Quiz 3

My 26th birthday is next week and I will lose coverage under my parent's plan at the end of this month. Open Enrollment has closed. What do I do now?

Apply for COBRA, apply using the Marketplace, or apply for Medicaid

Are there exemptions to the penalty? What are they?

Are incarcerated, are American Indian, don't make enough money to fill a tax return, cannot afford coverage, are not a US citizen

When can I enroll in Medicaid through the Marketplace?

At anytime during the year

When can small employers enroll in coverage through the SHOP Marketplace?

At anytime during the year

I have COBRA and it's too expensive. Can I drop it during Open Enrollment and enroll in a Marketplace plan instead?

If it is during open enrollment, yes. Dropping COBRA after open enrollment will not trigger a special enrollment opportunity

My employer health plan has a wellness feature that requires me to pay a higher premium if I don't meet certain health targets or if I don't participate at all. I can't afford the premiums if I don't participate or miss the mark. Can I leave my employer-sponsored plan and get one on the health insurance Marketplace?

If the program makes the coverage premium more than 10% of you income than yes, and you qualify for premium tax credit in the Marketplace

I'm behind on my payments and trying to catch up, but meanwhile I got sick and so had to make more health care claims. Does my health plan have to pay them?

If you are receiving premium advanced tax credit and it is within the first 30 days then yes

I live in State A but my small business is in State B. I want to buy group coverage for my employees through the SHOP Marketplace. In what state should I buy health benefits?

In state B, where the business is located

Can I be charged more if I have a pre-existing condition?

No

I'm under age 26, covered on my parent's plan as a dependent, and I'm getting married. Does my parent's plan have to cover my spouse?

No, Your parent's plan is not required to cover your spouse

Will covered benefits under all Marketplace plans be the same? How can I compare?

No, all plans provide a summary of basic coverage that can be compared

Can I buy a plan in the Marketplace if I don't have a green card?

No, but you can buy insurance outside the marketplace

If I qualify for a premium tax credit, can I use that to reduce my cost of a Catastrophic Plan?

No, catastrophic health plans are not eligible for premium tax credits

If I live overseas, do I still have to buy coverage in the U.S.?

No, if you are a resident of the country for a full calendar year

I lost coverage March 15 and didn't get new coverage until April 1. Am I considered uninsured for the month of March because I lacked coverage for part of the month?

No, if you are covered even one day during a month, you are considered to be insured for that month

I don't have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

No, insurance companies are required to provide multiple payment options

I live in a state that didn't expand Medicaid eligibility, I have low income, and I was uninsured this year. Do I have to apply to the Marketplace for an exemption?

No, low income individuals in states that did not expand medicaid can apply directly on their tax return

I've picked the plan I want. Now do I send my premium to the Marketplace?

No, premiums go directly to the insurance company

I can't afford the cost of a stand-alone dental plan in addition to buying major medical health insurance. Will I owe a penalty for not having Minimum Essential Coverage if I don't buy the separate dental plan?

No, the pediatric dental plan is not required

It looks like pediatric dental benefits are only offered through stand-alone plans in my state Marketplace. Will my tax credit premium cover the cost of the stand-alone dental plan?

No, the tax premium will not be increased to cover dental plans

Are multi-state plans available in and out of the Marketplace?

No, they are only available in the marketplace

I signed up for a Bronze plan with a high deductible during Open Enrollment. Now, six months later, I need surgery and would rather be in a different plan with a lower deductible. Can I change plans?

No, unless the open enrollment period is before then

I didn't apply for a hardship exemption from the Marketplace during Open Enrollment. Is it too late to apply for a hardship exemption for this year?

No, you can apply through the Marketplace at any time during the year, or apply on your tax return

Do my parents have to claim me as a tax dependent for me to be on their health plan to age 26?

No, you do not have to be a tax dependent to be a health care dependent

Do I have to live in my parents' home to be covered as a dependent under their policy?

No, you do not have to live in their house to be claimed as a dependent

I have COBRA and am finding it difficult to afford, but Open Enrollment is over. Can I drop my COBRA and apply for non-group coverage outside of Open Enrollment?

No, you will have to wait until open enrollment

If I sign up for a multi-state plan and then need to get care while I'm in a different state, can I count on being able to find in-network providers in another state?

Not necessarily, but consumers can be reimbursed for care for the providers in Blue Cross Blue shield

I'm covered as a young adult dependent on my parent's policy now, but my 26th birthday is next summer, at which point I won't be eligible for dependent coverage any longer. Should I apply for Marketplace health plans and subsidies now, during Open Enrollment?

Once you turn 26 you will be eligible for a special enrollment period, until then you can stay on your parents plan

I live in different states during the year. My summer home is in a northern state; my winter home is in a southern state. Where do I sign up for health coverage? And if I sign up for a plan in one state, how do I find in-network health providers in the other state?

Register in the state where your car is registered, and you are registered to vote, consider a plan that is easily transfers between states

I'm covered as a dependent under my parent's plan and I'm pregnant. Will my parent's plan cover my prenatal care and delivery? Will my parent's plan cover my baby after he's born?

