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Q. Is it true that every Texan must now have health insurance? What will happen if I dont get health insurance? A. The new law requires most Texans and legal immigrants to have health coverage by 2014. If you dont, you will pay a tax penalty. For adults, the penalties are these: 2014: $95 or 1 percent of income 2015: $325 or 2 percent of income 2016: $695 or 2.5 percent of income After 2016: The dollar amount increases with inflation. For children, the dollar amount of the penalty is half the numbers above. For a family, the penalty will be no more than $2,085, which is 2.5 percent of income or three times the penalty for one adult in 2016. In those states where Medicaid is not expanded, some people who cant afford to purchase health insurance wont have to pay the tax penalty. Q. How does the new law help me now? A. A new insurance pool, called the Pre-Existing Condition Insurance Plan (PCIP), allows uninsured people to buy coverage, even if they have a preexisting condition. Uninsured Texans even cancer survivors or those with illnesses like diabetes or high blood pressure can get the coverage they need. For more information, visit www.pcip.gov.
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Here are a few answers to many of the questions Texas patients have asked their doctors.
Dont see your question here? Go to MeAndMyDoctor.com and ask your question.
What If Im on Medicare?
Q. Will it be easier for seniors to find a doctor? A. No. In fact, the new law did nothing to fix a 10-year-old problem in Medicare. That problem is forcing doctors to limit the number of Medicare patients we see or even to quit taking Medicare patients. Your doctors are petitioning Congress to fix the problem so we can continue to care for our patients. Q. Will seniors get preventive services? A. Medicare now covers the entire cost of checkups and recommended screenings like colonoscopies and mammograms. Medicare patients will not have to pay any copay or deductible. Q. Does the new law affect the cost of prescriptions? A. The new law helps seniors on Medicare (Part D) prescription-drug plans by reducing their out-of-pocket costs for prescription drugs. The coverage gap, called the doughnut hole, will be gradually reduced until it goes away in 2020.
Q. How do I know if my children or I qualify for Medicaid? A. Currently, low-income people may qualify for Texas Medicaid if they fit into certain eligibility categories and have low enough incomes. The chart below shows the rules based on the federal poverty level (FPL) for 2012, with income examples for a family of three: Texas Medicaid Eligibility Percent of FPL Family of 3 Child: 0-1 years Child: 1-5 years Child: 6-19 years Working parent Pregnant woman Adult with disability 185% 133% 100% 26% 185% 77% Income Amount $35,316 $25,390 $19,090 $4,963 $35,316 $14,699
If you think you are eligible and wish to enroll, you can find links to the application information at www.healthcare.gov. Q. What decision did the Supreme Court leave up to each state to decide regarding Medicaid? The law told states that if they wanted federal Medicaid money, they had to cover more people under age 65, including, for the first time, childless adults. Families of three earning up to $25,390 or 133 percent of the FPL would qualify. However, the court ruled that states can decide not to expand their Medicaid enrollment but still keep their current level of federal Medicaid funding. With the expansion, about 2 million more Texans would get Medicaid. Without it, most of these Texans will remain uninsured because people with incomes below 100 percent of poverty are not eligible for subsidies to get coverage in the new health care exchanges.
What If Im on Medicaid?
Q. How can I find a doctor who takes Medicaid? A. Health reform did little to increase the number of doctors who take Medicaid. State budget cuts in the past two years have forced out even more doctors. Beginning in 2013, higher Medicaid payments to primary care doctors may help more participate in the program. Your doctors are working to find a solution. Q. Can undocumented immigrants get Medicaid or CHIP? A. The law has not changed. Medicaid coverage for undocumented immigrants is limited to emergency services. Under the Childrens Health Insurance Program (CHIP), undocumented immigrant women can enroll in the CHIP Perinatal Program to receive basic prenatal care so they have healthier babies.