Q&A on Affordable Care Act in Virginia
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RICHMOND, Va. — Hundreds of thousands of Virginians lacking health insurance can start enrolling Tuesday in the health insurance marketplace created through the federal Affordable Care Act. To receive benefits at the start of 2014, consumers must enroll by Dec. 15.
Virginia is among 36 states in which the federal government is running all or part of the health benefits exchange. Following are some questions and answers about key elements of the act in Virginia.
WHAT IS A HEALTH CARE EXCHANGE?
It’s created by the federal Affordable Care Act. The online marketplace allows for side-by-side comparison of coverage options before enrolling.
HOW MANY VIRGINIANS LACK HEALTH INSURANCE?
An estimated 844,753 are uninsured and eligible for coverage through the marketplace, according to the U.S. Department of Health and Human Services. The largest percentage of uninsured — 333,428 individuals or 39 percent of all uninsured people— are between the ages of 18 and 34.
WHO IS SELLING IT IN VIRGINIA?
Virginians will get to choose from an average of 47 different health plans in the marketplace. People can choose from four levels of coverage — bronze, silver, gold and platinum. The big difference is cost sharing. Bronze plans have the lowest premiums, while platinum have the highest. But low premiums could result in big bills later if your expenses exceed what’s considered reasonable.
HOW MUCH WILL IT COST?
The average premium, without tax credits, would be $237 a month for the lowest-cost bronze plan and $335 a month for the second-lowest silver plan.
For a family of four making $50,000, a midrange plan, after tax credits, would be $282 a month under the second-lowest silver plan. Without a tax credit, $799.
For a 27-year-old person earning $25,000 a year, the premium would be $80 a month, with a tax credit, for the bronze plan and $145 for the silver plan, also with a tax credit.
Six out of 10 Virginians who are uninsured will be able to find coverage for less than $100 a month when tax credits and Medicaid coverage are included
WHY SHOULD I SIGN UP?
If the government decides you can afford health insurance and you don’t have it by 2014, you may have to pay a fee. You also have to pay 100 percent of your medical bills on your own.
The fee is 1 percent of your yearly income, or $95 per person for the year, whichever is higher. For children, it’s $47.50 per child, up to $285 total.
The fee increases every year. In 2016, it will be 2.5 percent of income, or $695 per person, whichever is higher.
WHAT IF I HAVE A PRE-EXISTING CONDITION?
An estimated 3.4 million Virginians with pre-existing conditions can no longer be turned down or charged for more coverage.
WHAT IF I AM ON MEDICARE?
Medicare beneficiaries don’t have to do anything differently.
WHAT ABOUT MEDICAID?
A commission in Virginia currently is working through a process to determine whether to expand Medicaid. The legislature set up the commission this year and tasked it with determining whether certain cost-cutting and efficiency reforms in the Medicaid program were met. If so, Virginia would expand Medicaid to cover an additional 400,000 Virginians.
CAN SOMEONE HELP ME?
Virginia will have navigators, independent counselors who work under federal grants to help people find the best coverage plan. Many hospitals and health care facilities will have on-site navigators, and information about other places to find them will be coming out soon.
WHERE CAN I LEARN MORE?
U.S. Department of Health and Human Services: http://www.hhs.gov/
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