Healthcare Reform FAQ

If I have Medicare do I need to do anything?

No. Medicare isn't part of the health insurance marketplace, so you don't need to do anything. If you have Medicare, you are considered covered. The Marketplace won't affect your Medicare choices, and your benefits won't be changing. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you'll still have the same benefits and security you have now. You won't have to make any changes.

What if I already have insurance?

If you have job-based health insurance you like, you are considered covered and can keep your insurance. You may be able to switch to Marketplace coverage eventually if you want to. Any job-based health plan you currently have qualifies as minimum essential coverage. You don't need to change to a Marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014. With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.

What if I have a grandfathered health insurance plan?

"Grandfathered" plans are those that were in existence on March 23, 2010, and have stayed basically the same since then. These plans can enroll people after that date and still maintain their grandfathered status. The status depends on when the plan was created, not when you joined it. If you are covered by a grandfathered plan, you may not get some rights and protections that other plans offer.

What if I'm losing job-based insurance?

If you lose your job-based health insurance, you have two primary options for health insurance coverage: (1) Get an individual Marketplace plan or (2) Get COBRA Coverage.

What if I currently have COBRA coverage?

If you have COBRA continuation health coverage, you keep it—or you can decide to buy a Marketplace insurance plan instead at any time starting Jan. 1, 2014. Losing your COBRA coverage qualifies you to buy health insurance in the Marketplace, even if it's not during open enrollment. This is true whether the coverage runs out or you choose to end it.

Can I use a Flexible Spending Account (FSA) to pay some medical expenses?

Yes. You can use an FSA to pay for copayments, deductibles, some drugs and other health care costs. You can put up to $2,500 into an FSA every year. At the end of the year or grace period, you lose any money left over in your FSA, so it's important to plan carefully and not set aside more than you think you'll spend on allowed health care expenses. You can also spend FSA funds on some over-the-counter medicines, like insulin, without a doctor's prescription. FSAs may also cover costs of medical equipment like crutches, supplies like bandages and diagnostic devices like blood sugar test kits. You cannot spend FSA funds on insurance premiums.

Can children stay on a parent's plan through age 26?

Yes. If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old. Children can join or remain on a plan even if they are married, not living with their parents, attending school, not financially dependent on their parents or eligible to enroll in their employer's plan.

If I receive my coverage from my spouse's employer, will I have minimum essential coverage?

Yes. Employer‐sponsored coverage is generally minimum essential coverage. If an employee enrolls in employer‐sponsored coverage for himself or herself and his or her family, the employee and all of the covered family members have minimum essential coverage.

Do my spouse and dependent children have to be covered under the same policy or plan that covers me?

No. You, your spouse and your dependent children do not have to be covered under the same policy or plan. However, you, your spouse and each dependent child for whom you may claim a personal exemption on your federal income tax return must have minimum essential coverage or qualify for an exemption, or you will owe a payment when you file.

I am a retiree and I am too young to be eligible for Medicare. I receive my health coverage through a retiree plan made available by my former employer. Is the retiree plan minimum essential coverage?

Yes. Retiree health plans are generally minimum essential coverage.