Need health insurance? Consider the options

Haven't thought about the health care law for a while? Now's the time.

Passed in 2010, the law requires most Americans to have health insurance or pay a fine. While many Americans get health coverage through their employers, those consumers who instead have insurance through the law's federal or state online marketplaces, or exchanges, could re-enroll starting Nov. 15. Subsidies are available to help many people afford coverage, and some states have expanded their Medicaid programs to provide coverage for low-income people.

Last year when enrollment began, the federal website Healthcare.gov and some related state-run websites experienced severe technical difficulties, frustrating consumers trying to sign up through the exchanges. Nonetheless, more than 7 million people bought insurance plans in the exchanges and about 8.7 million signed up for Medicaid or the Children's Health Insurance Program, or CHIP. This time around, federal and state officials have promised streamlined, easier-to-use applications. Federal officials say Healthcare.gov is undergoing testing to make it better able to handle high demand.

Here's what you need to know for the coming enrollment period:

Q. I enrolled via Healthcare.gov last year. Do I have to do it again?

A. If you got your plan last year on the federal marketplace and take no further action now, officials have said you will be re-enrolled in your current plan. But since some plans have changed and some new plans are coming on the market, these officials are encouraging people to go back on Healthcare.gov to compare benefits and prices.

You should also update your income information to find out if you qualify for financial help to purchase coverage and to make sure you receive the correct amount. That's because if your subsidy is too high, you'll have to pay it back at tax time.

States running their own exchanges will make their own decisions about re-enrollment.

Consumers will have three months, until Feb. 15, to sign up for coverage, rather than the six months they had when the exchanges began accepting applicants last year. If you want your coverage to renew or begin by Jan. 1, you'll have to complete your application by Dec. 15.

Some plans that were available last year may not be offered for 2015. In some cases, insurers decided not to sell the same policy again; in some states, officials this year won't allow exchanges to list plans that fail to include all of the law's mandated benefits.

Insurers have expressed concerns that if consumers change health plans, the federal website might not notify the insurance company they are leaving and that some people might get billed for both their new plan and their old one. Be sure to keep proof of payments in case you face this problem, and watch your credit card and bank account statements to make sure you're not being billed twice.

A spokesman for the Centers for Medicare and Medicaid Services said the government is aware of the concerns and plans to give insurers lists of customers who have been automatically enrolled into a plan as well as consumers who chose to stay in the same plans. He said the government is also “examining options” on how to provide insurers the names of people who switched plans during the enrollment period.

Q. I want to buy health insurance, but I can't afford it. What should I do?

A. Depending on your income, you may be eligible for Medicaid. Before the health law, nonelderly adults without children didn't qualify for Medicaid in most states.

But now, states can choose whether to expand their programs so that anyone with an income at or lower than 138 percent of the federal poverty level (which is about $16,105 for an individual and $32,913 for a family of four, based on current guidelines) is eligible for the federal-state program.

Q. What if I make too much money to qualify for Medicaid but still can't afford to buy coverage?

A. You may be eligible for government subsidies to help you buy insurance sold in the insurance marketplaces.

These premium subsidies will be available for individuals and families with incomes between 100 percent and 400 percent of the poverty level, or about $11,670 to $46,680 for individuals and $23,850 to $95,400 for a family of four.

The subsidies are most generous for those who make the least money. They also require individuals to spend a certain percentage of their income on premiums.

Q. I didn't get around to buying health insurance in 2014. What is going to happen to me now?

A. When you file your income taxes for 2014, you'll be asked whether you have health insurance. If you don't have coverage, you'll have to pay a penalty of $95 or 1 percent of your income, whichever is higher, unless you qualify for an exemption. That penalty will increase in 2015 to the larger of $325 per person or 2 percent of income.

Q. What if I have health problems? Will I still be able to get insurance?

A. Insurers are no longer allowed to deny you coverage or charge you more based on a pre-existing medical condition. The law also eliminated annual and lifetime caps on coverage of essential health benefits, which include prescription drugs and hospitalization.

Q. I get my insurance through work and want to keep my current plan. Can I do that?

A. If you qualify for employer-provided coverage, you can stay in that plan. But, as was the case before the law was passed, your employer is not obligated to keep your current plan and may change premiums, deductibles, copays and network coverage. Insurers can also change the plans they offer, so your employer may not be able to purchase the same plan it did a year ago.

Q. I own a business. Will I have to buy health insurance for my workers?

A. No employer is required to provide insurance, but large employers that don't could face penalties.

Starting next year, in a part of the law that had been postponed, employers with 100 or more employees that provide insurance must do so for 70 percent of workers; in 2016, that figure rises to 95 percent. This requirement applies to full-time workers, who are defined as those working at least 30 hours per week.

Defining full-time work in this way has caused some concern that employers may be reducing workers' hours to avoid the law's coverage requirement. Some analysts say there is no evidence that workers' hours have been cut because of the law.

Starting in 2016, businesses with 50 to 99 employees also must offer health care coverage. If they don't and if they have at least one full-time worker who receives subsidized coverage in the exchange, they will have to pay $2,000 per full-time employee. The firm's first 30 workers would be excluded from the fee.

Firms with fewer than 50 people don't face any penalties.

In addition, if you own a business with fewer than 25 full-time workers and buy health care coverage for them, you may qualify for a tax credit to help offset the cost. Small-business owners can purchase coverage through the Small Business Health Options Program, also known as the SHOP exchange.

Q. What other parts of the health law are now in place?

A. Anyone who is insured with a marketplace-purchased plan will be eligible for some preventive services, such as blood pressure screenings and cholesterol tests, with no out-of-pocket costs.

Health plans can't cancel your coverage if you get sick unless you committed fraud when you applied for coverage.

An insurer must provide rebates to consumers if the company spent less than 80 to 85 percent of premium dollars on medical care in the preceding year. According to the Department of Health and Human Services, since 2011 consumers have saved $9 billion due to the provision.

And yes, children up to age 26 can still stay on their parents' insurance. This was one of the most popular provisions of the new law and it hasn't changed.

This article was produced by Kaiser Health News, a national health-policy news service that is an editorially independent program of the Henry J. Kaiser Family Foundation.