KHN contributing columnist Michelle Andrews writes the collection Insuring Your Health, which explores well being care protection and prices.
To contact Michelle with a query or remark, click here.
This story additionally ran on NPR. This story may be republished at no cost (details).
Work necessities for Medicaid protection. Insurance plans that don’t meet well being regulation requirements. Changes to Medicare drug lists. As the bottom continues to shift on well being care protection, I reply readers’ queries this week about these three various kinds of plans.
Q: I’m in a state that’s wanting into work necessities for Medicaid. At sign-up time, can I merely inform the alternate that I intend to be ineligible for Medicaid by refusing to work and get the premium tax credit score to purchase a non-public plan on the insurance coverage market?
Federal well being regulation laws don’t clearly handle the state of affairs you describe, however the brief reply might be not, stated coverage analysts.
In basic, people who find themselves eligible for Medicaid — the federal-state well being program for low-income folks — or employer protection can’t qualify for federal tax credit that assist pay for premiums on plans bought on the medical health insurance exchanges.
This 12 months, Kentucky and Indiana grew to become the primary states to obtain federal approval to require some Medicaid recipients to place in 80 hours every month at a paid job, faculty or volunteer work, amongst different actions, to obtain advantages. Nearly a dozen different states have made related requests.
If you refuse to work, does that make you ineligible for Medicaid? The guidelines aren’t clear, stated Judith Solomon, vice chairman for well being coverage on the Center on Budget and Policy Priorities.
States may argue that somebody in your state of affairs is eligible for Medicaid, you simply have to satisfy the work necessities, stated Timothy Jost, an emeritus professor of regulation at Washington and Lee University in Virginia who’s an knowledgeable on the well being regulation.
Email Sign-Up
Subscribe to KHN’s free Morning Briefing.
There are different actions folks might take — or fail to take — the place this challenge may come up. “You could argue that someone is not eligible because they haven’t completed the Medicaid application or provided the required documentation,” Jost stated. “There are any number of requirements, but I can’t imagine someone saying they didn’t do those things and so they’re not eligible for Medicaid.”
Whatever the principles, it’s unlikely that many individuals might be able to think about taking this stance. To qualify for premium tax credit, your revenue have to be between 100 and 400 p.c of the federal poverty level (about $12,000 to $48,500 for one individual in 2018). But you’d additionally need to be eligible for Medicaid, typically with an revenue restrict of 138 p.c of poverty (about $16,750) in states that expanded protection to adults. In addition, the Medicaid work necessities in your state must apply to you.
Q: I misplaced my job final 12 months and my employer protection led to January. I purchased a brand new plan by that went into impact final month. I simply acquired coverage data, and it states that as a result of the plan doesn’t cowl main medical companies, I could need to pay further taxes to the federal government. I used to be advised that the plan didn’t cowl main medical however wasn’t advised about any taxes. Will I be fined subsequent 12 months?
It sounds such as you purchased a plan that doesn’t adjust to the Affordable Care Act’s necessities, and if that’s the case chances are you’ll certainly need to pay a penalty for not having complete protection once you file your taxes subsequent 12 months.
The tax regulation repealed the individual penalty for not having medical health insurance, however that provision doesn’t take impact till 2019. So, for 2018, chances are you’ll be charged the higher of $695 or 2.5 p.c of your family revenue.
The federal- and state-run marketplaces established by the ACA promote solely complete plans that cowl 10 important well being advantages, together with “major medical” companies like hospitalization and pharmaceuticals.
But some insurance coverage dealer web sites name themselves marketplaces too, stated Sabrina Corlette, a analysis professor at Georgetown University’s Center on Health Insurance Reforms. These firms might promote different insurance coverage merchandise like short-term or accident protection alongside complete plans that adjust to the regulation.
Ever because the well being regulation was handed, “There have been opportunistic companies trying to take advantage of consumer confusion to make money,” Corlette stated.
If you aren’t pleased together with your plan, you should still be capable to change. Losing your employer protection qualifies you for a 60-day particular enrollment interval to select a brand new plan. Since it seems you’re nonetheless in that window, you could possibly select a complete plan.
To make sure you’re utilizing your state’s official market, go to healthcare.gov and click on on “see if I can change.” That will take you to your state market, even for those who reside in one of many dozen or so states that run their very own exchanges.
Q: I picked a Medicare Part D drug plan that coated all of the medication I take. But as quickly as I acquired my first Novolin R prescription stuffed, they notified me that they don’t cowl it anymore. Can they simply change it like that?
Medicare drug plans can change their checklist of coated medication, referred to as formularies. If they’re doing so at the beginning of the brand new calendar 12 months, as seems to have occurred in your case, the plan might notify you of the change once you fill the prescription for the primary time within the new 12 months. At that point, the plan would sometimes offer you a 30-day “transition” refill so you’ll be able to change to a different drug that’s on the formulary, in keeping with Juliette Cubanski, affiliate director of the Program On Medicare Policy on the Kaiser Family Foundation. (KHN is an editorially impartial program of the inspiration.)
If you and your physician assume it’s vital that you’ve got Novolin R and never one other drug that’s related, you’ll be able to ask your plan to make an exception to assist you to proceed to take the treatment.
To go that route, you would wish to get your physician to “make the case for why that formulary drug is not the right drug” for you, stated Casey Schwarz, senior counsel for training and federal coverage on the Medicare Rights Center, an advocacy group.
Michelle Andrews: @mandrews110
Related Topics Insurance Insuring Your Health Medicaid Medicare The Health Law Federal Exchange State Exchanges Tax Penalties src=”http://platform.twitter.com/widgets.js” charset=”utf-8″>