Affordable Care Act
Frequently Asked Questions
1. Why do I need health insurance?
Having quality insurance means that you and your family can get the care necessary to stay healthy. And when an accident or illness strikes, a quality health plan can offer protection from huge medical bills. Additionally, starting in 2014, if individuals do not have health insurance, they will have to pay a fine. Further information on the fine can be found here.
2. What is the health insurance Marketplace?
Under the ACA, every state must have a health insurance Marketplace to help individuals and families purchase health insurance. The Marketplace offers one-stop shopping and assistance in helping find and compare medical health insurance options offered by private companies. The Marketplace will also assist individuals and families in determining if they qualify for premium tax credits or other financial assistance. Individuals who are not eligible for coverage through their employer will benefit the most from this program and its services.
3. How do I get additional information about the Marketplace, based on the state in which I reside?
The Marketplace simplifies the search for health coverage by gathering the options available in your area in one place. You can compare plans based on price, benefits, quality, and other features important to you before you make a choice.
Visit www.HealthCare.gov (with a live chat option) or also get help by phone, or in person. Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325).
4. How can I get an estimate of costs and savings on the Marketplace health insurance?
Please see each state’s own health insurance Marketplace website for each states estimate of cost. Remember to visit the states Marketplace in which you reside.
You can find your states Marketplace website by clicking the link below: https://www.healthcare.gov/what-is-the-marketplace-in-my-state/
5. Can I save money on my health insurance premiums in the marketplace?
You may qualify to save money and lower your premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. If you qualify for a discount through the Marketplace, the amount of premium discount is based on the household income.
6. Does being eligible for medical coverage through my employer affect eligibility for premium savings through the Marketplace?
Yes.
Employees eligible for PEBB employee coverage
If you are currently eligible for the employer provided coverage and have been offered PEBB health coverage from WSU, you will not be eligible for a tax credit through the Marketplace. This is due to PEBB coverage meeting the ACA requirements of premium affordability and providing acceptable levels of health coverage. Therefore, most employees will not elect to waive their PEBB medical coverage to enroll in coverage through the Marketplace, since they will not experience a tax credit benefit.
However, if the cost of a PEBB health plan to cover you (and not any other members of your family) is more than 9.5% of your annual household income, you may be eligible for a tax credit or other financial assistance. This is referred to as the “affordability” standard of the ACA, and the PEBB option(s) are expected to meet this standard.
An individual could also be eligible for a tax credit or other financial assistance if their employer-sponsored health plan does not meet the “minimum value” standard, another requirement set by the ACA. This standard requires the insurance plan to coverage no less than 60 percent of the total allowed benefit cost. All PEBB plans meet or exceed the “minimum value standard.”
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by WSU, WSU is still responsible to pay the employer contribution to the Health Care Authority (HCA). Also, this employer contribution, as well as your employee contribution to employer-offered coverage, is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
Employees NOT eligible for PEBB coverage
Employees who are not eligible for insurance coverage through their employment with WSU, or do not have insurance coverage elsewhere that meets the “affordability” and/or “minimum value” standards (through a parent, spouse, or private insurance option) should consider applying for health benefits in the new Marketplace as they may qualify for a premium tax credit or other financial assistance. Your payments for coverage through the Marketplace are made on an after-tax basis.
If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. Graduate Student Assistants who are eligible for the GSA plan, would not be eligible for the tax credit, since WSU pays for the cost of your plan.
However, you may be eligible for a tax credit that lowers your premium or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. Also, if the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your annul household income, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. (The “minimum value” standard requires the insurance plan to cover no less than60 percent of the total allowed benefit costs.)
Graduate Students (Assistants, or Research Fellow/Trainee/Intern) may be eligible for the employer-paid graduate plan. Otherwise, they and all other student are eligible to elect to enroll in the Student Insurance Plan. Students under the age of 26 may also be able to be covered under their parent’s insurance plans. The Student and GSA plans have been structured to meet the “minimum value” standard level of coverage requirements as identified under the ACA. Student employees may wish to review which of the plans may be the best option for them: the WSU Student/GSA plans, their parent’s/spouse’s plan, other insurance coverage they may have, or a Marketplace plan.
7. What is the "Affordability" Standard
The affordability standard states that if the annual premium cost of an employer sponsored health plan to cover you (and not any other members of your family) is more than 9.5% of your annual household income, you may be eligible for a tax credit or other financial assistance. The amount of the annual premium is calculated by taking the employers lowest offered premium plan, not by using the premium of the plan in which the individual chose.
