Another in a series of Q&A columns answering consumers’ questions about the Affordable Care Act.
Q: I am a married, 62-year-old female unable to obtain health insurance. I am retired and financially comfortable and in general good health. My husband is on Medicare/Anthem Blue Cross supplemental, so he is taken care of.
Who can I contact by phone to walk me through the process correctly? I have had several insurance salesmen contact me, and they each tell me something different.
A: Every day, Ask Emily readers like Bonnie send me emails filled with their health care particulars. If you saw my inbox, you’d agree that there’s a desperate need for guidance, especially as Obamacare transforms the health insurance landscape.
Believe me, I’m trying! But I can’t definitively answer many of your personal questions because everyone’s situation is unique – and I’m not an insurance broker.
There’s some help available now for Californians who think they might be eligible for tax credits through the new health insurance exchange, called Covered California, which will open for business in October (with coverage to begin in January).
When you call 888-975-1142, an operator can help you get a sense of whether you’ll qualify for the tax credits. Or, you may learn that you qualify for Medi-Cal – the state’s version of Medicaid – which will expand its eligibility at the start of the year.
The phone number is just the beginning. Soon, outreach workers trained by Covered California will fan out across the state to provide education and application assistance. You’ll start seeing ads in newspapers, on TV and at sporting events. In fact, you’ll probably get sick of hearing about it.
Until then, start with the phone number.
Q: My son is 41 and has been unemployed for several years. He’s not married and doesn’t have children. He does not receive unemployment and is not eligible for Medi-Cal. When his COBRA plan expired, we tried to get him an individual policy. But because he has taken migraine medicine in the past, we were offered a plan for $500 per month with a $5,000 deductible. If he doesn’t find a job before next year, is there something available for him?
A: Unfortunately, Helen, 2014 is the magic number.
That’s when the most sweeping provisions of Obamacare kick in, such as the debut of the health insurance exchanges, the expansion of Medi-Cal and the requirement that most people have health insurance.
But some provisions already have kicked in and there are some existing programs that could help.
Anthony Wright, executive director of Health Access California, points to three possible options for your son and others in his situation:
- Most California counties have created “Bridge to Reform” programs that basically expand Medi-Cal before 2014. Check here to see if your son’s county participates and whether he might qualify.
- The state administered two special insurance plans for people with pre-existing medical conditions. One has stopped accepting new applicants. The other, called the Major Risk Medical Insurance Program, still takes applicants but can be pretty expensive, and in some cases requires a waiting period before coverage begins. Plus, your son would need to show that he has a pre-existing condition by, for example, proving that an insurance company has denied him insurance within the past year.
- Federal and state laws allow extensions of COBRA benefits in some cases, but Wright says that, too, is expensive.
“Help is coming,” he adds, “but for many it’s not soon enough.”
Q: Are premiums and subsidies on the exchange going to be based on Gross Income or Adjusted Gross Income? And what about Medi-Cal eligibility?
A: The answer to both questions is, technically, neither.
I’ve been throwing around a lot of confusing figures in my columns, such as “138 percent to 400 percent of the federal poverty level” and “9.5 percent of household income.”
I initially hesitated to answer this question, thinking it was venturing too deep into the weeds. But queries from Bob in Mission Viejo and many others changed my mind.
It turns out that the tax credits offered by Covered California as well as Medi-Cal eligibility for most people will be determined using Modified Adjusted Gross Income, known as MAGI.
For most people seeking tax credits and Medi-Cal coverage, MAGI will be the same thing as Adjusted Gross Income found on your 1040 federal income tax forms, according to Laurel Lucia, an Affordable Care Act expert at the UC Berkeley Center for Labor Research and Education.
But for some, it will include more. Technically, MAGI is Adjusted Gross Income “plus nontaxable Social Security benefits, tax-exempt interest, and foreign income and housing expenses for Americans living abroad,” Lucia says.
For those of you trying to figure out whether your work-based insurance is considered “affordable” under the law (click here for more details), you’ll also be using MAGI as your reference, she notes.
If you really want to get lost in the weeds, check out this helpful explainer.
Thanks for keeping things simple, Obamacare.
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.