How to comply with the new health care law

Now that open enrollment for plans on the Health Insurance Marketplace (a.k.a exchange) has begun,  we thought we’d put together some basic information in the event your constituents have questions about the who/what/when/where of Obamacare.

*This is not an endorsement of the law. It is to help answer common questions. Most of the information was derived from official sources, however, this should not be construed to be official instructions. Individuals are encouraged to do their own research and seek further information from official sources.

Who needs to sign up for coverage under Obamacare?

You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage. (Healthcare.gov)

If none of the above situations apply, go to Healthcare.gov to go through the application process.

If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution your employer makes to your premiums. (Healthcare.gov)

If you have Medicare, you’re considered covered and don’t have to make any changes. You can’t use the Marketplace to buy a supplemental or dental plan. (Healthcare.gov)

Where do NH citizens go to sign up for coverage?

Call 1-800-318-2596 or go to HealthCare.Gov  – Both are operated by the federal government.

 

How long is the initial enrollment period?

Open enrollment began October 1 and will last through March 31, 2014.

If you enroll by December 15, 2013, coverage can begin as soon as January 1, 2014.

 

When is the next enrollment period?

Oct. 15, 2014—Open enrollment on the health exchanges for coverage in 2015 begins. In future years, Oct. 15 also will be the opening of enrollment for coverage.  

Dec. 7, 2014—Open enrollment for 2015 coverage closes. In future years, Dec. 7 also will be the closing date for enrollment.

What is the penalty for not enrolling in coverage?

If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. Some people may qualify for an exemption to this fee.

In you don’t have coverage by Jan 1, 2015, you must pay a penalty of $325 for individual adults or 2 percent of income, whichever is higher.

 

Where can I find information on rates and subsidies?

Go to HealthCare.gov or visit the website of NH’s only provider current of plans on the exchange, Anthem, at www.anthem.com

I own a business. What are my requirements under Obamacare?

 

If you have over 50 employees:

Jan. 1, 2015—Employers with 50 or more full-time workers must offer affordable, comprehensive insurance by this date or face penalties of $2,000 per employee. (Healthcare.gov)

If you have under 50 employees:

Small businesses may get health coverage in the Small Business Health Options Program (SHOP) Marketplace.

Starting in 2014, businesses with 50 or fewer full-time equivalent (FTE) employees can use SHOP to offer coverage to their employees. This applies to non-profit organizations as well. You control the coverage you offer and how much you pay toward premium costs.

If you insure your employees now, you can keep the coverage you have. If you have 50 or fewer full-time employees, you may offer a plan via SHOP instead.

If you have other business related questions, it’s best to consult your current provider or healthcare.gov

I’ve heard that plans offered on the exchange/marketplace have a “narrow” network of providers. Is that true?

Yes. As of 2014, the only plans being offered on the exchange will be through Anthem and will utilize a smaller network of hospitals and physicians. Only 16 of the state’s 26 hospitals and about 85% of the state’s primary care physicians will be in the network. Anthem has stressed that for emergency and specialty care, there will be opportunities for out of network referrals. In 2015 it is likely that there will be competing plans offered on the exchange that may offer other provider network options.

About Rep. Steven Smith

Steven Smith is a member of the New Hampshire House of Representatives, serving his fifth term. Rep. Smith currently represents Acworth, Charlestown, Goshen, Langdon, Lempster, and Washington. Rep. Smith is the Chairman of the Sullivan County Delegation.
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