Example: Jane’s annual household income is $30,000. 9.5% of her household income = $2,850 (.095 x 30,000). To be eligible for a tax credit or other financial assistance, Jane’s annual premium for the lowest cost plan at WSU would have to exceed $2,850 per year. For 2014, the lowest premium plan offered through WSU will be $21 a month, equating to $252 a year, which is approximately .84% of her annual income. Since this amount is lower than 9.5%, Jane’s employer plan meets the “affordability” standard, and she would not be eligible for a tax credit.
8. What is the "Minimum Value" Standard
The minimum value standard requires each plan’s share of the total allowed benefit costs covered by the plan to be no less than 60 percent of the allowed costs. Meaning, all plans must pay at least 60 percent of covered service costs while you would pay no more than 40 percent of covered service costs.
Example: Bill has seen a covered doctor under his plan and received covered services. After his visit, he receives a $500 bill. If his plan pays at least $300 of this bill (.60 x 500), leaving the the remaining $200 (.40 x 500) for Bill to pay, it will meet the “minimum value” standard.
Note: the provider you are seeing and the services being performed must be covered by your insurance provider. Always contact your provider for questions on provider networks and covered services.
9. When does open enrollment for the Marketplace begin and when will I be covered?
Open enrollment for the Marketplace begins October 1, 2013, for coverage starting as early as January 1, 2014. Open Enrollment will close March 31, 2014 for 2014 coverage.
The Marketplace open enrollment should not be confused with the annual open enrollment period for Public Employees Benefit Board (PEBB) plans, which will occur during the month of November, 2013, with a January 1, 2014 effective date.
10. Is open enrollment for the Marketplace and open enrollment for PEBB coverage at the same time?
No. The Marketplace open enrollment should not be confused with the annual open enrollment period for PEBB plans. PEBB open enrollment will occur November 1 through November 30, 2013 for coverage effective January 1, 2014.
11. What key dates do I need to know?
For the Marketplace:
- October 1, 2013: Marketplace open enrollment starts
- January 1, 2014: Health coverage can start
- March 31, 2014: Open enrollment ends For
For PEBB coverage:
- November 1 - 30, 2013: PEBB Open Enrollment
- January 1, 2014: Effective date of any changes made during Open Enrollment
For Student employees:
- Contact Health and Wellness for information as to when you are able to enroll in the student insurance coverage
12. What if I need coverage that starts before January 2014?
HealthCare.gov can help you review possible options prior to January, 2014, but some of the rights and benefits of the regular Marketplace coverage may not apply yet.
If you are eligible for coverage through your employment or student status with WSU, you can also review those options. Additionally, you can determine if you are eligible for coverage under a spouse, registered domestic partner, or parent’s plan, as well as also determining is something ay be available on the private market.
13. If I am already covered and satisfied with my WSU coverage, do I need to do anything?
No. The new health insurance Marketplace is intended to assist individuals and families who need to enroll in coverage or would like to compare their current coverage to newly offered plans. If you are currently satisfied with your WSU coverage, no further action is needed.
14. What if I’m a part-time employee without health coverage?
If you’re a part-time worker without employer sponsored coverage, you may be able to buy health insurance in the Marketplace and get lower costs based on your income.
If WSU has not offered you employer sponsored coverage
If you’re a part-time employee and WSU has not offered you health insurance, you can use the Health Insurance Marketplace to find a plan. You may be able to get lower costs on your monthly premiums and out-of-pocket costs based on your household size and income. You may also qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). You’ll learn if you qualify for these options when you fill out your Marketplace application. You can apply as soon as October 1, 2013. Coverage begins as early as January 1, 2014. If
WSU has offered you employer sponsored health coverage as a part-time employee, but you have declined it
If WSU has offered you employer sponsored coverage and you have waived participation in that coverage, you may buy insurance through the Marketplace instead. But in most cases you won’t be able to get lower costs based on your income. You would be eligible for lower costs only if the coverage WSU offered wasn’t considered affordable to you or doesn’t meet certain minimum standards. WSU’s coverage meets both these standards. If you have previously waived coverage through WSU, and expected to continue to be employed with WSU in a benefit eligible position in 2014 or later, you can take advantage of PEBB open enrollment during the full month on November, with a January 1 coverage effective date. Student employees should contact Health and Wellness Services regarding future enrollment options for their plan.
15. What if I’m losing my employer sponsored coverage?
If you lose your WSU employer sponsored coverage, you have two primary options for health insurance coverage: a Marketplace plan or COBRA continuation coverage. Learn more at HealthCare.gov You may also investigate if you are eligible to be covered under a spouse, partner or parents plan.
16. What if I currently have COBRA coverage?
If you have COBRA continuation health coverage, you may keep it — or decide to buy a Marketplace insurance plan. Open enrollment for the Marketplace starts October 1, 2013 and if you select a plan by December 15, you can have coverage starting January 1, 2014. Learn more at HealthCare.gov
