But in general, for patients on Medicare the exchanges are not going to be helpful for them.

Transcription

1 Eligibility Q&A: Q: What if someone is eligible for HUSKY but wants to choose a health plan through the exchanges, can they get subsidies? A: Unfortunately, no. If someone is eligible for public insurance (such as HUSKY), they are not eligible for subsidies. Q: What about permanent residents? NOTE: The previous glitch affecting permanent residents with less than five years has been fixed! Be sure to call in permanent residents who you postponed! A: There are two categories permanent residents are divided into: Permanent residents with more than five years residency, and those with less than five years. Permanent Residents with more than five years residency are eligible for either Husky or QHPs with subsidies based on the same income rules as citizens Permanent Residents with less than five years residency are not eligible for HUSKY but they are eligible for getting subsidies and cost sharing on QHPs through the exchange (so long as their income fits within the guidelines for these benefits) Q: What happens to permanent residents who signed up before the glitch was fixed and got Medicaid when they weren t eligible? A: Xerox (an Access Health/DSS contractor) will be calling everyone in this situation starting 12/9 and informing them what their next steps are. They will be told what their new options are, and all this should be fixed for coverage starting January 1 st. Q: What about people who are here on three year work visas? A: A person who is here on a work Visa would count as lawfully present and thus are eligible for subsidies and cost sharing on the exchange (assuming their income fits within the limits for those). However, because they are not permanent residents with more than five years of residency they are not eligible for Medicaid. Q: What if I have patients with Medicare who also want to get insurance through the exchanges? (NEW!) A: Generally (except in the case of a few rare and unusual exceptions) people with Medicare can not enroll in QHPs through the exchange, in fact it is illegal for an insurance company to knowingly sell someone who is on Medicare an exchange plan. However, many of the exchanges have forgotten to include this rule in their eligibility screenings. Additionally, so called Medigap plans that fill in the areas that Medicare doesn t cover are not available on the exchanges. Here s a useful summary of Medicare and the exchanges:

2 It is possible for someone on Medicare to also be eligible for Medicaid. These situations are called dual eligible. They would have to be elderly or disabled AND low income. The section of Medicaid they would be eligible is HUSKY C, which is the only section that they can t apply for online. HUSKY C is unaffected by the Medicaid expansion, and will continue to be determined under the old eligibility rules. Your Health Center s Medicaid outreach worker would likely know how a patient who fits these criteria should proceed. But in general, for patients on Medicare the exchanges are not going to be helpful for them. Q: What if I turn 65 during 2014? A: If you turn 65 after March, you would have to sign up for a QHP or Medicaid (whichever you are eligible for) so that you are covered and don t have to pay a penalty for the months you are uncovered. If you sign up in advance for Medicare, your coverage starts on the first of the month you turn 65. Once you sign up, you should inform your insurance plan about your Medicaid coverage, and your coverage will be cancelled the day your Medicare coverage begins. You will still be eligible for subsidies for the months you are on a QHP. If you turn 65 in the first three months of 2014, you could be exempt from the penalty with a short coverage gap exemption, but you would then be without health insurance for those three months, so you still should sign up for coverage! Q: Did the Affordable Care Act cause any other changes to Medicare? A: Yes! The Medicare prescription drug coverage gap (the donut hole ) is being gradually closed over the next 7 years. Medicare also now covers more preventive services more comprehensively. However, your Medicare coverage is protected and if you are on Medicare now your plan will not change. Medicare Advantage plans are also continuing. Q: What about someone who is disabled but on a spend-down for HUSKY C? A: Assuming their income is under the 133% FPL limit, the patient would be eligible for expanded Medicaid. If they are on a spend-down for HUSKY C, they are not required to stay on that spend down, but can choose between staying on a spend down for HUSKY C or applying for expanded Medicaid (HUSKY D) through Access Health CT. Sometimes HUSKY C offers better coverage for long-term care services that disabled patients need, so this will be a coverage decision for the patient, but they can choose either based on what is best for them. Q: Do I need to file taxes to be eligible for subsidies? A: You need to file taxes for 2014 in order to be eligible for subsidies, even if you are having your subsidies applied directly to your premiums. If you didn t file taxes in 2012, you are still eligible for subsidies, but you must indicate that your tax status will change and you will file taxes in 2014 in order to be eligible. Q: Can I still get tax credits if I don t have a tax liability? A: Yes. These are not a tax deduction, but a tax credit, and thus you will get them even if you have no tax liability (so long as you file taxes).

