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Brandon Merritt: Answers to questions on health care plan

Editor's note: The author is the son of the editorial page editor.

The headlines and misinformation about Obamacare have left many people confused about the law and what they have to do it comply with it.

To help clear the air, let's review some of the most common questions people have about Obamacare.

Do I have to sign up for Obamacare?  

No.  While Obamacare did create an individual mandate that requires almost everyone to have health insurance coverage, it did not create a single government insurance plan nor does it require anyone to purchase a specific plan.

Obamacare, aka the Affordable Care Act (ACA), expands Medicaid for low-income working age adults and creates an online "Marketplace" where people can shop for private health insurance plans.  If you choose not to have health insurance of any type, you will be required to pay a penalty when you file your taxes.

I have health insurance through my job or my spouse, so what do I have to do?

Nothing. If you are happy with your health insurance, then you don't have to do anything.  If you are self-employed or your employer doesn't offer health insurance, you qualify for coverage through the Marketplace. If your income is below 400 percent of the federal poverty level ($94,200 for a family of four) you may also qualify for tax subsidies that reduce your monthly insurance costs.

What's the deal with Oct. 1?  

October 1st is the day that "open enrollment" begins, meaning that the Marketplace will officially be up and running so people can compare and purchase a plan or enroll in Medicaid if income eligible.

Coverage for these plans begins Jan. 1, 2014, and enrollment will run through March 31.  

Do seniors with Medicare need to do anything?

No, seniors on Medicare already have health insurance.  In fact, it is illegal for anyone to sell you a plan under Obamacare.

There have already been a number of scams targeting seniors, so if you suspect someone is trying to scam you, call the W.Va. Insurance Commission hotline at 1-888-879-9842.

I want to keep my doctor, what if he/she doesn't accept Obamacare?  

Plans purchased on the Marketplace are just like regular private plans and doctors or clinics won't treat them any differently.  

However, just like a typical private plan today, not all doctors will accept every plan.  If being able to see a certain doctor is important to you, you will be able to verify if they are "in-network" before you purchase your plan.  

I'm a small business owner. Will I have to offer health

insurance to all of my

employees?

Any business with fewer than 50 full-time employees is not required to provide health insurance for its employees. However, you can use the Small Business Health Options Program, or SHOP, to offer your employees coverage.

If you have less than 25 employees, you may qualify for significant business tax credits if offering insurance through the SHOP Marketplace.

I'm still confused. Who do I contact to get help?

Many people around the state have been trained to assist people in getting enrolled.  You can search a list of these people to assist by county online at bewv.wvinsurance.gov and click "Where Can I Find Local Help?"  There is also a national toll-free hotline at 1-800-318-2596.

In short, Obamacare is subsidized private insurance plans and expanded Medicaid for low-income households.  

The additional regulations protect consumers by ensuring that health insurers offer plans that meet minimum requirements like primary care, prevent insurers from charging you more due to gender or previous illnesses, and prohibit insurers from setting annual or lifetime limits on the care you receive.  

There will be many bumps along the way, just as there are with any large policy change, but over time they will become smoother and the debate over Obamacare will fade away as millions of Americans and hundreds of thousands of West

Virginians gain health insurance.

Brandon Merritt is health policy analyst for the W.Va. Center on Budget and Policy. Read his health care blog at www.wvpolicy.org.


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