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Health Care Reform:

Health Insurance & Affordable Care Act

Complex Personal Issues Cloud Insurance Decisions

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"This will be a steep learning curve," says Sabrina Corlette, project director for Georgetown University's Center on Health Insurance Reforms. She likened it to the launch of the Medicare Part D prescription drug program in 2006, when beneficiaries tried to enroll in the new benefit and initially encountered snags in getting accurate information. 

Here's a case in point. A woman wrote in asking about coverage options for her family, including their two kids with special medical needs. She writes, "My husband and I carry dual coverage through his employer and my employer group plans because neither plan covers our children's needs adequately individually. Because of our children's special needs, it is a hardship for both of us to work. We would like to drop one or both plans and purchase insurance on the exchange in October when open enrollment begins. Is this possible?"

Experts tell me that the simple answer is yes, it's possible. But that may not be the best answer for this family. Most people can shop for coverage on the health insurance marketplaces, also called exchanges. But if people have access to employer coverage that's considered adequate and affordable under the law, they won't be eligible for subsidies to reduce the cost of an exchange plan. (A premium tax credit is available to people with incomes up to 400 percent of the federal poverty level, or $94,200 for a family of four. Cost-sharing subsidies to reduce deductibles and copays will be available to those earning up to 250 percent of poverty, or $58,875 for a family of four.) Since employers typically subsidize a good portion of their employees' health insurance costs, buying an unsubsidized plan on the exchange might not make financial sense.

If both parents dropped down to part-time status, they might no longer be eligible for their companies' health insurance plans and could buy subsidized coverage on the exchange. But if one of the parents kept working full time and had access to good family coverage on the job, no family member would be eligible for subsidized exchange coverage.

Mon, Dec 19 2011

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