3 Q: What if there is an undocumented immigrant in the household? Note: The glitch has been resolved! A: The undocumented immigrant is ineligible for any kind of coverage, but you SHOULD still be able to apply. In fact, the government is not allowed to use the information for immigration checks or anything like that, so there is no reason to fear an immigrant getting in trouble or getting deported because of information they enter into Access Health CT. HOWEVER, there is currently a glitch where having an undocumented immigrant in the household will make the entire family declared ineligible. Access Health CT is working on a fix, but for now you should collect these families contact information so you can contact them once the glitch is fixed (we will let you know). Q: What about applicants for adjustment to Legal Permanent Resident status? A: People who are applying for adjustment to LPR status are considered lawfully present and are eligible for QHPs and subsidies! People in this situation will often have a work authorization. Some other groups with work authorizations are also eligible, if you re not sure, feel free to check with ask@chcact.org! Q: What about the Dream Act/ a.k.a. people under Deferred Action for Childhood Arrivals (DACA)? A: This answer requires some explaining. The Dream Act was actually never passed by Congress, but the Obama administration implemented much of it through a program called Deferred Action for Childhood Arrivals also known as DACA. These would be people who came to the US as children and have lived here for more than five years (along with several other criteria). People who have been granted deferred action under this category are unfortunately considered NOT lawfully present and are not eligible for subsidies or even unsubsidized QHPs on the marketplace. Q: What if I m planning to get a divorce in 2014? A: These clients should file based on their current status, because you never know whether a divorce will be legally finalized as planned. When they become divorced they can file for a change in status. Additionally, if they list themselves as divorced now, Access Health will ask for verification that they have become divorced (which they won t be able to provide since they are not yet divorced). We re waiting on more guidance from Access Health about this situation. Q: Are there any exceptions to the married couples must file jointly rule? A: Yes, if you can file using the head of household status, you can still receive subsidies. To qualify for the head of household filing status you must: Live separately from your spouse for the entire last six months of the year Have a qualifying dependent Pay more than half the expense of keeping up your home These rules are for the year they would be getting the subsidies/filing taxes (2014), and this information can be difficult to predict so far in advance. People who are in this situation should contact a tax professional because the rules for filing as head of household can be complicated. Q: What if my employer offers health coverage? Can I still get subsidies? A: People who are offered health coverage by their employer can only get subsidies through Access Health CT if their coverage is either 1) too expensive OR 2) doesn t cover enough. If you meet one of these two conditions you can get subsidies:

4 Too Expensive: If the amount you have to pay for your premiums for yourself (not including costs for your dependents) is more than 9.5% of your income, then you can get subsidies Doesn t cover enough: If your employer coverage is not considered minimum value you could be eligible for subsidies. Minimum value means that the plan is expected to cover at least 60% of the total costs of the average patient. Your employer should be able to tell you if the coverage they offer qualifies as minimum value. Anyone whose employer coverage does not meet either of these exceptions can still shop on the exchange, but they will not be eligible for subsidies (even if they turned down the employer coverage). Q: What are the different possible conditions for being exempted from the penalty? Do I need to apply for these exemptions? A: You can be exempted for a number of reasons, and there are two general categories: those that you have to apply for through Access Health CT, and those that you apply for or are granted automatically when you file your taxes for 2014 in April 2015 If you fit into any one of these exemption categories you will have to fill out Access Health s application for exemption located here: (if this link is dead, go to AccessHealthCT.com and click the Can I Opt Out? button in the lower right) If you are a member of a recognized religious sect whose members object to insurance If you are a member of a Health Care Sharing Ministry (this exemption can also be If you are a member of a federally recognized Indian Tribe (this exemption can also be If you are incarcerated (not awaiting disposition of charges) (this exemption can also be Coverage available through the marketplace is unaffordable because the minimum amount you would have to pay for premiums is more than 8% of your income. To apply for this exemption you will need to apply for insurance through AccessHealthCT.com and attach the eligibility determination notice. If you experienced a hardship that affected your ability to purchase insurance, possible hardship exemption circumstances might include (note some hardships can only be claimed when filing your federal income tax return): You were homeless You were evicted in the past 6 months or were facing eviction of foreclosure You received a shut-off notice You recently experienced domestic violence You recently experienced the death of a close family member You experienced a fire, flood, or other disaster which cause substantial property damage You filed for bankruptcy in the last 6 months You had medical expenses you couldn t pay in the last 24 months You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member Your insurance plan was cancelled and you believe other Marketplace plans are unaffordable

5 You claim a child as a dependent who was denied Medicaid/CHIP and someone else is under a court order to support the child (this would exempt you from paying the child s penalty A taxpayer whose gross income is below the return filing requirement, but claims a dependent who must file a return and whose income pushes the household above the filing requirement may claim an exemption (but this is done on your taxes, not through AHCT) A family for whom employer self-only coverage is affordable, but for whom the aggregate employer-sponsored family coverage cost is unaffordable may claim an exemption (but this is claimed on your federal taxes, not through AHCT). If you fit into any of these exemption categories you will not need to apply for an exemption Your income is low enough that you are not required to file taxes You had a gap in coverage of less than three months (dealt with when you file your taxes) You are not lawfully present in the U.S. (dealt with when you file your taxes) Got a different question? ask@chcact.org!!