Frequently Asked Questions

Affordable Care Act

Updated May 31 2018 Our video here provides detailed information on health insurance buying options. Also, view the graphic below on what you should know about the different types of health insurance products: Can you still work with eHealth in 2018? Yes, licensed agents are still the only people legally able to advise you regarding health insurance options and benefits when you're trying to choose the right health insurance plan for your specific needs. By law, working with a licensed agent cannot cost you extra. Prices for each available plan have agent commissions built into the cost. So you'll pay the same whether you use a licensed agent or not.   Affordable Care Act navigators are not able to advise you on which plans to purchase. By law, navigators can only assist you in determining whether or not you're eligible for a subsidy, and they can help you through the application process.  
Whether or not you can keep your plan or will need to reapply for health insurance in 2018 might depend on the insurer and your state. Some of the insurers that are available at eHealth have indicated that they'll transition people in one of three ways:
  1. Inform and Automatically Enroll -- The insurer will make you aware that it's moving you to a metallic benefit plan and will transition you automatically to that new plan with no action required on your part.
  2. Inform and Actively Reenroll -- The insurer will contact you and assist you in actively reenrolling in a new metallic benefit plan.
  3. Only Inform -- The insurer would simply make you aware that your current plan may not qualify you to avoid the tax penalty next year and you have the option to change plans, but the insurer may elect to let you remain on your current plan.
Watch our video on the "Three things you need to know, if your health plan is being cancelled". View our graphic below for a breakdown of grand-fathered plans, non-grandfathered plans and new plans under the Obamacare. Three types of Obamacare plans  
Updated May 31 2018 Watch this short video on Obamacare subsidy to see if you qualify. What is a health insurance subsidy   Also, keep this checklist below handy: Health Insurance Subsidy checklist You may qualify for premium tax credits, or subsidies, to help pay for your health insurance if your total Modified Adjusted Gross Income (or MAGI) is between 100% and 400% of the Federal Poverty Level (or FPL) and you meet these requirements:
  • You live in the U.S.
  • You are a U.S. citizen, U.S. national, or lawfully present in the U.S.
  • You are not currently incarcerated.
  • You are not eligible for other minimum essential coverage.
These subsidies are set on a sliding scale so that what you spend each month is limited to a defined percentage of your income, adjusted to the second least-expensive silver-level plan available in your area. In most cases, people who earn 400% or below the federal poverty level for their household size, are eligible for subsidies. Government subsidies can only be determined by the governing body in your area. The dollar value of your subsidies will depend in part on the cost of the benchmark Obamacare plan in your area.  If the benchmark plan costs more than a certain percentage of your estimated annual income, you can get a subsidy in the amount of the difference. You may then use that subsidy when you buy a qualified Obamacare health insurance plan. In order to calculate your Obamacare subsidy amount, the following variables are considered:
  • Your estimated household income for the year
  • The cost of plans in your area. ACA considers health insurance unaffordable when annual premiums for the lowest priced plan costs more than 8.16% of your modified adjusted gross income (MAGI).  
Updated May 31 2018 Tax penalties are pro-rated by the number of months you’re uninsured. In 2018, the penalty for going uncovered will be $295 per adult or 2.5% of your household income, whichever is higher. In 2017, the Trump administration repealed the individual mandate (requirement for everyone to have health insurance), which will apply in 2019. As for 2018, there is still a requirement to have health insurance, or face tax penalties.
Updated June 1 2018.  It's unlikely that your doctor will know if your health insurance plan is subsidized or not. All the doctor is likely to know is the name of your insurance company. In most cases, access to doctors will work much like it does today. Health insurance plans contract with networks of doctors, specialists, and hospitals.This network is generally referred to as your plan's "provider network." Some plans have very limited provider networks, and others have very large provider networks. More restricted networks often cost less, and networks with more choices often cost more. But plans may be marketed and priced more aggressively based on the size of their provider networks. Watch this video for more detailed information.
Updated June 5, 2018.  Until 2019, a lapse in coverage must be three months or less, in order to avoid the individual mandate fee. If you wish to get a new health insurance plan outside of open enrollment, your ability to apply  may vary from state to state. And it may be limited to a "qualifying life event," such as, but not limited to, the loss of a job, a marriage or divorce, a move, or the birth of a child. If you wish to get some form of coverage during a lapse, there are temporary options like short term health insurance plans, which are available for enrolling in year round.
Updated June 5, 2018.  Since January 1, 2014, insurance companies cannot decline your application for health insurance due to a pre-existing medical condition or for any other health-related reason. This applies to ACA-compliant health insurance plans.
The Affordable Care Act did make some changes to Health Savings Accounts -- also called HSAs -- and how they will work:

First, the law eliminated a person's ability to use money in his or her HSA account to buy over-the-counter drugs.

The second big change is that the law increased the penalty for withdrawing funds from your HSA before you reach age 65. The early withdrawal penalty increased from 10% to 20%.

No. There is no requirement in the Affordable Care Act that spouses be on the same plan.

But if you want to qualify for a premium tax credit, or subsidy, to lower the cost of your insurance, be aware that subsidies are based on your total household income level. So even though your spouse will not be covered by the subsidized insurance plan, his or her income will be included when determining the level of subsidy you are eligible for.

View this video on spouse health insurance.
 
Updated June 5, 2018 Since 2014, all major medical health insurance plans for individuals and small employers have been required to have bronze, silver, gold, and platinum benefit levels. And any plan with an effective coverage date after March 23, 2010 in the individual and small group health insurance markets will have to meet one of these four benefit levels. Bronze, silver, gold, and platinum benefit levels actually refer to a plan's actuarial value level or "AV." What is actuarial value? The easiest way to explain this is it's the percentage of total average costs for the benefits a plan covers within a given year. So a plan with a 70% actuarial value would typically cover 70% of the costs, and the customer would typically be responsible for 30% of the costs. The different "AVs" have metallic designations:
  • A bronze plan is 60%.
  • A silver plan is 70%.
  • A gold plan is 80%.
  • A platinum plan is 90%.
Insurers may also offer catastrophic-only coverage to eligible individuals, and this would have higher cost-sharing than the standard metallic plans. "Metal levels" are designed to let consumers compare plans with similar levels of coverage, based on monthly premiums, provider networks, and other factors with the goal of helping consumers make more informed decisions.
If you have fewer than 50 employees and you offer your employees coverage, they may decline that insurance and seek individual coverage under the Affordable Care Act. Once they make that choice, your administrative duties end. However, whether you offer health insurance or not, it is absolutely critical that you make your employees aware of their obligation to get health coverage under the Affordable Care Act. And you have to let your employees know that they have access to guaranteed coverage in the individual market and that they may be eligible for subsidies.
To know if you can still see your doctor, you need to make sure if your doctor is covered by your Obamacare health plan. Watch our video for more information.

For additional information, watch our webcast video on doctors, drugs and out-of-network coverage.

In most cases, access to doctors will work much like it does today. Health insurance plans will contract with networks of doctors, specialists, and hospitals. As long as your doctor is contracted with your plan, there is no reason to believe that doctor will stop taking appointments.

However, it may take longer to see a physician in person. In some areas, the number of people who have health insurance will increase significantly, but there may not be a corresponding increase in the number of doctors and other medical providers.
To understand more about tax penalty under Affordable Care Act, view our short video here. You can buy insurance for your kids without insuring yourself, but you and your spouse will be subject to a tax penalty if you do not have qualifying health coverage. When it comes to buying insurance for your kids, since January 1, 2014, the Affordable Care Act has required any insurer that offers a metallic level plan to an individual adult must also make that plan available to an individual child -- provided the child has not reached his or her 21st birthday at the beginning of the plan year.
The Trump administration ended something called “cost-sharing reduction” payments, which were paid to insurance companies by the federal government. Unfortunately, the media confused a lot of people by calling these “subsidies.” The government assistance that most people actually think of as “subsidies” is still available. These subsidies (technically known as “advanced premium tax credits”) are the ones that help qualifying people lower their monthly health insurance premiums.

No, you should be able to determine if you're eligible for a subsidy before you shop for a plan and then have that subsidy applied to any qualified policy you apply for.


Any person who is a U.S. resident and is a U.S. citizen or a U.S. national and is not in jail can apply for a government subsidy and they may qualify as long as they meet, among other requirements, the household income requirements. Under the new law, a person whose household income is between 100% and 400% of the Federal Poverty Level will be eligible for a premium tax credit to reduce the cost of coverage. A person with household income up to 250% of the Federal Poverty Level will be eligible for cost-sharing assistance, as long as they are enrolled in a silver plan.

