Click on any of the frequently asked questions about the Affordable Care Act below to see an answer from HealthKY.com.
Yes. If your income is between 100% and 250% of the federal poverty level, you can also qualify for cost sharing reductions. These will reduce the deductibles, copays, and other cost sharing that would otherwise apply to covered services. The … Continue reading
No, you can only get cost sharing reductions by enrolling in a Silver Marketplace plan. You will not receive cost sharing reductions if you enroll in a Bronze, Gold, or Platinum plan. Note that this is different from the rule … Continue reading
That depends on your income and where you live. To give a general idea, a typical Silver plan might have an annual deductible of $2,000 to $3,000 and an annual out of pocket limit on all cost sharing of $6,350. … Continue reading
No. Unlike premium tax credits, which are reconciled each year based on the income you actually earned, cost sharing reductions are not reconciled.
Premium tax credits will be available to U.S. citizens and lawfully present immigrants who purchase coverage in the Marketplace and who have income between 100% and 400% of the federal poverty level. Premium tax credits are also available to lawfully … Continue reading
No. Premium tax credits are only available for coverage purchased in the Marketplace.
You can apply the premium tax credit to any Bronze, Silver, Gold, or Platinum plan offered through the Marketplace. Premium tax credits cannot be applied to Catastrophic plans or to stand-alone dental plans. If you are also eligible for cost … Continue reading
Premium tax credits reduce your premium for most Marketplace policies. The amount of the tax credit you may receive depends on your income and the cost of Marketplace health plans in your area. The Marketplace will determine the expected contribution … Continue reading
On the health insurance Marketplace web site, you will find an Application for Health Coverage and Help Paying Costs. Filling out the application online is the fastest, though you can also submit a paper application or call your Marketplace call … Continue reading
In general, if you have any of the following types of coverage, you would be ineligible for premium tax credits through the Marketplace: Employer-sponsored coverage, unless the coverage is unaffordable (your required contribution to premium for self-only coverage costs more … Continue reading
Usually no. If you are offered health benefits at work and your required contribution costs no more than 9.5 percent of your household income, you will not be eligible for premium tax credits through the Marketplace. If you are required … Continue reading
Beginning in 2015, large employers will be required to offer health benefits to full-time workers and to their dependent children, or face a penalty. A large employer is one that employees at least 50 workers. Once the provision takes effect … Continue reading
You can always shop for coverage on the Marketplace, but your family members won’t be eligible for tax credits to help pay the premium. When people are eligible for employer-sponsored coverage, they can only qualify for Marketplace premium tax credits … Continue reading
For certain types of coverage, if you are eligible but not enrolled, then you can still qualify for premium tax credits. These include: Retiree health coverage offered by a former employer COBRA coverage Student health plan coverage Medicare Part A … Continue reading
You can add your children to your Marketplace plan, but because they are eligible for your state’s Children’s Health Insurance Program (CHIP), they are not eligible for premium tax credits. The exception to that is if you live in a … Continue reading
Premium tax credits are available to people who buy Marketplace coverage and whose income is between 100% and 400% of the federal poverty level.
When you get health insurance coverage in the Marketplace, you may be able to get lower costs on monthly premiums. This depends on your income and family size.
There are three options: Your plan is still available but there’s a fine. Your provider is informing you that your health plan is still available through them but it doesn’t meet the “minimum essential benefits” required by law. You will … Continue reading
No, if you are covered even one day during a month, you are considered to be insured for that month. Similarly, a person who is considered exempt from the individual responsibility requirement for even one day during a month is … Continue reading
For some types of exemptions, you must apply through the health insurance Marketplace; for other types, you must apply when you file your taxes; some types of exemptions can be claimed either way. The religious conscience exemption and most hardship … Continue reading
Everyone is required to have health insurance coverage – or more precisely, “minimum essential coverage” – or else pay a tax penalty, unless they qualify for an exemption. This requirement is called the individual responsibility requirement, or sometimes called the individual mandate.