Under a small employer plan prenatal and delivery is probably covered Under a large employer plan prenatal care may be covered but delivery is not required to be covered Neither plan will cover the baby as a dependent, however the child may be eligible for CHIP

Can I buy or change private health plan coverage outside of Open Enrollment?

Under special circumstances such as loss of eligibility, gaining a dependent, moving to another state, etc., yes

Does a student health plan count as Minimum Essential Coverage?

Yes

We buy health coverage in our state Marketplace and our son attends college in a different state. We want to cover him on our policy. Can we do that?

Yes

My parents are self-employed and buy coverage through the Marketplace. They earn too much to qualify for subsidies. I'm 24 and only earn $30,000 a year (about 255% of FPL.) My parents don't claim me as a tax dependent, I file my own return. Can I be covered as a dependent under their Marketplace policy? If so, can I qualify for a premium tax credit and apply that to their premium?

Yes you can be covered as a dependent until 26, Yes if you qualify for a premium tax credit it can be applied to their policy

I was in jail for 4 months awaiting trial and ultimately was exonerated. During that time I was also uninsured. Do I owe a penalty for the months I was in jail?

Yes, an exemption for incarcerated people does not apply to those awaiting trial

I signed up for a health plan at the beginning of Open Enrollment, then changed my mind. Can I switch to a different plan as long as the Open Enrollment period hasn't yet ended?

Yes, as long as the open enrollment period is still open.

My employer offers a workplace wellness program that increases premiums for employees who can't meet certain health targets, such as normal weight or blood pressure. Is this allowed?

Yes, as long as the program meets certain standards

My employer offers a workplace wellness program that increases premiums for employees who don't participate. The program doesn't require people to meet health targets or attend classes, but does require people to answer questions about personal health and lifestyle and to grant access to our medical records. Is this allowed?

Yes, as long as the program meets certain standards

I'm eligible for health benefits at work but want to see if I can get a better deal in the Marketplace. Can I do that?

Yes, but you may not qualify for premium tax credits

I'm 24 and I used to be covered as a dependent on my parent's policy. I dropped off last year when I found other coverage, but now I've lost that other coverage and want to get back on my parent's policy. Can I do that?

Yes, but your parents policy must offer a special opportunity to re-enroll that lasts at least 30 days

I'm buying coverage on the Marketplace for my family. I notice many health plans don't cover pediatric dental care, but there are also stand-alone dental plans for sale. Is that allowed?

Yes, each marketplace can decide what it requires all insurers to cover

I'm leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?

Yes, for a period of 60 days if you do not apply for COBRA through your previous employer

My income is very low, so I'm only required to pay about $30/month for my health insurance premium. The tax credit picks up the rest, which is more than 90 percent of the total premium. I've missed 4 premium payments in a row. Can the insurance company cancel my coverage even though they got 90 percent of the payment on time from the IRS?

Yes, if the amount owed by the insured is not paid in full by then end of the 90 day grace period

I smoke cigarettes and I buy my own health insurance. Can I be charged more because I smoke?

Yes, in most states

I'm a foreign student studying in the U.S. Does the requirement to have health coverage apply to me?

Yes, international students are not automatically exempt but may qualify for exemption for another reason

I'm an American college student and I plan to study abroad next semester. Am I required to have U.S. health insurance while I'm living in another country?

Yes, only those with a taxed home outside the US are exempt

I'm uninsured. Am I required to get health insurance?

Yes, or there will be a tax penalty

I'm covered under my parent's policy but I'm moving to another state. Can I remain covered as a dependent?

Yes, under 26 you can remain a dependent regardless of where you live, but it may be difficult to find providers

Can be charged more because of my age?

Yes, within limits

I just got a job that offers health benefits, but my parent's policy is better and less expensive to me. Can I stay on my parent's policy?

Yes, you can stay on your parent's policy

I'm going to a college that offers a student health plan. Can I stay covered as a dependent on my parent's policy or do I have to take the student health coverage?

Yes, you can stay on your parents' plan

I just moved from State A to State B. I don't have a permanent home yet, am staying with a friend until I find a job and can get settled, but I need health insurance right away. How can I establish/document residency in State B?

