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Healthcare 411: Viewer questions

9:29 PM, Nov 4, 2013   |    comments
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Question:  I am 68, and just lost my personal health insurance.  Medicare won't allow me coverage until July 2014.  What can I do to cover myself with insurance until I become eligible for Medicare B?  I am healthy, but worried about having no insurance. -- no name given

Dr. David Lubin, MD: This person actually lost his/her insurance because he/she was covered as a dependent under a domestic partnership and the partner's carrier would no longer carry this person as the primary. 

Neither Medicare, nor the Cobra law, recognizes domestic partnerships for insurance purposes, so this person must wait until open enrollment for Medicare next year. This person does have Medicare Part A, however, which covers hospital admissions. The other alternative would be to find some basic policy under the Affordable Care Act, if and when it's back up and running. 

 I am a divorced man with 2 young boys that I have part of the time. I pay 100% of their health insurance. I tried to get a quote for all three of us. Since my x wife claims them as dependents, I can't get a quote. Even though I pay for the health care.   -- Gregg Brotman

Eric Brown: I'm assuming that you went to the Federal Marketplace for an insurance quote on you and your two boys.  If my assumption is correct, the Federal Marketplace asks specific questions that relate to your household to determine your eligibility.  

Since your ex-wife claims your boys as dependents on her tax return only she will be eligible to receive the household credit.  For the purposes of the Federal Marketplace, you are considered a household of one which prevents you from qualifying for a subsidy on you and your boys.  (You can only receive subsidies or tax credits on the Federal Insurance Marketplace). There may be some tax benefits to you for paying their premiums when you file your taxes, but you should consult with your tax advisor for legal guidance.

You could get an individual/family plan quote from a licensed agent like me or from a private insurance marketplace to cover you and your boys. You can also purchase a plan on the Federal Marketplace for you and your boys however; you won't qualify for any subsidies.

: Before the law was passed the insurance company said how much cheaper the insurance would be if everybody bought insurance, now I just came from a meeting with my insurance and my shirt my insurance is going to triple even though I am in good condition. 

My question is are the people going to be served here or are the insurance companies going to be dancing in the aisles with the extra money you'll be making from the people now that it is mandatory that you buy insurance. -- Phillip Ficarrotta

Eric Brown: Insurance agents are very busy right now helping our clients navigate through the swift changing waters of the Patient Protection & Affordable Care Act (ACA or ObamaCare).  Starting in January 2014, most of the mandatory requirements of the ACA along with the other mandatory requirements since March 23, 2010 when the law was enacted will go into effect.  Based upon those requirements, individuals who don't qualify for subsidies will see varying ranges of increases in their premiums.  Premium subsidies are solely based upon your income.  

If your income is between 100% to 400% of the Federal Poverty Level (FPL) you will qualify for a premium subsidy.  Additionally, if your income falls between 100% to 250% of the FPL you will also qualify for a Cost-Sharing subsidy.  A Cost-Sharing subsidy will lower your Out of Pocket expenses such as Co-Pays & Deductibles.  If you qualify, you can only receive premium & cost-sharing subsidies on the Federal Insurance Marketplace.

There are several ways to help lower your premiums, ask your licensed insurance agent for advice.  Also you can find numerous subsidy calculators on the internet to help you simulate different scenarios to determine your premiums based upon your household size, income and your age.  If you purchased your plan before March 23, 2010, you could possibly have a Grandfathered plan.  If so, you may be able to keep your existing plan without most of the ACA changes.  Check with your agent to see if you meet the requirements. 

I am a kidney and pancreas transplant recipient and have Careplus and BlueShield Blue Cross (USF State) as my Health Insurance.   Tricare and Medicare Straight (or Careplus and the others Advantage Health Insurances available are options too.)  Which one could be my best options at this moment.  I use Cyclosphorine 100 mg and 75 mg daily, Cellcep 500 mg and 1000 mg daily, and Paxil 40 mg.  

Would you please help with the best option available for me?  It is not easy for me to get it because of my Pancreas and Kidney Transplantation.  -- Gladys E. Gomez

Leslie Spencer, MSW, Associate State Director for Advocacy, AARP: Health care coverage decisions are very personal and will differ from person to person depending on their health care needs.  While I can't offer advice as to which plan may best suit your needs, I can recommend a program with volunteers who can help with your specific health care needs.  It is called the SHINE program (Serving the Health Insurance Needs of Elders) and they can provide personalized assistance to your questions.  They can help on the phone or you can schedule an appointment.  You may call 1-800-963-5337 and ask to speak to a SHINE volunteer.

