Ask Emily: Obamacare deadline looming -- are you ready?

12/17/2013 5:44 PM

12/18/2013 3:30 PM

Ask Emily is a biweekly column by Emily Bazar of the CHCF Center for Health Reporting, answering questions about the Affordable Care Act. Read all her columns at sacbee.com/askemily

Calling all procrastinators: There’s still time! Granted, I warned you in previous columns that Dec. 15 was the deadline to sign up for health insurance from Covered California or the open market if you want it to kick in Jan. 1.

But things have changed. You now have until Dec. 23 to enroll for Jan. 1.

For the extreme procrastinators among you, that isn’t even the final deadline. This year – and this year only – the open-enrollment period lasts through March 2014. Please note, however, that the later you sign up, the later your health coverage begins.

I need to buy a health plan but make too much money to qualify for tax credits from Covered California. Should I still shop for a plan from Covered California or take my chances on the private market? What’s the difference?

I’ve wondered the same thing.

Let’s start with this important baseline fact: Here in California, insurers are required to offer the same plans with the same benefits, on our health insurance exchange – Covered California – as well as on the open market. And at the same price.

Assuming that you don’t qualify for tax credits, which can be applied only to plans purchased through Covered California, that means you’d be paying the same, full-cost price inside or outside Covered California for the same plan.

But you may have other options.

Some insurers might sell additional plans outside Covered California, says Charles Bacchi, executive vice president of the California Association of Health Plans.

Those plans still have to meet Obamacare coverage requirements, he says, but they may offer different benefits, such as other cost-sharing arrangements (lower or higher co-pays, out-of-pocket maximums and the like). Or some may offer more doctors and hospitals to choose from (the networks for some Covered California plans are limited). Such choices may affect plan prices.

“Some regions might have different options than other regions,” Bacchi says.

If you need help figuring out what’s available on the private market, call the health plans directly. Or you may consider seeking the advice of an insurance agent who is certified and trained by Covered California. A certified agent can help you enroll in the exchange or the open market, and you won’t pay extra for the help.

To find certified agents near you, visit CoveredCA.com.

My daughter, 30, is unemployed and lives with us. She has no income but is looking for work. Should she apply for Medi-Cal or a plan from the health insurance exchange? The Covered California application asks for household income, which would disqualify her from tax credits, based on my income.

Judging from the number of questions I receive from parents such as Steve in Azusa, many adult children are back at home with mom and dad – out of necessity.

As I’ve mentioned before, the Affordable Care Act relies heavily on our tax data to determine program eligibility and financial assistance. That’s where Steve’s question comes in. As he notes, the amount of tax credits you’re eligible for rests on your household income.

So, what’s household income?

In the case of an adult child living at home, it can be more complicated than you think. If you claim your child as a tax dependent, your income will count toward hers, even if she’s unemployed and even if she’s just applying for herself.

“If (Steve’s daughter) is claimed as a dependent, then her income is the income of that tax filing,” says Covered California’s Anne Gonzales. “If she is not claimed as a dependent, then it’s her own income.”

The same is true of Medi-Cal, which is public health insurance for low-income Californians.

Starting Jan. 1, Medi-Cal will broaden its eligibility requirements, raising the income threshold and opening the program to people who were previously ineligible, such as childless adults.

Again, if you claim your adult child as a tax dependent, your income will count toward your child’s income for Medi-Cal eligibility purposes, says Tony Cava of the state Department of Health Care Services.

So what options are you left with? Perhaps not the ones you were hoping for: You could pay out-of-pocket for a plan. There’s also a catastrophic-coverage plan from Covered California for people under 30 (which your daughter may be too old for).

Please check with your tax preparer.

Ask Emily: A new column answering questions about Obamacare from CAhealthReport on Vimeo.

Questions for Emily: AskEmily@usc.edu

Learn more about Emily here .

The CHCF Center for Health Reporting partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism , it is funded by the nonpartisan California HealthCare Foundation .

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