Q&A on health care exchanges and Obamacare

OK, so the rollout of the health insurance marketplaces created under the Affordable Care Act didn’t go so smoothly.

Technical glitches and heavy traffic occurred almost right away. Nonetheless, interest in the exchanges hasn’t waned. As open enrollment continues, many people will have questions about the marketplaces. Here are some queries I’ve received from readers.

Question: I have two granddaughters, 20 and 21. One is working part time for a small business and the other is a student. Neither currently has health insurance. If they enroll on the exchange by Dec. 15 and at some future date gain health insurance — either through marriage, with the spouse’s employer offering insurance coverage for the employee’s family, or through employment with an employer who provides health insurance to employees — can they drop out of the exchange? Will there be a penalty for dropping out?

If their status should change in the future — e.g., change to an employer who does not offer health insurance — will they be able to obtain insurance in the exchange again? Will they have to wait for an open enrollment period to apply?

Answer: One of the benefits of the Affordable Care Act is that it creates marketplaces to allow people to buy health insurance not connected to their employment. This means if you don’t have a job, lose a job or switch jobs, none of those actions will affect your ability to get access to health insurance and possibly insurance coverage that comes with subsidies to reduce your cost.

So to answer this grandmother, yes, both her grandchildren can get coverage. And if their status changes, they can drop their marketplace coverage. There will not be a penalty if they obtain other insurance. They would be eligible for a special enrollment period, or SEP, which allows people to change their insurance if they have a qualifying life event such as moving to a new state, getting married or divorced, or having a baby.

The marketplace special enrollment period begins 60 days before your individual coverage is terminated. If you wait until after you lose coverage, you have 60 days from the loss of the coverage to enroll in a new marketplace plan.

After this first open enrollment period — Oct. 1 to March 31 — consumers can enroll in the marketplaces from Oct. 15, 2014, to Dec. 7, 2014, for the following plan year.

Q: I was told that eligibility for subsidies would be based on my 2012 income. Is this true? This presents a huge problem for households where the breadwinner (in our case, me) has lost her job in 2013. If I don’t get a job, how am I going to afford both insurance for me and my husband on a much-reduced income? We won’t be eligible for a subsidy based on my 2012 income. This, too, is a glitch, if those tasked with informing the community are not fully informed themselves!

A: You were given incorrect information. If you aren’t sure about information you are receiving on the exchanges, always fall back on going to healthcare.gov or go to the website created by your state if it has its own marketplace. On healthcare.gov, search for the question “What income and household information do I provide when I apply for Marketplace coverage?” Here’s the direct link: tinyurl.com/ACAincomeinfo.

When you set up an account and apply for insurance on the exchanges, you’ll need to estimate your income for 2014. The information will also be used to determine if you qualify for a premium tax credit that will lower the cost of your insurance. In the income estimate you’ll include your salary, tips, net income from any self-employment or business, unemployment, Social Security payments, including disability payments (although but not Supplemental Security Income) and alimony. When estimating your 2014 income you will also have to include any retirement, investment and/or pension income, rental income and any other taxable income. You won’t have to include child support, veteran disability payments or worker’s compensation.

The overall income figure will be based on your modified adjusted gross income, or MAGI. But don’t worry if you don’t know your MAGI. When you fill out your application, the calculation will be done for you.

Q: I am a veteran and I get my health care through the Department of Veterans Affairs. I am wondering if my VA insurance counts as my insurance for the ACA?

A: You don’t need to make any changes if you have insurance through Tricare or the veterans health care program. For the purpose of the health care law, you’re considered covered.

Michelle Singletary: michelle.singletary@washpost.com.

Washington Post Writers Group

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