Ask the Times: Obamacare questions, asked and answered | Arkansas Blog

Tuesday, October 1, 2013

Ask the Times: Obamacare questions, asked and answered

Posted By on Tue, Oct 1, 2013 at 4:43 PM

Obamacare is here. Enrollment in the Arkansas Health Insurance Marketplace began today, with coverage set to start in January. But with the law gearing up, many still have questions about what the new coverage options mean for them. And we have answers! Here are a few queries we’ve received lately. Have a question about Obamacare and how it impacts you? Send to davidramsey@arktimes.com. Previous Obamacare Ask the Times here

Q:
 I’m trying to parse the Affordable Care Act for some young neighbors of mine. They are 30-35 years old. Two kids are both covered by ARKids. The husband is covered at his work — I don’t know details of his policy. They recently enrolled in the SNAP program. Income is in the $20,000 to $25,000 range. I think she should be eligible for Medicaid as well as the kids, but I am not sure. How does ACA help them and at what cost? These are nice, hard-working young people. They have been fed a lot of misinformation by someone.

A: For a family of four, if household income is less than $32,499 (138 percent of the federal poverty level), she qualifies for Medicaid via the “private option.” She can pick a private plan on the Arkansas Health Insurance Marketplace and will pay ZERO for a premium. Coverage will start Jan. 1. Probably the simplest way to sign up would be to show up at her county DHS office, the same place she likely went to for ARKids or SNAP.


Q: My work offers health insurance, but can I look for a plan on the Obamacare exchange instead?

A: If your employer offers you health insurance, you can choose to decline that and shop on the Arkansas Health Insurance Marketplace instead. However, if your employer offers coverage that is considered affordable and sufficient under the law, you are not eligible for Marketplace subsidies. Your employer will give you a letter that tells you whether the coverage offered meets minimum standards (your employee contribution cannot exceed 9.5 percent of your household income, and the plan must cover 60 percent of the total cost of medical services for a standard population).

An exception to the above: if your household income is less than 138 percent or less of the federal poverty level ($15,856 for an individual, $32,499 for a family of four), then you qualify for a zero-premium plan via the “private option” (see previous question) even if your employer offers you coverage.


Q: My spouse gets insurance through her job but I don’t. Am I eligible for subsidies?

A: If your spouse gets employer-sponsored insurance AND it meets the standards described above AND the employer offers spousal coverage, then you will not qualify for marketplace plan subsidies. The way this works in practice is a little funky: the rule that the employee contribution can’t exceed 9.5 percent of household income applies to coverage for the individual employee alone. If that’s below 9.5, the family will not qualify for subsidies, even if the employee contribution for spousal or family coverage is above 9.5 percent.

The same exception about the “private option” applies. If household income is less than 138 percent of the federal poverty level, you and you both qualify for a zero-premium plan via the “private option” even if your spouse’s employer offers your spouse coverage.

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