You don't need a permeant residence, The Marketplace will accept the applicant's address without verification

Does my student health plan have to cover contraceptives?

a fully insured plan does, a self-insured plan may not

What is the Cadillac tax?

a tax on high cost insurance offered by employers

Who can buy a Catastrophic Plan?

adults under 30, older adults who can't find a health plan that costs less than 8.1% of their income

What health plans are offered through the Marketplace?

all health plans that cover essential benefits, limit cost-sharing (deductibles and co-pays), and satisfy the ACA

I'm 59, my spouse is 55, and our kids are 24, 17, 15, and 13. What age premium will we be charged for health insurance in the Marketplace?

family premiums will reflect adult prices for those over 21 and chill prices for those under 21

Do I have to prove eligibility for a special enrollment period?

for some life events you will have to provide documentation

On what grounds can I apply for a hardship exemption to the individual mandate?

if applying for coverage would cause the applicant to be deprived of food or shelter or if they have experienced difficult financial or domestic circumstances

How do I prove that I had coverage and satisfied the mandate?

insurance companies will provide an 1095-B form that will serve as proof

Is dental coverage an essential health benefit?

it is an essential benefit for children but not adults

How can I find out if my doctor is in a health plan's network?

look in the directory provided by the Marketplace

Can I pay my health insurance premium with a credit card, debit card, money order, or cash?

many insurers accept all these forms, but it varies

What happens if I end up needing care from a doctor who isn't in my plan's network?

most plans will cover part of ht cost but it will be more expensive for you

What is a Catastrophic Health Plan?

once that covers essential benefits and has the highest cost sharing, but has a high deductible

What is a multi-state plan?

one that is approved to participate in the health insurance marketplace by a federal agency

How do I find my state Marketplace?

online at healthcare.gov

I had several short coverage gaps in a year - I was uninsured in March, then again in August. Since the total gap was less than 3 months, am I exempt from the penalty?

only the length of the first coverage gap will be considered

What health benefits are covered under Marketplace plans?

outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and disorder services, prescriptions, lab work, preventative services, pediatric services

I'm enrolled in student health coverage now, but now I think I can get a better deal in the Marketplace. Can I drop student health plan coverage and go to the Marketplace instead?

outside of open enrollment no, unless you involuntarily lose student coverage, during open enrollment, yes

I also notice "Catastrophic Plans" that look even cheaper. What are those and can I buy one if I want?

plans with the highest deductible, where the insurance won't pay until you've reached a certain level for the year, they are only available for certain people who meet the requirements

How long after I enroll in a plan will coverage take effect?

the first day of the month that is at least 15 days after the day you bought coverage

I live in one state but drive across the border to a different state to work everyday. Which marketplace should I use to buy coverage?

the state you live in

Are multi-state plans available in every state?

they are available in 22 states

I notice Marketplace plans are labeled "Bronze," "Silver," "Gold," and "Platinum." What does that mean?

they are labeled based on the cost-sharing, the higher plan the less cost sharing, the higher the deductible

Who can buy coverage in the Marketplace?

those living in the state where they are purchasing coverage, legally and lawful i the United States, and non-incarcerated

How do I apply for an exemption?

through the Marketplace or on a tax return

I'm about to turn 19 and I'm covered under my parent's health plan as a dependent. How long can I stay covered as a dependent?

until age 26

How can I find out if a health plan covers the prescription drugs that I take?

use the formulary (list of prescription drugs) provided by the Marketplace

If I owe a penalty, when and how do I have to pay it?

via tax return when you file it

Can I be covered under my parent's plan if I'm married?

yes, as long as you are under 26

How is the "permanent move" special enrollment period changing?

you are only eligible for special enrollment if you were enrolled in your previous state unless you were previously incarcerated, a new citizen or your previous state did not expand medicaid eligibility

My spouse and I want to cover our 25-year-old son as a dependent on our policy. We have no other children. We don't claim him as a dependent, he doesn't live with us, and he has a job. We also have modest income and hope we can qualify for premium tax credits in the Marketplace. Do we have to count our son as a member of our household when we apply? Do we have to count his income when we apply?

you be counted as separate household, your premium tax credit will be calculated and then applied to the family policy you apply for to reduce what you owe

I'm eligible for the student health plan but haven't signed up yet. Do I have to take that or can I apply for coverage and subsidies in the Marketplace?

you can always apply through Marketplace, even if you are eligible for a student plan

What is the health insurance Marketplace?

Also known as exchanges, organized and competitive place to shop for health insurance, offer health plans, certify those health plans and provide assistance choosing a plan

What's the penalty if I don't have coverage?

A flat amount or a percentage of household income, whichever is greater

When can I enroll in private health plan coverage through the Marketplace?

During the open enrollment period, November- January

Can my brother (or my church or another third party) pay my portion of the monthly health insurance premium for me?

It depends on your health care plan

Does a student health plan have to cover essential health benefits?

It does if it is a fully insured student plan

I'm a young adult and I need health insurance. What are my coverage options?

Medicaid, being a dependent until age 26, buying a policy through the Marketplace, catastrophic policies, coverage through the University in attendance

Since the 2016 election there has been a lot of talk about repealing Obamacare. Is Open Enrollment for 2017 coverage still happening? Does it still make sense to sign up?

Open enrollment is still happening in 2017. Insured would not be subject to changes made mid year

What is a student health plan?

Special policies offered by the University the student is attending

I'm a part-time student. Does my college have to let me enroll in the student health plan?

That decision is up to the university

What happens if I'm late with a monthly health insurance premium payment?

The insurance company can withhold coverage after the first 30 days and terminate coverage after 90 days if you are receiving advance premium tax credit