FAQ

Frequently Asked Questions .. for Presenters

1. Questions with easy answers 2. Questions with longer answers NOTE: Kaiser Family Foundation has an excellent searchable list of FAQs: http://kff.org/healthreform/faq/health-reform-frequently-asked-questions/

1. Easy Answers
Does the ACA affect Medicare Supplemental insurance? Does it affect Veterans insurance? NO. Those rates are set by the CT Dept of Insurance. Those with concerns should contact groups like the Center for Medicare Advocacy
(860) 456-7790 http://www.medicareadvocacy.org/

NO. Although vets who are currently uninsured could get covered through Access Health CT. healthcare.gov factsheet on veterans:
https://www.healthcare.gov/if-im-a-military-veteran-what-do-i-need-to-knowabout-the-marketplace/

Does the ACA affect what Medicare reimburses providers, so that more will take Medicare? Does the ACA affect what Medicaid reimburses providers, so that more will take Medicaid?

NO. The reimbursement issue is separate and gets periodic temporary fixes. YES. Medicaid reimbursement for primary care providers goes UP to the Medicare rate for 2013 and 2014 just those 2 years. This does not include federally qualified health centers which already get higher reimbursement rates.
Source: Kaiser Family Foundation: Increase Medicaid payments in fee-forservice and managed care for primary care services provided by primary care doctors (family medicine, general internal medicine or pediatric medicine) to 100% of the Medicare payment rates for 2013 and 2014. States will receive 100% federal financing for the increased payment rates. (Effective January 1, 2013)

Am I responsible for updating Access Health CT when there are changes in my income or family size?

Can I buy insurance on Access Health CT if I am on COBRA now? Are undocumented immigrants eligible to purchase insurance on Access Health CT directly, as individuals or families?

YES. Its important to update if you qualify for discounts and your eligibility changes much during the year. Not reporting increased income or fewer dependents, for example, could result in a big expense when you file your taxes the following year if you received discounts based on the old information. YES. It may well be cheaper, for comparable coverage, and you may be eligible for discounts No. Congress specifically prohibited undocumented immigrants from buying insurance coverage as individuals or families neither discounted nor at full price.

2. Longer Answers
Questions
If all these facts are true .. Why is my doctor opposed to the ACA? Why is Congress fighting Obamacare? Why is everyone so against it?

Answers

First, anticipate these reactions at the beginning by asking people to recognize that, out there, anyone can say anything they want for any reason, and on this issue we hear wild and crazy claims every day. Ask them to ignore all that during this session: here, we will focus on JUST THE FACTS. Docs and other providers are split, though primary care providers tend to be more supportive and specialists tend to be more skeptical, due to the ACAs focus on increasing primary care. Congress is, well, not always a truth-seeking body. While reasonable people can disagree about many aspects of the ACA, the scale of the deliberate misinformation campaign about health reform over several years is nearly unparalleled in our history. We believe that over time the facts will out, and thats why were all here today. Also, see fact-check sources below. How do I know if my health The list of providers doctors, hospitals, health centers etc. is provider is included in a specific available for review for each plan on insurance companies websites, insurance plan? which Access Health CT links to. When comparing plans, click on Check if your doctor is in-network. What are the life events will allow Examples are divorce, get/lose job, moving in/out of state, change in people to enroll outside of the open family size, etc. The 6-month open enrollment is only for the first year likely Oct 1 to Dec. 15 in enrollment periods?
future years.

How will fraud be prevented?

How does Dental insurance work?

When people apply, they will not be able to use fake income info because the Access Health CT system will be connected to the IRS. Citizenship will be checked with the INS. For adults, standalone dental plans are available through Access Health CT, separate from health insurance plans. For children, health insurance plans are required to include pediatric dental and vision care. Discounts (subsidies) do not cover dental plans. Standalone plans -- Anthem for individual/family, Anthem and MetLife for small employers:
https://www.accesshealthct.com/AHCT/LoadAdultDentalCoverageAction.action (Click A licensed insurance broker )

How do we find out which Brokers Access Health CT has certified to help small employers sign up? Ditto: Who are the Assisters in our community?

Contact us for the list of brokers. Once brokers training and certification is complete, Access Health CT puts their information on their website here:
https://www.accesshealthct.com/AHCT/DisplayAssistanceSearch.action (click General help ...)

The Assister list continues to grow as they are certified and can be accessed here:

https://www.accesshealthct.com/AHCT/DisplayAssistanceSearch.action

Ditto: Navigators

What benefits do the plans cover?

Navigators work generally behind the scenes and most people dont need to contact them. We can provide the list with key contact people if needed. All plans sold through Access Health CT re required to cover all stateand federally-required essential health benefits. Federal benefits:
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/ehb-2-20-2013.html

Who can buy catastrophic coverage?

