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What About Me?

We all have unique questions regarding Affordable Care. Find a scenario below that fits your specific situation. It's all right if you don't fit into one of these categories! Contact us to help guide you through YOUR specific situation.




I am 23 and just graduated from college. Can I stay on my parent’s health insurance even though I am no longer a student?

The Affordable Care Act requires private insurers to continue dependent coverage of children until age 26 under the dependent coverage extension. A young adult can qualify for this dependent coverage extension even if he or she is living with a parent, is not a dependent on a parent's tax return, or is no longer a student. Both married and unmarried young adults can qualify for the dependent coverage extension, although that coverage does not extend to a young adult’s spouse or children.



I am 62 years old. I want to retire, but I don’t qualify for Medicare yet. My wife and I also both have health issues. I have heard that insurance companies will no longer be able to turn me down because of pre-existing health conditions. Is this true?

Starting on January 1, 2014, all health insurance companies will have to sell coverage to everyone who applies no matter what their medical history or health status is. Also, insurance companies will not be allowed to charge more to individuals with pre-existing health conditions, and they will not be able to exclude coverage of those conditions from insurance plans they sell.



We have a family of four and our household income is $55,000. Will we qualify for any premium tax credits or subsidies to make our health insurance more affordable?

The vast majority of people who will be eligible for premium tax credits—about 88 percent—will be in working families.

Starting in 2014, the premium tax credits will be available to U.S. citizens and legal immigrants who purchase coverage in the insurance exchanges and who have incomes between 138 and 400 percent of poverty (between $15,860 and $45,960 for an individual, and between $32,500 and $94,200 for a family of four in 2013). To be eligible for the premium tax credits, individuals must not be eligible for public coverage—including Medicaid, the Children's Health Insurance Program, Medicare, or military coverage—and must not have access to health insurance through an employer.

When a person or family qualifies for a tax credit, the dollars from the credit will flow directly to the health plan in which the individual or family enrolls, offsetting the total cost of the family’s health insurance premiums for that plan. The tax credits will be fully advanceable. This means that the tax credit will be available to pay the premium at the time the person enrolls in a plan. Thus, families will not need to wait until their taxes have been filed and processed in order to receive the credit and enroll in coverage, nor will they need to pay the full premium at the time of enrollment and then wait to be reimbursed.

Calculate your premium tax credit here.



I own a small business. How does the Affordable Care Act affect me?

Businesses with fewer than 50 employees are not required to offer health insurance to their employees and are exempt from penalties faced by larger employers that do not offer coverage.

From 2014 and every year after, eligible small businesses (25 or fewer full-time equivalent employees) that purchase group health insurance through an exchange may receive a tax credit of up to 50% of the employer's contribution toward the employee's health insurance premium. The credit phases out as firm size and average wage increases.



I heard that if I don’t have coverage on January 1, 2014 I will have to pay a penalty. Is that true?

Starting in 2014, most people will be required to have health insurance or pay a penalty if they don't. Coverage may include employer-provided insurance, coverage someone buys on their own, or a government program like Medicare or Medicaid. When you file your federal tax return each year, you'll be asked for proof of health insurance. If you don't have coverage, you will pay a penalty that increases every year. In 2014, the penalty is $95 per adult and $47.50 per child (up to $285 for a family) or 1% of income, whichever is greater.



I am confused. Am I buying health insurance from the government?

The Affordable Care Act is based on more people buying health insurance from private insurance companies — not from the government. The government’s role includes making sure these private plans meet standards for coverage and service, providing financial assistance for people who need it to buy insurance, broadening eligibility for public insurance programs, and encouraging efforts to improve quality and control costs.



I am a single mom with two part time jobs. What if I can't afford health insurance?

You should have access to more choices in health plans in 2014 that may allow you to find coverage that meets your needs and stays within your budget. You also may be able to qualify for the new premium tax credits to help lower your monthly premium, as well as for subsidies to help limit your out of pocket expenses. You’ll be able to see what your premium, deductibles and out-of-pocket costs will be before you make a decision to enroll.



I am 68 years old. I am on Medicare. I also have a Medicare Supplement and a Part D prescription plan. How will the Affordable Care Act affect me?

The Affordable Care Act gradually reduces the amount that Medicare Part D enrollees are required to pay for their prescriptions when they reach the coverage gap. When the coverage gap is fully closed in 2020, beneficiaries will be responsible for paying 25 percent of the cost of their prescriptions under the standard drug benefit. Medicare Part D plans will cover 75 percent of the cost of generic prescription drugs and 25 percent of the cost of brand-name prescription drugs, in addition to a manufacturer discount of 50 percent on brand-name drug prices for prescriptions filled in the coverage gap.



