Healthcare 411: Viewer questions

5:48 PM, Dec 3, 2013   |    comments
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Our panel of experts answer YOUR questions about the Affordable Care Act.

Question: I'm a veteran and I get health insurance through VA. Am I exempt from having to get Obamacare?
-Sam from Sarasota

Michelle Cyr from AARP: The health care law does not change VA health care eligibility, benefits or out of pocket costs for Veterans.  If you are enrolled in any of VA's programs below, you have coverage under the standards of the health care law and you do not need to take additional steps.

Question: My husband has preexisting condition and I am healthy - should we do separate policies or go on the same one? Neither of us have insurance through work.
-Sally Council

Dr. Jay Wolfson from USF: After 1 January, ALL health care policies will cover all preexisting conditions. the health care plan has to fit YOU.  

Therefore, after exploring all of the options, it could make financial sense to purchase two separate products - or it may not. Make sure to look not only at the premium costs - but the scope of coverage, deductibles and coinsurance. 

Question: If I choose to purchase healthcare through a private firm, and not through the website, or if I choose to not purchase healthcare at all, do I still qualify for the tax credits? I need to understand this before being able to decide which path to take.
-Tim Quilen

Dr. Jay Wolfson from USF: If you do not purchase healthcare at all, you do not qualify for any tax credits at all.

If you 'purchase' healthcare through your employer, you will not be eligible for a tax credit, but your employer might receive one.

Other than the government website, private brokers, navigators and other sources in the community can also sign you up for health insurance under the affordable care act - and they will be using the Exchange software to do this.  

In the process, if you qualify financially, then you may receive a tax credit. 

Question: I just learned that my doctor may not be on the plan - Humana Connect Bronze [which is] the most affordable for me.
Do I need to check another plan? I don't want to lose my doctor.
-Michelle Williams, Tampa

Dr. David Lubin: She has a choice, change plans for what is most affordable and covers what she needs or pay more to keep her doctor on some plan that he's on. I'm assuming she's in some Medicare Advantage plan and not the ACA. So she needs to contact the doctor's office and match her affordability to the plans he or she is in.

Question: What is the penalty if I don't get insurance through Obamacare or get it at all?
-Rebecca from Odessa

Insurance expert Eric Brown: You must be enrolled in a qualified healthcare plan in 2014 or they will incur a penalty as they file their taxes at the end of the year.

In 2014:
$95 per adult and $47 - $50 per child up to a family, max of $285 or one percent of the family income.

In 2015:
$352 per adult and 162-50 per child up to a family max of $975 or two percent of family income.

In 2016:
$695 per adult and 347-50 per child, up to a family max of $2,085 or 2.5 percent of family income.

Question: If I sign up for the new Affordable health care, will preventive care and prescriptions be covered? And does it matter which plan I sign up for?
-Rob Skolton

Sherri Gay from Suncoast: All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover.

The essential health benefits include at least the following items and services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

Click here for more Healthcare 411 Viewer Questions

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

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