This coverage is cheaper, but has a deductible, except for certain preventive visits. In CT its a variant of the Bronze plan. People who can buy it include: People under age 30 People over 30 with low incomes People who have received hardship exemptions More info:
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Small employer questions of all kinds

Best resources:
Small Business Majority (SBM) Health Coverage Guide: http://healthcoverageguide.org/ SBM Reference -- index: http://healthcoverageguide.org/reference-guide/ IRS: http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-for-Small-Employers

Criteria for small employers who can buy on the SHOP exchange and get tax credits What information about employees will small employers need to provide when applying for coverage through the SHOP Exchange?

Simple factsheet:
http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-InsuranceMarketplaces/Downloads/job-aid-shop-eligibility.pdf

Just as today, small employers will provide basic information (name, date of birth, last 4 digits of Social Security numbers, employment status, date of hire and number of hours worked) when applying for small group coverage. The ACA does not impose additional requirements on small employers to provide information on the immigration status of their employees. CTs small employer application form:
http://www.accesshealthctsmallbiz.com/pdfs/broker/Health%20Coverage%20Appl ication%20for%20Employers.pdf

Large employer questions such as: How will it be determined that the insurance a large employer offers is not affordable and of sufficient quality? How will penalties be determined?

The presentation cant answer detailed questions about large employers (50 employees and over). Requirements and penalties have been delayed a year, to 2015. Refer to:
IRS:
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-for-Large-Employers

US Dept of Labor:
http://www.dol.gov/ebsa/healthreform%5C

Kaiser Foundation Infographic:

http://kff.org/infographic/employer-responsibility-under-the-affordable-care-act

I hear companies like WalMart are cutting employees hours below 30/week so they dont have to provide health care ..

For every story we hear about big employers trying to avoid providing insurance, there are examples like Cumberland Farms and Starbucks announcing plans to increase employee hours over 30 and providing them insurance. Since the penalties are delayed until 2015, this kind of churning and positioning will continue, and all of us can weigh in --

companies are sensitive to public pressure. Examples:

Walmart cutting hours: http://www.huffingtonpost.com/2012/12/01/walmart-health-care-policymedicaid-obamacare_n_2220152.html Papa Johns backing off cutting hours: http://www.forbes.com/sites/rickungar/2012/11/21/papa-johns-schnatter-sayshe-will-honor-obamacare-and-give-health-insurance-to-all-employees/ Cumberland Farms increasing hours: http://blogs.wsj.com/atwork/2013/06/10/what-makes-employees-stick-aroundone-company-has-an-answer/?mod=wsj_streaming_stream Starbucks increasing hours: http://money.cnn.com/2013/08/27/news/companies/starbucks-obamacareschultz/index.html Forever 21 denying cutting hours: http://losangeles.cbslocal.com/2013/08/19/forever-21-denies-cutting-employeeshours-due-to-obamacare/ Study: ACA limited impact on hours -- Health Affairs, Sept 9 2013: http://www.crainsdetroit.com/article/20130909/NEWS/130909881/studyobamacare-expected-to-have-little-impact-on-employer-sponsored#

Does the ACA apply to self-insured plans?

YES and NO Parts of the ACA apply to several different kinds of plans (outside of Access Health CT). Factsheet:
http://www.cms.gov/Regulations-and-Guidance/Health-InsuranceReform/HealthInsReformforConsume/index.html?redirect=/healthinsreformforcon sume/

What is reportable as income?

How will the IRS know I am covered? How will the penalty be levied? What if one spouse gets good coverage through their employer but the spouse and kids do not get that coverage or have high costs with coverage? What if I am covered through Access Health CT but my spouse refuses to get covered? How does the penalty get figured? Various erroneous claims about the ACA for your background

For calculations to determine eligibility for discounts, Access Health CT starts with your Adjusted Gross Income on your last tax filing. If your income is likely to be different in 2014, make a good estimate and plan to come back during the year if it changes much from that estimate. We hear it will be on the honor system the first year, with a more formal system in the future. It will be part of the federal income tax filing process. More info:
https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in2014/

The rest of the family should try to get coverage on Access Health CT or HUSKY. All children can get covered, regardless of income. Lower income families can get kids covered for free, and it doesnt cost much to pay the full amount of HUSKY. The penalty is $95 per year or 1% of household income (minus the first $10k), whichever is greater, for every individual not covered. The penalty for kids is about half the adult penalty. There are several excellent sources that debunk the claims:
Fact-check.org: http://www.factcheck.org/2013/08/obamacare-by-the-numbers/ Politifact.com: http://www.politifact.com/subjects/health-care/ (see pants on fire)