Obamacare Q&A: Will my plan skyrocket? How will the unemployed pay?

Rosana Herrera, left, operations coordinator at the Health Benefits Resource Center at St. Francis Medical Center in Lynwood, offers daily help and counsel on the Affordable Care Act and insurance exchange issues to confused patients and clients.
Rosana Herrera, left, operations coordinator at the Health Benefits Resource Center at St. Francis Medical Center in Lynwood, offers daily help and counsel on the Affordable Care Act and insurance exchange issues to confused patients and clients.
(Mark Boster / Los Angeles Times)

Millions of Americans have been checking out new health insurance exchanges since enrollment in Obamacare launched Oct. 1.

During its first week, California's insurance exchange received nearly 60,000 calls from consumers and about 1 million Web visitors. Despite numerous technical glitches, federal officials say 8 million people logged on last week to their online exchange for 36 states not running their own marketplace.

This rollout has prompted many questions from people about what President Obama's Affordable Care Act will mean for them.

Here are some answers from healthcare reporter Chad Terhune to questions we received through Twitter. You can tweet more questions to @chadterhune or email

An accurate income estimate is important to determine what amount of premium subsidies you may qualify for. Individuals earning less than $46,000 annually could receive some financial help in purchasing insurance.

Trouble is, if you underestimate your income, you could end up owing a sizable refund on those subsidies to the federal government. This makes it crucial for consumers to report any significant changes in income during the year to limit surprises later at tax time.

Another approach is to only take a portion of your monthly subsidy in advance and collect the rest later when you file your taxes. That would increase what you pay upfront, but could save some heartache if you’re worried about the numbers.

Health plans have begun notifying many existing customers about the changes ahead and what their options may be. To receive the tax credits, you must buy a plan inside California’s health exchange. There will be other policies available outside the exchange, too.

Talking to an enrollment counselor or insurance agent trained by state would give you an idea of the new options from various insurers.

That isn’t a myth, but it doesn’t kick in right away. They are referring to a provision in the Affordable Care Act that’s commonly called the “Cadillac tax.”

It’s new surcharge on high-cost health plans that generally provide workers some of the most generous benefits, including ultralow deductibles and small copays. Starting in 2018, a 40% excise tax would be levied against health plans that exceed a certain value, such as $10,200 for individual coverage or $27,500 for a family.

In response, some employers have started to scale back benefits to escape the tax in future years. Supporters of the tax say these generous health plans lead to the overuse of medical care because workers are shielded from so much of the cost.

There’s no top income that bars people from buying a policy in the government-run exchanges. At lower levels, some people will qualify for Medicaid at no cost to them.

There is a cutoff for who can receive financial assistance with their premiums. A family of four can qualify for premium subsidies at $94,000 a year or less. The financial aid is calculated on a sliding scale to help the lowest income people the most.

For years, health insurance premiums have been steadily climbing for individuals and businesses. The trend has moderated somewhat the last few years amid record-low increases in U.S. healthcare spending since the recession.

But many experts are split on whether this marks a permanent shift or just a temporary reprieve. It’s also unclear whether various provisions of the healthcare law will help hold down costs.

Probably not and this has been one of the more controversial parts of the healthcare law. If your employer provides affordable insurance for you, then nobody else in the family is eligible for subsidized coverage on the exchanges. And the definition of “affordable” isn’t left up to you.

The law says it’s affordable coverage if it costs 9.5% or less of the employee’s household income.

Critics have called on Congress to fix this issue, but the political fight over the law makes that very unlikely.

People in Medicare aren’t directly affected by the new exchange plans that are part of Obamacare. This insurance is geared toward people under 65. Separately, insurers offer a wide variety of supplemental plans for Medicare, and insurance agents can help you understand it all, too.

Those different metal tiers, from bronze on the low end to platinum at the high end, are available to all consumers. It just depends on what level of coverage you’re seeking and how much you’re willing to spend.

Workers don't have much control over the cost of employer-provided insurance. Premiums have been rising steadily and employers increasingly ask workers to contribute more. You can pick a higher deductible plan to save on premiums in some cases.

The unemployed may qualify for no-cost coverage through an expansion of Medicaid, depending on what state they live in. California has accepted federal money to expand its Medi-Cal program.

Beyond that, there are federal premium subsidies for lower-income people. Check the Covered California rate calculator online and punch in some income levels to see what coverage may cost.

You would need to check the specific health plan and what their rules are on out-of-state care. Some major insurers that operate in multiple states can help with that.

You also need to be careful when choosing out-of-network care in general because your share of the medical costs can increase substantially.

No, you don't have to wait until COBRA ends or take it at all. But these new exchange health plans don't take effect until Jan. 1 at the earliest, so you don't want to have a break in coverage. You can also check rates now on the Covered California calculator to see how it compares to COBRA premiums, which usually run pretty high.

Yes, you can switch, but I would carefully check the prices and benefits before making any move. You should look at all of your out-of-pocket costs, premiums plus deductibles and copays, to make a sound comparison.

One key factor will be how much your employer is contributing to your health plan. That should probably be your first option. Also, does your employer help pay for dependent coverage? Many firms have cut back on that.

Then check the Covered California rate calculator to see whether you qualify for federal premium subsidies based on your income. Families earning less than $94,000 a year can receive some financial help.

That could make coverage there more affordable. There’s plenty of time to consider all these options. Enrollment in the state exchange runs through March 31.

Residents in the country illegally are not eligible for federal subsidies in the government-run exchanges like Covered California. There are other county and private programs that may assist people with their medical bills.

Yes, the benefits are the same in each metal tier, such as platinum. That makes it much easier for an apples-to-apples comparison among health plans.

One of the biggest factors driving the difference in price then is the network of doctors and hospitals the insurers are offering for that policy. Some may be a more limited HMO plan. Others may be a PPO plan with greater choice of physicians and specialists.

Many health plans have restricted their provider networks in the exchange to help hold down rates, so consumers should ask about that before signing up.

The IRS penalties for not having health insurance start relatively small in 2014 at $95 per adult or 1% of income, whichever is greater. They increase over time. In 2016, they reach $695 or 2.5% of income.


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