income ranges.
• $11,490 to $45,960 for individuals
• $15,510 to $62,040 for a family of 2
• $19,530 to $78,120 for a family of 3
• $23,550 to $94,200 for a family of 4
• $27,570 to $110,280 for a family of 5
• $31,590 to $126,360 for a family of 6
• $35,610 to $142,440 for a family of 7
• $39,630 to $158,520 for a family of 8
Here is a question from Carl: "Hi, I was wondering how a person or couple's income for Obamacare is determined. I understand a person is eligible for certain subsidies if his income is below a certain level. Is this gross income or adjusted gross income? Is it W2 income only or all income including social security and investments? Does tax-free income such as with municipal bonds count? Is the income based on previous tax returns or current estimates which have to be compiled by the consumer? I have never seen the answers to these questions in any article I have read."
Carl: Here is the answer to your question and it's a good one. Lots of consumers have asked us about this.
The exchange will use “modified adjusted gross income.” That’s your household’s gross income, plus any tax-exempt Social Security, interest, and foreign income you have.
Here are the types of income that will be included:
• Wages
• Salaries
• Tips
• Net income from any self-employment or business
• Unemployment compensation
• Social Security payments
• Rental income
• Interest, dividends, capital gains and annuities
• alimony, and some retirement and pensions.
You will have to estimate what you think your income will be in 2014 from various sources and The Health Insurance Marketplace will use that information to figure out if you qualify for any tax credits or other assistance. We’re told the system will do all the math for you. What you got in advance tax credits will be reconciled with your income when you do your 2014 tax return.
Our reader, Jim, sent us this question. "I am 71 yrs old on humana medicare. will it affect me?"
Jim, we have received a lot of questions about what the law will mean for people on Medicare.
The short answer: Not much!
The Health Insurance Marketplace that opens next week has nothing to do with Medicare. Consumers will continue to get through Medicare’s traditional fee-for-service program and Medicare Advantage plans.
You will continue to shop for Medicare just as you always have and you will not have to go on the exchange to get a Medicare plan.
The Affordable Care Act did give Medicare beneficiaries some new benefits: more preventative care services. Also, the law will close the gap in prescription drug coverage- - a gap usually referred to as the ‘doughnut hole” by 2020.
While Medicare spending will continue to increase as more baby boomers join the program every year, the law does try to constrain future spending. Some of these plans are aimed at saving money by improving care. For example, there is a big push now for hospitals to cut back on the number of patients who are quickly readmitted to the hospital after treatment.
From Andrea:
What if you are unemployed and would really be entitled to the Medicaid expansion, but can't get it thanks to Gov. Deal, will you be totally not benefit from the ACA?
Hi Andrea,
It depends on your income. If you make between 100 and 400 percent of the federal poverty level, then you should be eligible for a federal tax credit through the Health Insurance Marketplace, or exchange. Unfortunately, most people in Georgia who make under 100 percent of poverty, or under $11,490 for a single person, won’t be eligible for a tax credit. However, you will still be able to shop on the exchange.
Moderator's note: Going forward, we're going to answer your questions as responses to your original post, rather than create a new post. So if your question is further down on this list, look for your answer there.
Another moderator note: We're just answering questions today about how the new law works. We won't be addressing the politics of the law in this discussion, but refer you to those discussions on our opinion and politics blogs.
From Jeanne to our ajchealthcare@ajc.com email account: My employer only offers a one health insurance plan option, a high deductible plan with a deductible of $2000. There is no coverage for prescriptions drugs or office visits until the deductible is met. Would I qualify for the exchange? The plan does cover preventative care such as annual physicals, mammograms, etc. We also receive $500 from our employer that is deposited into an HSA account and the employee portion of the premium is very low.
From what you have told us, it's likely that your plan meets the minimum requirements for a plan. Whether or not you could get a tax credit on the exchange depends on your income. If your share of the cost of your employer-sponsored insurance totals more than 9.5 percent of your modified adjusted gross income, then the plan is not considered “affordable” under the law, and you may shop on the exchange. Unfortunately, the 9.5 percent threshold applies to your share of the premiums.
Ben Lopez asks: I don't exactly understand the silver plans $6,350 annual out of pocket expense. Say I visit my doctors office, how much will I have to pay?
