Q&A: The Affordable Care Act

Transcript from a live chat on health care reform held on October 1, 2013 with Robert I. Field.

Robert Field: I look forward to your questions about the Affordable Care Act and what may be confusing you.

Comment From Guest: I am 68 years old and am still currently working and covered by my ER health plan. I would like to retire and pick up Medicare Med coverage ( I have part A only right now). However, my wife is only 58 and has no ER coverage and so she is covered under my plan here at work.

Robert Field: Unfortunately, she will lose coverage under your employer plan. However, she will be able to get coverage through an exchange once you retire.

Comment From Tony: Since I would like to retire, she will not have health insurance coverage. I was wondering if I should seek individual coverage for her under an individual health insurance plan or seek coverage under the new health plan offerings....which would be better and more cost effective. Also...I am confused by Medicare Supplement plans and Medicare Advantage plans......which is better?

Robert Field: The new health plan offerings on the exchanges are individual health plans. Your wife is guaranteed that she can get coverage through one. As for your Medicare, Medicare Supplement is an add-on for traditional Medicare coverage to cover co-pays and deductibles and some other benefits. Medicare Advantage replaces all of your Medicare coverage with a private plan.

Comment From Matt: I'm a City employee with benefits. How much are my rates going to go up to pay for the people who don't pay for their own health coverage?

Robert Field: Your rates will not be affected. The City will continue to offer coverage as it has in past. The exchanges will not affect the rates that you are charged.

Comment From Amanda: How can I get an exemption from the mandate to have health insurance?

Robert Field: You don't need to formally apply for an exemption. If you are exempt because your income is low, which will apply for most exemptions, that will be evident from your income tax return.

Comment From Eric: We are on one income right now and it would cost us less to get insurance through ACA then what my ER charges us each paycheck. Is there any way for us to drop my ER coverage without it affecting what we would pay for ACA?

Robert Field: If your employer premium costs you more that 9.5% of your income, you can purchase coverage on an exchange and receive a subsidy to help with the cost. If you work for a company with fewer than 100 employers, you can also go to an exchange directly.

Comment From Guest: I'm a 32yo uninsured resident of nj, making 32k.Employer doesn't offer insurance. Healthy, except for a severe case of psoriasis. I stopped paying for an individual plan last year because the only meds I needed were expensive biologics (Enbrel, Humira, Stelara) that would cost $800/month. Any idea if major meds like these will not cost astronomical fees under the exchanges? thanks!

Robert Field: You have to check the details of each plan. Some will limit the meds they cover, and some will have high co-pays. The better plans (platinum and gold) will probably cover your meds, at least to some extent, although they will be the most expensive. You need to check the insurance company's website carefully. Companies are required to list details of coverage, and the information will be there.

Comment From Guest: 1. Will older people have to pay more for insurance? 2. Is PA going to expand Medicare so that those who have a very low income can get insurance?

Robert Field: 1. Older people will have to pay more for insurance in the exchanges. Insurance companies can charge older people up to three times more than younger people for the same coverage. However, older people will not be charged more under employer coverage.
2. It is not yet clear whether Pennsylvania will expand Medicaid (I assume you mean Medicaid, rather than Medicare). Governor Corbett's p roposal has not yet been approved by the federal government, and it may not be. Even if it is, it would not take effect for another year.

Comment From Chaz: I'm unemployed. How does ACA affect me?

Robert Field: It affects you in two main ways. The good news, is that you are guaranteed the ability to obtain coverage through an exchange. However, the bad news is that you will have to obtain coverage or pay a penalty.

Comment From Guest: I'm a full time employee with a high end retail company. I have health insurance. My company just cut health insurance for our part time workers. I know other companies have done this too. Should I be worried about my company dropping insurance coverage for full timers too?

Robert Field: For the time being, very few companies are dropping coverage for full-time workers. That may change in coming years, but it remains to be seen. So for now, you probably don't have to worry.

Comment From Guest: I just went on Independence Blue Cross's website, and it's not allowing me to find a rate for a same-sex couple. My understanding is that if I am in a same-sex marriage, even though I live in Pennsylvania, because the exchange is federal, all of the policies in the exchange should offer us insurance. Is that right?

Robert Field: You should try going through the exchange website, rather than the Blue Cross website. That is where federal rules would apply. However, I suggest waiting a few weeks for the web traffic to subside. The site, healthcare.gov, is likely to be very busy for awhile.

Comment From Guest: What will happen with premiums for Year 2 and beyond if only sick people sign up? Seems like the entire system will collapse rather quickly if healthly people don't participate.

