What is the Health Benefit Exchange and how will it benefit me?
An HBE is an online market place for individuals and small businesses to purchase health insurance coverage. The HBE will allow for easy comparisons of available insurance plan options, benefits and services, participating provider groups, price and quality. Users of the HBE will also be able to determine if they are eligible for premium tax credits or other public programs allowing for more affordable coverage.
How do employers, their employees and dependent access the HBE?
Beginning in 2014, employers with fewer than 50 employees can use the HBE to purchase health insurance for their employees.
How do individuals or families qualify for health care tax credits and premium subsidies in the HBE?
Tax credits and premium subsidies are available based on income and family size. Individuals and families with incomes between 133 and 400 percent of the federal poverty level will be eligible for premium subsidies and tax credits on the HBE. The subsidies and tax credits will be offered on a sliding scale basis and will reduce the cost of the premium amount. See the Kaiser Family Foundation premium subsidy calculator to determine if you are eligible.
How can I find out what my tax credit will be for my small business?
The Small Business Majority is an advocacy group founded and operated by small business owners that works to support solutions to promote the growth of small businesses and stimulate the economy. According to its research, starting in 2010, as many as 4 million small businesses that offer health coverage may be eligible for tax credits. To see if you qualify for a tax credit visit the Small Business Majority website and use the Tax Credit Calculator.
Who will be able to purchase coverage on the HBE?
Starting Jan. 1, 2014, individuals who are uninsured and self-employed will be able to purchase health insurance through the KHBE with tax credits and premium subsides available to individuals and families with income levels between 133 percent ($14,400 for an individual and $29,000 for a family of four) and 400 percent ($43,000 for an individual and $88,200 for a family of four) of the federal poverty level.
What is an individual mandate?
The individual mandate requires all individuals who can afford health care insurance to purchase some type of health insurance coverage. For those individuals who can afford insurance but refuse to purchase coverage, the annual penalty would start at $95, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. The annual penalty for families is $2,085, or 2.5 percent of household income, whichever is greater.
Will I be required to give up my current insurance coverage?
No. Health plans in effect as of March 23, 2010 are grandfathered under the law and considered qualified coverage, meeting the mandate to have health insurance beginning in January 2014. Employers offering health insurance will continue to have the flexibility to change premiums, deductibles, co-pays and network coverage.
Will small businesses be required to provide health insurance to employees and their dependents?
No employer is required to provide insurance. However, in 2014, businesses with more than 50 employees that do not provide health insurance and have at least one full-time worker who receives coverage in the HBE will have to pay a fee of $2,000 per full-time employee. The small business' first 30 workers are excluded from the fee. Firms with 50 or fewer employees are not required to provide health insurance to their employees. In additionally, if you own a small business, the ACA offers tax credits to help cover the cost of providing health insurance if a employer chooses to do so.
What insurance reforms are already taking place?
The reforms already in place include:
- New health plans must cover preventive services, like mammograms, for example, with no co-pays.
- Health plans must allow young adults to remain on their parent's health insurance plan until age 26.
- Prevents insurance companies from imposing lifetime dollar limits on health benefits.
- Health plans can no longer deny coverage to children younger than 19 based on a pre-existing condition.
- Certain Medicare participants falling in the doughnut hole, the point when prescription drug coverage stops and does not begin again until the participant pays a set amount out of pocket for his or her medicines, received a $250 rebate to help cover the cost of their prescription drugs and other participants received a 50 percent discount on their covered brand-name prescription drugs.
- Health insurers are required to spend 80 percent of premiums they collect on benefits and quality improvement. If insurance companies do not meet this goal because administrative costs or profits are too high, they must provide rebates to consumers and employers.
How does the new law affect me if I am on Medicare?
The Medicare benefits you currently receive will remain the same. Medicare will continue to cover your health costs the way it has with no changes in eligibility. If you need help with your Medicare coverage, visit the federal Medicare website or call 1-800-MEDICARE.
Who can I call if I have a problem or a complaint with my health plan?
The Kentucky Health Insurance Advocate Program is a toll-free consumer assistance call center where callers can get help identifying health insurance options and get vital information to make better choices selecting a health insurance plan. Callers can also get help with appeals, grievances and complaints. Call 877-587-7222 for assistance or e-mail the advocate program.