I am currently enrolled on Insure Oklahoma. Is it true that it is going away?

The Insure Oklahoma program is scheduled to expire at the end of 2014.Govenor Mary Fallin recently announced that Insure Oklahoma has been approved for a one-year extension from January 1, 2014 to December 31, 2014. There will be eligibility and coverage changes for the Insure Oklahoma program's individual plan or IP.



I have heard that Oklahoma is not setting up a health insurance exchange. Does that mean I won't have access to any health insurance exchange plans?

Yes. On November 19, 2012, Governor Mary Fallin announced that Oklahoma would not pursue the creation of a state-based exchange. However, the federal government has assumed full responsibility for running a health insurance exchange in Oklahoma in 2014. Multiple insurance companies are expected to participate in the federal health insurance exchange to give you many plan options.



I am 27 and I am no longer covered under my parents' health insurance. Will there be affordable health insurance options for me?

Young adults have historically been uninsured at higher rates than any other age group, not because of a lack of desire for health coverage but because they have lacked access to affordable health coverage. Many young adults who purchase health insurance through the federal exchange will qualify for financial assistance in the form of premium tax credits to lower their monthly premium and cost-sharing subsidies to reduce their out-of-pocket costs for covered benefits. The Affordable Care Act also includes out-of-pocket limits that are more generous at lower income levels. Finally, many of the preventive care services that young people need more frequently than other medical services will be covered at no cost, including birth control and yearly doctor's visits. The Affordable Care Act’s “catastrophic plans” are another option for young adults who might still find premiums in the non-group market unaffordable.



I find health insurance to be very confusing.  Will it be easy to compare plans on the health insurance exchanges?

Often people who buy health insurance have difficulty comparing health plans based on different benefits and out-of-pocket costs. In addition, it is often difficult to know, even once a person has a health plan, the entitled benefits and costs of services. One way to address this problem is to standardize the types of benefits and cost-sharing in health plans.

Beginning in 2014, private health insurers will need to meet new requirements for standardizing health insurance plans. Research has found that when people have too many health plans to choose from, it can be confusing. Standardization will help individuals and businesses make better-informed comparisons between different insurance plan options.

Under the Affordable Care Act, insurers will be required to offer plans that fit within four levels of coverage: Bronze, Silver, Gold and Platinum. Insurers don't have to offer plans in all four levels, but within the health insurance exchanges, all insurers must offer at least one silver and one gold plan.

All plans must cover certain essential health benefits, such as ambulatory services, emergency care, maternity care and prescription drugs. While the scope of benefits will be the same among the plans, the value of those benefits will vary across the bronze, silver, gold and platinum levels. This means the amount of cost-sharing required will differ in those tiers. Bronze plans will have the least generous coverage with more out-of-pocket costs for enrollees, and platinum plans will have the most generous benefits.

The four levels of coverage - bronze, silver, gold and platinum - are based on actuarial value, a measure of the level of financial protection a health insurance policy offers. It indicates the percentage of health costs that a health plan would pay for an average person. For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person. For a silver plan, the insurance would cover 70 percent. For a gold plan, the insurance would cover 80 percent and for a platinum plan, the insurance would cover 90 percent of all health care costs for an average person.

Starting in 2014, the Affordable Care Act provides premium tax credits and subsidies for people up to 400 percent of the federal poverty level (FPL) (about $94,200 per year for a family of four) who need help paying insurance premiums and out-of-pocket expenses. The amount of premium assistance each individual or family receives is related to the coverage tiers. The subsidy is based on the premium for the second lowest-cost silver plan available. A silver plan will cover 70 percent of the average costs, with the enrollee paying, on average, 30 percent. However, if an individual decides to purchase a gold or platinum plan, he or she will need to pay the difference between the premium credit amount and the cost of the more expensive plan.



I am an American Indian. How will the Affordable Care Act affect me?

As a Native American, you will have more options as well as certain protections starting January 2014.  As a Native American, if you enroll in a health insurance plan on the federal exchange, you will more easily qualify for lower out-of-pocket costs for deductibles, copayments and coinsurance.  You may also qualify for special monthly enrollment periods outside the yearly open enrollment period.  If you are eligible to receive medical care through the federal Indian Health Service, you will not be required to purchase health insurance or pay a penalty.  However, if you choose to enroll in a health insurance plan on the federal exchange, you can still keep receiving medical care through the federal Indian Health Service.