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Affordable Care Act FAQs

1. Why do I need health insurance?

It protects you and your family financially in the even of an unexpected serous inllness or injury that could be very expensive. In addition, you are more likely to get routine and preventive care if you have health insurance. If you do not have health insurance, you will have to pay a fine/tax. Further information on the fine/tax can be found here.

2. What is the health insurance Marketplace?

Under the ACA, states may have set up their own Marketplace or elected to offer the Federal Marketplace. The Marketplace offers one-stop shopping to find and compare medical health insurance options offered by private companies or facilitates enrollment through that states medicaid plans for those who qualify. The Marketplace will also determine initial eligibility for premium tax credits. Individuals who are not eligible for coverage through their employer will benefit the most from this program and its services.

3. How do I get additional information about the Marketplace, based on the state in which I reside?

The Marketplace simplifies the search for health coverage by gathering the options available in your area in one place. You can compare plans based on price, benefits, quality, and other features important to you before you make a choice.
Visit www.HealthCare.gov (with a live chat option) or also get help by phone, or in person. Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325).

4. How can I get an estimate of costs and savings on the Marketplace health insurance?

Please see each state’s own health insurance Marketplace website for each states estimate of cost. Remember to visit the states Marketplace in which you reside.
You can find your states Marketplace website by clicking the link below: https://www.healthcare.gov/what-is-the-marketplace-in-my-state/

5. Can I save money on my health insurance premiums in the marketplace?

You may qualify to save money and lower your premium, but only if your employer does not offer you coverage, or offers you coverage that doesn’t meet certain standards. If you qualify for a discount through the Marketplace, the amount of premium discount is based on the household income.

6. Does being eligible for medical coverage through my employer affect eligibility for premium savings through the Marketplace?

Yes.

Employees eligible for PEBB employee coverage

If you are currently eligible for the employer provided coverage and have been offered PEBB health coverage from WSU, you will not be eligible for a tax credit through the Marketplace. This is due to PEBB coverage meeting the ACA requirements of premium affordability and providing minimum standard level of coverage. Therefore, most employees will not elect to waive their PEBB medical coverage to enroll in coverage through the Marketplace, since they will not experience a tax credit benefit.

However, if the cost of a PEBB health plan to cover you (and not any other members of your family) is more than 9.66% of your annual household income, you may be eligible for a tax credit or other financial assistance. This is referred to as the “affordability” standard of the ACA, and the PEBB option(s) meet this standard.

An individual could also be eligible for a tax credit or other financial assistance if their employer-sponsored health plan does not meet the “minimum value” standard, another requirement set by the ACA. This standard requires the insurance plan to coverage no less than 60 percent of the total allowed benefit cost. All PEBB plans meet or exceed the “minimum value standard.”

Employees NOT eligible for PEBB coverage

Employees who are not eligible for insurance coverage through their employment with WSU or do not have insurance coverage elsewhere should consider enrolling in health insurance through the Marketplace. You may qualify for a premium tax credit or other financial assistance.

Students

If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan.

You may be eligible for a tax credit that lowers your premium and reduces certain cost-sharing if your employer does not offer coverage or does not offer coverage that meets certain standards. However, you may not be eligible for a tax credit, if the cost of a plan to cover just you is more than 9.66% of your annul household income or if the coverage does not meet the “minimum value” standard set by the Affordable Care Act.

Graduate Students (Assistants, or Research Fellow/Trainee/Intern) may be eligible for the employer-paid graduate plan. Students under the age of 26 may also be able to be covered under their parent’s insurance plans. The GSA plans has been structured to meet the “minimum value” standard level of coverage requirements as identified under the ACA. Student employees may wish to review which of the plans may be the best option for them.

7. What is the “Affordability” Standard

The affordability standard states that if the annual premium cost of an employer sponsored health plan to cover you (and not any other members of your family) is more than 9.66% of your annual household income, you may be eligible for a tax credit or other financial assistance. The amount of the annual premium is calculated by taking the employers lowest offered premium plan, not by using the premium of the plan in which the individual chose.

Example: Jane’s annual household income is $30,000. 9.66% of her household income = $2,898 (.0966 x 30,000). To be eligible for a tax credit or other financial assistance, Jane’s annual premium for the lowest cost plan at WSU would have to exceed $2,898 per year. For 2016, the lowest premium plan offered through WSU will be $21 a month, equating to $252 a year, which is approximately .84% of her annual income. Since this amount is lower than 9.66%, Jane’s employer plan meets the “affordability” standard, and she would not be eligible for a tax credit.

8. What is the “Minimum Value” Standard

A health plan meets this standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population, and if its benefits include substantial coverage of inpatient hospital and physician services.

9. When does open enrollment for the Marketplace begin and when will I be covered?

Each fall the Marketplace will have an Open Enrollment period. They are expected to gor from October 1st – December 15th each year. New benefits will be effective the following January 1st. As these dates may change, please check with www.healthcare.gov for additional details.

10. Is open enrollment for the Marketplace and open enrollment for PEBB coverage at the same time?
No. The Marketplace open enrollment should not be confused with the annual open enrollment period for PEBB plans. PEBB open enrollment will occur November 1 through November 30 each year for coverage effective the following January 1st.

13. If I am already covered and satisfied with my WSU coverage, do I need to do anything?

No. The new health insurance Marketplace is intended to assist individuals and families who need to enroll in coverage or would like to compare their current coverage to newly offered plans. If you are currently satisfied with your WSU coverage, no further action is needed.

14. What if I’m a part-time employee without health coverage?

If you’re a part-time worker without employer sponsored coverage, you may be able to buy health insurance in the Marketplace and get lower costs based on your income.

If WSU has not offered you employer sponsored coverage:
If you’re a part-time employee and WSU has not offered you health insurance, you can use the Health Insurance Marketplace to find a plan. You may be able to get lower costs on your monthly premiums and out-of-pocket costs based on your household size and income. You may also qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). You’ll learn if you qualify for these options when you fill out your Marketplace application.

If WSU has offered you employer sponsored health coverage as a part-time employee, but you have declined it:
If WSU has offered you employer sponsored coverage and you have waived participation in that coverage, you may buy insurance through the Marketplace instead. But you may not be able to get lower costs based on your income. You would be eligible for lower costs only if the coverage WSU offered wasn’t considered affordable to you or doesn’t meet certain minimum standards. If you have waived coverage through WSU you can take advantage of PEBB open enrollment during the full month on November, with a January 1 coverage effective date.

15. What if I’m losing my employer sponsored coverage?

If you lose your WSU employer sponsored coverage, you have two primary options for health insurance coverage: a Marketplace plan or COBRA continuation coverage. Learn more at HealthCare.gov. You may also investigate if you are eligible to be covered under a spouse, partner, or parents plan.

16. What if I currently have COBRA coverage?

If you have COBRA continuation health coverage, you may keep it — or decide to buy a Marketplace insurance plan. Open enrollment for the Marketplace is every fall with coverage beginning the following January 1st. Learn more at HealthCare.gov

Washington State University