Robert Field: You raise a good point. That is why the law includes the mandate requiring everyone to have insurance. The success of the exchanges will depend in large part on how many young healthy people use them.

Comment From Sammie: How can I shop for health insurance? Is it just online?

Robert Field: There is also a toll-free number - 1-800-318-2596. However, I suggest waiting a few weeks before trying either it or the website, since they are both likely to be overloaded for awhile.

Comment From Guest: Lets say you were unemployed, doing only odd jobs and earning about 5K for the year. Would you be eligible to buy subsidized health insurance?

Robert Field: With an income that low, you would qualify for Medicaid in states that expand their programs, like New Jersey. However, you would probably not qualify in Pennsylvania, unless its Medicaid expansion takes effect. Since you earn less than 100% of the federal poverty level, you are, unfortunately, caught in a glitch in the law, where you cannot get Medicaid in Pennsylvania but also cannot get a subsidy on an exchange.

Comment From Mark: The Obamacare website isn't working for over 2 hours now. What's up with that? And why does it that any information on my computer as well as any device connected to my network can be accessed by the government, that nothing is private.

Robert Field: I would not try to website today. There is a huge amount of traffic. I would wait a few weeks. You have until December 15 to sign up and have a policy be effective on January 1.

Comment From Millennial: How many millenials do you expect to be taking advantage of the provisions of this bill given that we are covered up to our necks in educational debt? If we chose to not opt in and remain uninsured will we be penalized?

Robert Field: You will be subject to a penalty if you do not get insurance. However, up to the age of 30 you can satisfy the mandate with a catastrophic-only policy with a very high deductible. The premiums for those policies are expected to be quite low. You should also have a policy of some sort for your own protection if you get sick or are injured.

Comment From Guest: What's the penalty if I drop my current insurance plan and don't sign up for any of the government plans? Will I still be able to receive medical services?

Robert Field: If you do not have any coverage, you will have difficulty receiving anything but emergency medical services. You will also be subject to a penalty for not having health insurance. You need to get it from somewhere, whether an exchange, an employer, Medicare or Medicaid, for your own protection and to comply with the law.

Comment From Shanique E: What exactly should I be doing? I'm a 23 yr old college student working less than 30 hours a week (Hourly wage); Yearly under 15K. Will I be able to finally qualify for Medicare? Medicaid? God knows how many times I've applied.

Robert Field: You would qualify for Medicaid in New Jersey, but not in Pennsylvania. You would not qualify for Medicare at your age unless you are totally disabled. Unfortunately, you will also not qualify for a subsidy on an exchange because you earn less than 100% of the poverty level. That means if you live in Pennsylvania, you are not eligible for financial assistance under the health reform law at all. However, you can get a catastrophic-only policy that will likely have a very low premium.

Comment From Guest: What is 100 percent of the federal poverty level? And could someone buy unsubsidized insurance for you if you only made 5K for the year? I have a relative that I'd like to do this for.

Robert Field: 100% of the federal poverty level for 2013 is $11,490. Your relative has to buy their own coverage, although you can reimburse them for the cost. They can buy unsubsidized coverage on an exchange. They will not be eligible for a subsidy, but if they live in a state that expands Medicaid, they would be eligible for that program.

Comment From Shanique E: I'm in Florida; The website reads: Medicaid in Florida Florida has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Florida’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Robert Field: Many people who live in states that don't expand Medicaid will have difficulty finding affordable coverage. However, if they earn more than 100% of the federal poverty level, they can receive a subsidy to buy coverage on an exchange.

Comment From Guest: Do you really think young people will sign up if they only face a $95 penalty vs several thousand dollars annually for a high deductable plan? Seems like penalities are woefully inadequate to make the system work.

Robert Field: That remains to be seen. Many young people will sign up because they want coverage, not because they have to. Also, the penalties rise each year for several years. However, it is not yet known how many will sign up.

Comment From Guest: Is there a place where you can get a cheat sheet on health insurance rates on the exchanges just to have the info? A simple PDF, for example? Just asking because I realize the official website might be too congested right now.

Robert Field: I am not aware of one right now. However, the website should be available in a few weeks, and you may find information in the media.

Comment From Jim: Where are the locations of the navigators that are going to be helping people who want to sign up for coverage but do not have a computer or do not know how to operate one. Thank You.

Robert Field: A list of local resources is available on the Philly.com website.

Robert Field: Thanks for you questions. You can continue to submit them and find answers to others at philly.com/healthcare.

Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog.