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Congressman C.A. Dutch Ruppersberger

Representing the 2nd District of Maryland

Health Reform 101

Here are answers to some of the most commonly asked questions about how the new law healthcare reform law known as the Affordable Care Act may affect you.

What is the insurance exchange?

The exchange will be set up like a virtual store. People who want to purchase insurance will be able to shop from a number of privately-run insurance plans. These are the same high-quality commercial plans available on the open market. You will be able to compare premiums, deductibles and out-of-pocket costs before you decide to enroll. Many people will receive tax credits to help them pay for their premiums.

Who can purchase health insurance plans from the new exchange?

The exchange is designed for people who buy their own coverage individually or who don’t currently have coverage at all. This could include people who work part-time and don’t qualify for benefits through their employer, are self-employed or those who have retired early and don’t yet qualify for Medicare.

I have insurance through my employer, but my premium is expensive. Can I find a better deal by buying insurance through the exchange?

Most people who can buy insurance from their employer (or through the employer of a spouse or other family member) won’t be eligible to purchase it from the exchange. If your employer offers health benefits, you will only be able to buy it from the exchange if your current premium is more than 9.5 percent of your household income or if your employer’s plan pays less than 60 percent of covered benefits.

When will I be able to enroll in an insurance plan through the exchange and how will it work?

Enrollment for plans on the exchange is being coordinated by the State of Maryland under a new marketplace called Maryland Health Connection. Enrollment in plans will begin October 1, 2013. At that time, you will be able to visit marylandhealthconnection.gov to shop for various plans and determine if you qualify for federal tax credits to help pay for your health insurance, or determine if you or a family member is eligible for insurance under the Medicaid program. Small businesses will also use Maryland Health Connection to find plans that best meet the needs of their employees and to qualify for tax credits.

When will coverage under my plan begin?

Coverage for all individuals covered under plans through the Affordable Care Act will begin January 1, 2014.

Who qualifies for tax credits to help them buy health insurance?

People will be eligible for premium credits if they have a household income between 100 and 400 percent of the poverty level, which was between $23,500 and $94,200 for a family of four in 2013. (Click here for current poverty levels.) The online application process will help you determine if you qualify for help. 

How much is the tax credit to help buy health insurance?

If eligible, the amount of the credit is determined by how much income your household has. The more you make, the less your credit will be. The credit is applied when you purchase the insurance plan, unlike regular tax credits.

I get my health insurance through the military’s Tricare program. How will the new healthcare law affect me?

It won’t. The healthcare law requires all insurance plans to cover certain services at a minimum. But existing programs like Tricare, Medicare, Medicaid, the Children’s Health Insurance Program, VA benefits, COBRA and plans offered by employers already meet these requirements. 

I get my health insurance through Medicaid. What should I do?

If you or your children are currently enrolled in Medicaid, you do not need to do anything. You will be contacted when it is time to renew your coverage. In 2014, you will be able to renew your coverage online at marylandhealthconnection.gov.

I think I may now qualify for Medicaid under the new healthcare law. Is this true?

Under the new law, Medicaid is expanding to cover all adults under age 65 with a household income up to 138 percent of the poverty level, or about $32,500 for a family of four. This rule does not apply to the elderly, people applying on the basis of need for long-term care, people who qualify for assistance with Medicaid premiums and cost-sharing or foster care youths.

Beginning October 1, 2013, you will be able to apply for Medicaid online, in-person or over-the-phone through the Maryland Health Connection. You can also visit your local Department of Social Services or Health Department office to apply.

I can’t afford to buy health insurance, but I don’t qualify for premium assistance. What happens if I don’t buy insurance?

Under the new healthcare law, most people over the age of 18 must have health insurance beginning in 2014. If buying health insurance will cost you more than 8 percent of your income, you will be exempt from having to buy it. However, many lower-income families qualify for Medicaid or the Maryland Health Insurance Plan, so it’s worth exploring your options. You can learn more about exemptions and penalties here.

What if I have an illness or disability? Can I still get insurance?

 Yes. Under the new healthcare law, no one can be denied healthcare coverage because of a pre-existing condition.

I have heard a lot of disturbing rumors about the healthcare reform bill, including that it is a “government takeover.” 

Unfortunately, there is a lot of misinformation being circulated about this new law. The law was designed to help reduce healthcare costs for all Americans by expanding the pool of people who can buy insurance. You can read my responses to several myths about healthcare reform here.