Health & Medicine

Breaking down the complexity of Obamacare with answers

The Sacramento Bee’s recent live chat answered readers’ questions about the Affordable Care Act. Emily Bazar, a journalist and expert on the health insurance reform law, and Pauline Bartolone, who covers health care for Capital Public Radio, answered questions and provided guidance. The Bee’s senior reporter on health, Cynthia H. Craft, was moderator for the panel. The full chat can be read on The Bee’s Healthy Choices blog,

I have insurance for my family through my work. Do I still have to sign up for the ACA?

Bartolone: If your family already has health care coverage, you won’t have to do anything different.

How do two unmarried adults living and raising a child together identify their incomes on the Shop & Compare tool on Covered California’s website? If the mom wanted to see what she is eligible for subsidy-wise, what does she enter as income? In this case, the adults pool their two incomes to share the household expenses and costs of raising their daughter.

Bazar: Basically, it has to do with how you file your taxes, and who claims the child as a dependent. The member of the couple who claims the children as dependents can sign up for a plan with the children on it.

Does a person use their best-guess estimate of what their 2014 income will be on the Shop & Compare tool to help them determine what would be their subsidies? Or do they get out their 2012 tax return and go right to line 37 on their 1040 return? Isn’t it adjusted gross income that is being used or gross overall income?

Bazar: Yes, estimate your 2014 income. I know that’s hard for some people. But do your best. And no, it’s not adjusted gross income. It’s modified adjusted gross income. And take note: Be careful when you estimate your income, because if you’re off, that will change the amount of your tax credits and you will owe, or be owed, money.

As someone who will be switching to Medicare during 2014, can you clarify if the assistance (subsidy) is based only on the months the exchange insurance is used?

Bartolone: Under the ACA, people on Medicare don’t get the tax subsidies available through the exchanges.

Bazar: If your income qualifies you for tax credits before your Medicare kicks in, you can get them and then switch to Medicare when you’re eligible. You won’t be penalized for switching to Medicare because that’s a legitimate reason to change insurance outside of open enrollment.

As a certified insurance agent, writing Medi-Cal policies for folks is something that I have not typically done in the past. Now that the policy of Covered California is “no wrong door” as a pathway to coverage, are there local county Medi-Cal offices that I refer clients to that are Medi-Cal-eligible once that determination is made?

Bartolone: Good question. That can happen at county offices. There are also certified enrollment assisters through community-based organizations. The enrollment service is free. You can find contact information for these assisters through the Covered California website (

I’ve been unemployed since July. My husband’s employer offers health insurance, but we’re unable to afford it. Can we apply for Obamacare?

Bartolone: The federal government says you are not eligible for subsidies to buy coverage if “affordable coverage” is available. Here’s where to find the federal government’s definition of what’s “affordable”:

What is the deadline for getting insurance? What if I don’t? Would I really have to pay a fine?

Bartolone: About the deadline for getting insurance, the open-enrollment period under the exchanges ends March 31, 2014. If you don’t have insurance at all next year, you will probably have to pay a fine. The penalty for not having insurance in 2014 will be $95, or 1 percent of your income, whichever is greater. And the fine goes up in subsequent years.

Do the kids have to sign up if they are covered under me? Their ages are between 19 and 23; two work, the other two are in college.

Bartolone: If you and your kids are already covered, you won’t have to sign up for coverage.