When you file your 2014 tax return (most people will do this by April 15, 2015) you will have to enter information about your coverage (or your exemption) on the return. You should get a notice from your insurance provider … Continue reading
If you do not maintain minimum essential coverage in 2014 and you don’t qualify for an exemption you will need to pay a “shared responsibility payment” to the IRS on your 2014 tax return. If you are like most people, you … Continue reading
If someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee. They also have to pay for all of their health care. The fee is sometimes called the “individual responsibility payment,” “individual … Continue reading
If you already have health insurance, you now have access to expanded preventative services like checkups, cancer screenings, mammograms and contraception at NO additional cost. Young adults can now remain on their parents’ health insurance plan until the age of … Continue reading
You can always shop for coverage on the Marketplace, assuming you meet other eligibility requirements, but if you have access to job-based coverage, you might not qualify for premium tax credits.
If you have coverage from a job (or a family member’s job), you’re considered covered and won’t have to pay the fee that uninsured people must pay.
Small employers can buy coverage for their employees through the SHOP Marketplace at any time during the year.
No, in general, once you sign up for a plan, you are locked into that coverage for 12 months, or until the next Open Enrollment period. A change in health status doesn’t make you eligible for a special enrollment opportunity.
You can enroll in Medicaid or CHIP at any time during the year, not just during Open Enrollment.
In general, you can only enroll in non-group health plan coverage during the Open Enrollment period. This year the Open Enrollment period begins October 1, 2013 and extends through March 31, 2014. After that, the Marketplace Open Enrollment period will … Continue reading
Generally, you should buy coverage in Marketplace in the state where you live.
If you are not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S., you are not eligible to buy a plan on the health insurance marketplace. However, you can shop for health insurance outside of … Continue reading
Most people can shop for coverage in the Marketplace. To be eligible you must live in the state where your Marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., and you must … Continue reading
Plans in the Marketplace are separated into categories — Bronze, Silver, Gold, or Platinum — based on the amount of cost sharing they require. Cost sharing refers to health plan deductibles, co-pays and co-insurance. For most covered services, you will … Continue reading
Insurers can also offer “Catastrophic” plans. Catastrophic plans have the highest cost sharing. In 2014, Catastrophic plans will have an annual deductible of $6,350 ($13,700 in family plans). You will have to pay the entire cost of covered services (other … Continue reading
The Marketplace, also known as the insurance “exchange,” is a new way to find health coverage that fits your budget and meets your needs.
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic. The categories help you choose a plan that’s right for you.
You can potentially save money on monthly premiums when enrolling in a private health plan because ALL plans will cover essential health benefits and pre-existing conditions. You can also reduce health care costs because you may be eligible for a … Continue reading
In the Health Insurance Marketplace, you generally can get dental coverage as part of a health plan or by itself through a separate, stand-alone dental plan.
Yes. You must request any extension before the 90-day deadline runs out. You can request the extension in writing or through the Marketplace call center. In your request you should include your name, a description of the supporting documents requested, … Continue reading
If the Marketplace hasn’t received the requested information within 90 days and you didn’t already ask for an extension, the Marketplace will make a determination based on the information it has.
You can request an appeal of any Marketplace decision, including decisions about Your eligibility to buy coverage in the Marketplace Your eligibility for, or the amount of, premium tax credits or cost sharing reductions Your eligibility for an exemption from … Continue reading
This will depend on the reason for your appeal and the documentation needed to decide your appeal. Contact the Marketplace for more information about your appeal.
You can enroll in Medicaid or CHIP at any time during the year, not just during Open Enrollment.
You qualify for Medicaid based on income and family size. If you’re eligible, you get free or low-cost care and don’t need to buy a Marketplace plan.
Most people with health coverage today have a plan that will count as minimum essential coverage. The following types of health coverage count as minimum essential coverage: Employer-sponsored group health plans Union plans COBRA coverage Retiree health plans Non-group health … Continue reading
All health insurers and employer-sponsored group health plans must provide people with a Summary of Benefits and Coverage, which uses a standard format to outline the benefits, cost-sharing and coverage limits of plans. The Summary of Benefits and Coverage must … Continue reading
No. Some types of coverage do not qualify as minimum essential coverage. These include hospital indemnity policies (that pay a fixed dollar amount per day when you are hospitalized), discount plans, short-term nonrenewable policies, or plans that provide coverage only … Continue reading
Yes, grandfathered plans count as minimum essential coverage.