Major medical plans are what most people think of as health insurance. These plans are required to provide coverage for the 10 “essential health benefits” defined by the Affordable Care Act law. These plans come in bronze, silver, gold, and platinum varieties based on how much of your medical bills are covered. Some are also defined as PPO-plans, HMO plans, etc. Supplemental or alternative plans like short-term, accident insurance, or critical illness insurance can be much more affordable and provide you with protection against many unforeseen medical costs, but you should know that these do not meet the coverage requirements of the Affordable Care Act. These plans generally provide much more limited coverage and it may be possible to be declined based on your medical history with these plans. These plans also do not qualify for government subsidies and you may be subject to a tax penalty under the Affordable Care Act law.
Yes, you can still buy health insurance through eHealthInsurance.com in 2014 and beyond. But in some states, lower-income Americans may not have the same freedom to use eHealthInsurance.com or other web-based brokers as wealthier Americans. That's because some states may require low-income people to apply for insurance that can be purchased with a government subsidy through their state exchange. Federal regulations make it clear that states can allow online brokers to enroll people in subsidized insurance, but some states may elect not to pursue this option.
Updated June 7, 2018  You may be subject to a tax penalty if you go without ACA-compliant health coverage for more than two consecutive months in 2018. The penalty for 2018 is either 2.5 percent of your taxable household income or $695 per adult and $347.50 per child, whichever is higher. These penalties are pro-rated by the number of months you were without qualifying health insurance. Under current law, the IRS will stop enforcing this penalty for coverage in 2019.
Updated June 5, 2018 Beginning in 2013, there has been an annual Open Enrollment Period (OEP), which is the time to choose a new health insurance plan or make changes to your current one. The Open Enrollment Period usually occurs towards the end of the year. In 2017, the period lasted from November 1st to December 15th, and coverage began on January 1st 2018 for those who paid their premiums. Some states who run their own health insurance exchanges have extended open enrollment periods, so make sure to check if you reside in a state with an OEP extension.
Updated June 5, 2018.  Watch our short video on subsidy eligibility. This infographic below shows a checklist of documents that you would need for your subsidy application process. Apply for Obamacare subsidies There are eligibility requirements if a person wants to receive subsidies to help them pay for their health insurance under the Affordable Care Act. To qualify, a person must:
  • Live in the U.S.
  • Be a U.S. citizen or national, or be lawfully present in the U.S.
  • Have a household income between 100% and 400% of the Federal Poverty Level.
  • Cannot be currently incarcerated.
  • Cannot be eligible for other minimum essential coverage (for example: Medicare, Medicaid, CHIP, employer-sponsored coverage).
If you do not meet these requirements, you may still apply for health insurance under the Affordable Care Act, but you would not qualify for government subsidies to help you pay for the coverage.
Maternity coverage is one of the ten essential health benefits that must be covered by all health insurance plans. If you do not already have coverage under a major medical health plan, you will be able to purchase a policy once your baby is born. The birth of your baby is considered a qualifying life event, and triggers a 60-day special enrollment period during which you, your spouse, and your children can enroll in and/or change health plans. Additionally, you can always enroll in or change to a different health plan during the National Open Enrollment Period. If you do not currently have major medical coverage, we have supplemental coverage options available, but they typically do not include prenatal care. Another option would be to contact your state Medicaid office as some states offer coverage for expectant mothers through Medicaid.
Most likely. What we've seen indicates that people who lose their jobs will have the option to stay on their employers' health insurance plans for up to 18 months -- which is essentially how COBRA works. What's nice about the Affordable Care Act is that it gives people on COBRA the ability to apply for individual coverage without concern that their application can be declined. And people who opt out of COBRA and buy an individual insurance policy may qualify for low-income subsidies to help them pay for cost of their plan.
Updated June 7, 2018 Under the Affordable Care Act rules, to be eligible for a subsidy your income needs to fall within 100% and 400% of the federal poverty level – that’s approximately $12,000-$48,00 for an individual or $24,000-$98,000 for a family of four (Alaska and Hawaii have different thresholds). If you fall below these guidelines it’s possible you may qualify for Medicaid. Otherwise, it’s important to know there are other more affordable and limited coverage alternatives to the ACA; such options include short-term health insurance, accident, or what we at eHealth call medical insurance packages (these combine a number of different non-ACA products into one). These alternatives to the ACA aren’t eligible for government subsidies, don’t meet the coverage requirements for ACA plans, and don’t count as qualified health insurance if you’re subject to the ACA tax penalty, but these alternatives are also generally less expensive and may be a good fit for your budget and needs. We recommend speaking with a licensed agent to review the options available in your area, and help you in choosing the coverage that best meets your needs.
Updated June 7, 2018 Watch this short video on pre-existing condition under Obamacare. Since January 1, 2014, insurance companies have not been allowed to charge higher rates to people within the same age group based on their gender or health status -- said another way, you can't be charged a higher price for health insurance because you're a woman or because you have a health condition. If you buy your own health insurance now, your application for coverage cannot be declined because you have a pre-existing condition or for any other health related reason. Insurers can only price plans based on four factors:
  • Your age: The oldest person can only be charged three times more than the youngest person for the same plan.
  • Where you live: The price to deliver care changes from city to city and state to state.
  • The size of your family.
  • Your tobacco use: A smoker can be charged up to 50% more for the same plan as a non-smoker.

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