Health Care Reform FAQ'sPlease visit https://www.healthcare.gov/ for the most up to date information
On Jan. 1, 2014, getting health care will be easier than ever.
- Insurance companies will accept everyone who applies for coverage, regardless of health status.
- Medicaid will expand to help more low-income individuals get health care.
- The law requires most individuals to have at least minimal health care coverage. If you don’t, you will have to pay a penalty.
- If employees choose not to enroll in the District's plan or are not eligible for benefits, you need to shop for a plan yourself in the exchange, an online marketplace for comparing and buying health insurance plans.
Health Insurance Marketplace Questions & Answers
If you have health insurance: https://www.healthcare.gov/if-you-have-health-insurance/
What does Marketplace health insurance cover?
Marketplace health insurance plans will offer all essential health benefits such as: Ambulatory patient service; Emergency services; Hospitalization; Maternity and newborn care; Mental health; Prescription drugs; Rehabilitative services; Laboratory services; Preventive and wellness services; Pediatric services.
How do I apply for Marketplace coverage?
Marketplace open enrollment begins Oct. 1, 2013; you can go to the Marketplace and see the health coverage options available to you. Then you can compare plans side by side and choose a plan that meets your needs and fits your budget.
How much will Marketplace health insurance cost?
All plans available through the Marketplace will be offered by private insurance companies. Starting in October, when you use the Marketplace to compare plans you’ll see prices for all plans available to you. Prices will show any cost savings you may be eligible for based on your income.
How can I get lower costs on Marketplace coverage?
When you use the Marketplace you may be able to get lower costs on monthly premiums or out-of-pocket costs, or get free or low-cost coverage. You can save money in the Marketplace in three ways. All of them depend on your income and family size.
- You may be able to lower costs on your monthly premiums when you enroll in a private health insurance plan.
- You may qualify for lower out-of-pocket costs for copayments, coinsurance and deductibles.
- You or your child may get free or low-cost coverage through Medicaid or CHIP.
When you fill out your Marketplace application, you’ll find out how much you can save. Most people who apply will qualify for lower costs of some kind
Will I qualify for lower costs on monthly premiums?
When you get health insurance coverage in the Marketplace, you may be able to get lower costs on monthly premiums, and therefore lower the costs of your coverage. You’ll see the amount of savings you’re eligible for when you fill out your Marketplace application. Prices shown for insurance plans will reflect the lower costs.
These lower costs are accomplished with a tax credit called the Advance Premium Tax Credit. The tax credit can be applied directly to your monthly premiums, so you get the lower costs immediately.
Note: If you are eligible for coverage on an employer-sponsored health plan which is affordable and meets a minimum value, you will not be eligible for a tax credit through the Marketplace.
The amount you save depends on your family size and how much money your family earns. In general, people at the following income levels will qualify to save in 2014. The lower your income, the higher your savings will be. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.)
- Up to $45,960 for individuals
- Up to $62,040 for a family of 2
- Up to $78,120 for a family of 3
- Up to $94,200 for a family of 4
- Up to $110,280 for a family of 5
- Up to $126,360 for a family of 6
- Up to $142,440 for a family of 7
- Up to $158,520 for a family of 8
You may also be able to get lower out-of-pocket costs, depending on your income and family size.