Grandfathered plans are those that were in existence on March 23, 2010 and have stayed basically the same. If you buy coverage on your own and you first purchased your policy prior to March 23, 2010, it may be a … Continue reading
As the name implies, a short-term health insurance policy offers coverage for a period of less than 12 months (e.g., many offer coverage for just 6 months) and are renewable at the option of the insurance company. Though you may … Continue reading
Assuming you are eligible for premium tax credits, the amount of your credit will be calculated based on how you file your taxes. If for example, you each claim one of your children, you each will be considered as a … Continue reading
Assuming you plan to file your federal income taxes as a married couple, yes you can apply for premium credits as a married couple. It does not matter if you no longer live in the state where your marriage was … Continue reading
Because you are not married, you will be considered two separate households for the purposes of determining eligibility for premium tax credits and Medicaid. Assuming that neither of you are claiming any dependents on your tax returns, you will each … Continue reading
The Affordable Care Act (ACA) and other new federal policies put in place important new protections for LGBT individuals and their families. Health insurance marketplaces, which are new organizations set up in every state to create more organized and competitive … Continue reading
If you’re retired without coverage, you may use the Health Insurance Marketplace to buy health insurance. If you don’t have coverage you may have to pay a fee.
Yes, VA pension benefits, like Social Security benefits, are counted as income in determining eligibility.
Yes, Social Security benefits are counted as income in determining eligibility for premium tax credits in the Marketplace.
Yes, as long as you do so during the Open Enrollment period. People with employer-provided retiree health benefits should know that most early retiree health plans are considered qualified health plans, and thus meet an individual’s requirement for coverage. If … Continue reading
Yes. Most early retiree health plans are considered qualified health plans, and thus meet an individual’s requirement for coverage. However, if you want to obtain coverage through the Marketplace, you may do so, and if your income is at or … Continue reading
Yes, assuming you meet the other requirements, you can apply for health plans and premium tax credits in the Marketplace. Your spouse’s eligibility for early retiree coverage will not affect your ability to seek coverage and financial help in the … Continue reading
No. Your eligibility for premium tax credit subsidies and the amount of your premium tax credit will be based on your family income. The amount your husband pays for his Medicare, Part D, and supplemental insurance premium costs will not … Continue reading
Yes, your plan must cover the full range of FDA-approved contraceptive methods, but can impose some restrictions on the contraceptives offered at no cost to you. For example, the plan may require that you choose a provider within the network, … Continue reading
If your plan is “grandfathered” then it is not required to pay for contraceptives without cost-sharing. If you are in a non-grandfathered plan, however, your contraceptive costs should be covered. Your plan must cover at least one type of IUD, … Continue reading
Yes, all non-grandfathered plans (plans that started or made changes after March 23, 2010) must provide contraception with no cost sharing. If there is a generic alternative to your birth control pills, you can be charged a co-payment for the brand … Continue reading
Yes, your insurance company is required to cover contraceptives without co-payments. Your employer may have applied for an accommodation which allows your employer not to pay for contraceptives. Your insurance plan will still cover contraceptives at no cost to you, … Continue reading
If your college has a self-funded health plan, then it is not subject to requirements under the Affordable Care Act, including covering contraceptives with no cost sharing. Ask your college if the plan is self-funded. If it is self-funded, it … Continue reading
You should check if your Family Planning Clinic is listed in the network for your new insurance plan. If the Family Planning Clinic is listed in the network you will be able to continue to go there for your birth … Continue reading
Contraceptives, including sterilization, are covered only for women as preventive services. Since sterilization for men is not considered a preventive service under the Affordable Care Act, plans are not required to cover and can charge a co-payment for vasectomies.
It depends on where you live and the specific plan you choose. Some states allow plans in the Marketplace to cover all abortions and some states prohibit or limit plans’ coverage of abortion to certain cases. In about half the … Continue reading
In general, Medicaid coverage for abortion is very limited. In most states, Medicaid covers abortions only when the pregnancy is the result of rape or incest or if the woman’s life is endangered because federal law limits the use of … Continue reading
If you are enrolled in a non-grandfathered plan, then you must be allowed to see your OBGYN without a referral. Women in grandfathered plans and Medicaid may be able to schedule a visit with an OBGYN without a referral. Check … Continue reading
Although most employer plans were already required to cover maternity care prior to enactment of the ACA, most individual plans did not cover maternity care. Starting in 2014, new plans in the nongroup market, including those available through the Marketplaces, … Continue reading
Yes, you may enroll and your plan will be required to cover maternity services. You may also qualify for a premium subsidy, depending on your family income and your eligibility for employer coverage, or, depending on your income you might … Continue reading
The ACA requires that all new private plans, including those in the employer market, individual market, and health insurance Marketplaces, cover lactation counseling and breast pump rental without any charge. Check your plan details to find out the specific number … Continue reading
This will vary by state. Some states have requirements that plans cover some infertility services, but there is no national requirement for coverage of infertility services. If you need these services and are shopping for coverage, check the plan details … Continue reading
No it does not. However, when the baby is born you will be eligible for a special enrollment opportunity. You can enroll your baby in coverage at that point. You (and your spouse) can also change health plans during this … Continue reading
This fall you and your husband will apply as a household of two. When the baby is born, you can update your family information with the Marketplace to reflect that you have become a household of three. At that point, … Continue reading
If you are in a non-grandfathered, or a new private plan, including those available through health insurance Marketplaces, then your plan is required to cover a wide range of preventive services and may not impose cost-sharing charges (such as copayments, … Continue reading
The ACA includes a number of preventive services for women that “non-grandfathered” private plans are now required to cover without cost sharing. For example, these include counseling and screening services including prenatal and preconception care; breast and cervical cancer screening; … Continue reading
If you are considered to have a family history that makes you at high risk for certain genetic mutations that are associated with increased risk of breast cancer (BRCA1 and BRCA2) and are enrolled a non-grandfathered plan, then your insurance … Continue reading
“Student health plan” refers to a special policy of health coverage that colleges and universities make available to their enrolled students. Typically the student health plan is different from the employer-sponsored group coverage that colleges and universities offer their faculty … Continue reading
Generally, yes it does, if it is a fully insured plan. A fully insured plan is one that your college or university purchases from a health insurance company. These plans are required to provide, without cost sharing, access to all … Continue reading
It does if it is a “fully insured” student health plan. A fully insured plan is one that your college or university purchases from a health insurance company. If your student health plan is fully insured, it must cover essential … Continue reading
It is up to the college or university to establish eligibility rules for student health plans.
Eligibility for a student health plan does not make you ineligible for Marketplace coverage and subsidies. Even if you are eligible for student health coverage, you can get coverage through the Marketplace. In addition, if your income is between 100% … Continue reading
If you are currently enrolled in a student health plan, you can still qualify for Marketplace policies and subsidies if you apply during Open Enrollment. During Open Enrollment, you can sign up for a Marketplace plan and, if your income is between … Continue reading
In general, yes. There is no group exemption for international students to the individual responsibility to have health coverage. However, you might qualify for another exemption to the requirement.
Yes, unless you qualify for another exception. In general, U.S. citizens with a tax home outside the U.S. and who are residents of a foreign country for the entire taxable year are exempt from the requirement to have health insurance … Continue reading
Health plans that offer dependent coverage must cover dependents up to their 26th birthday.
Yes. Eligibility for student health coverage does not make you ineligible to be covered as a dependent on your parent’s policy up to the age of 26.
Generally yes. Eligibility for group health benefits through your own job does not make you ineligible to be covered as a dependent on your parent’s policy up to the age of 26. One exception to this rule applies to grandfathered … Continue reading
Yes. You are still eligible to be covered as a dependent. Your parent’s plan must offer you a special opportunity to re-enroll because you lost other coverage. That special enrollment opportunity must last at least 30 days from the date … Continue reading
No. You do not need to be a tax dependent of your parents to continue to be covered as a dependent on their health plan.
No, living in your parents’ home is not a requirement for eligibility to be covered as a dependent under their policy.
Yes, as long as you are younger than 26. Being married does not affect your eligibility to be covered as a dependent under your parent’s plan.
No. Your parent’s plan is not required to cover your spouse.
Your parent’s plan is required to cover your maternity care and delivery. However, after that, the plan is not required to cover your child as a dependent. You will be responsible for obtaining coverage for your baby. Depending on your … Continue reading
You can remain covered as a dependent on your parent’s policy until you turn 26. Once you lose eligibility as a dependent, you will qualify for a special enrollment opportunity. At that point, you will also be able to apply … Continue reading
If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old. Children can join or remain on a plan even if they are: married not living with their parents … Continue reading