You may also try the Medicare website, which will allow you to compare plans in your area.  On the site you can enter your zip code and prescription drugs which will help compare plans.

: I'm self employed filled out the app and didn't get any prices, have to prove my wife doesn't work and that she's a citizen yet no address to send anything to? 

Dr. Jay Wolfson: You didn't get any prices because the website was not functioning completely.  That will change.  As soon as the site is functional, you will be able to accomplish all of those things. 

I filled out an application on the health care website and it said I should print and mail it? Is this correct mail something I created online. I do not understand how to pick a policy or find the cost. I was told I will receive tax credits to help pay the cost of the policy. What are tax credits? How do they work?  -- Steve LaMalfa 

Dr. Jay Wolfson: If you were told that you would receive tax credits, then the website analysis system determined that your income was above Medicaid but low enough to qualify for tax credit.  You generally have to provide additional, tangible proof of this before it is finalized. Once the web sites are functional, you will have access to more accurate plan pricing information so that you can make a better choice as to the level and scope of coverage you wish to purchase  --- but given the challenges that are being contemplated, it is possible that the insurance companies will seek to adjust their prices after the first of the year.  Stay tuned and we'll see where it goes.

I am unemployed, do not carry health insurance due to cost.  I have been taking money from my 401k savings to live on until I can hopefully find a job.  I don't currently have any employment income, but at tax time I have to pay income and early withdrawal penalty taxes on the 401k money.  My question is, as of January if I still choose not to sign up for insurance do I have to pay a penalty fee (does my 401k money count as income, what are the requirements for the fee to kick in, will it be another line on the tax form, etc...)?  -- Jayne

Dr. Jay Wolfson: Your income from the withdrawals from your 401K is taxable in the tax year it is withdrawn.  The amount of money you withdraw will determine the income category into which you may fall with respect to entitlement to receive a subsidy under the Affordable Care Act.   

You will have till March 2014 to sign up during this first round of the Marketplace Exchanges.  But because of the difficulties in getting the websites functioning completely, the jury remains out as to whether or not and what kind of extension may be granted regarding signing up and paying taxes.

Question:   I am presently on Medicare and Social Security Disability.  I chose to get into an HMO rather than traditional Medicare because of Co-Payments. Prior to this month (October), I had no Co-Pays for Medications and then all of a sudden I went to pick up meds and each and everyone had CoPays. I live alone and have no other type of income.  No pensions---NOTHING !  Is there a plan I can get into that will help me?  If I have to pay for all these co pays, it will leave me short every month for bills etc.  -- Beverly, New Port Richey

Dr. Mark Morris: Beverly's situation does not fall under the Affordable Care Act. She is dealing with a particular company's policies that are not working for her any longer. Fortunately, we are in the middle of the open enrollment period for Medicare up until mid December. That should give her time to shop for a Medicare plan that meets her needs.

The Tampa Bay Times just published an extensive review of the plans that should help. The web site is and it is very helpful. Finally, the SHINE volunteers can help someone who is having trouble making a decision.

I'm sure she can find a plan that fits her needs.

I have a chronic health issue. How do I pick a plan I can afford and that will actually pay for my doctor visits? With my current family income we should qualify for assistance. -- Jackie 

Dr. Mark Morris:  Jackie's question goes to the heart of the affordable care act. The first and best news is that she cannot be denied coverage because of her chronic health issue.

For the second part -  picking the best plan for her situation - the best bet is to work with a Navigator or an Enrollment specialist in whatever county she lives in. There are over 100 plans to consider so most people need some help to narrow the choices.

For the third, Jackie can estimate her own assistance subsidy using the Kaiser Family Foundation web site:  She may also qualify for assistance with out of pocket costs if the family income is between 100 and 250% of FPL. Again a Navigator or Enroller can help with this information.  Whatever assistance Jackie is eligible for can be used on any of the plans offered via the ACA - Bronze (not recommended), Silver, Gold or Platinum.

Finally, if Jackie know which company's plans she wants to work with, she can work with a broker. Aetna, Coventry, Cigna, Blue Cross/Blue Shield or Humana will all be delighted to talk with her and compare plans.

It will definitely pay off to get all the information and to shop carefully!

Healthcare 411 - Your source for Affordable Care Act info:

WTSP 10 News continues to answer questions on healthcare with the Affordable Care Act and the Health Insurance Market Place.

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