Update: What You’re Asking Us About Healthcare Reform

Email and telepheon questionsDo you have questions about the Affordable Care Act and the health insurance marketplace?  Trying to make health plan coverage decisions but need help?  Join Premera and KOMO News (@komonews) from noon to 1 p.m. Wednesday, October 23, for a Twitter chat.  Our team of experts will answer all of your questions @premera using the hashtag #ShareTheHealth. 

It’s been almost two weeks since open enrollment for 2014 began and in that time we’ve spoken to thousands of people across Washington to help them understand what these changes mean for their healthcare coverage. Last week we answered some of the most common questions we’d been hearing from you. Here’s a round-up of what we’ve been hearing from you this past week.

How do I know I’m buying my plan from the right place?

We know there are lots of different websites out there to help you compare health plan benefits and prices. One of the biggest concerns people may have this year is whether or not they’ll be able to get help with their costs in the form of a premium tax credit.

In Washington there are a few ways you can make sure you’re getting what you’re entitled to:

  1. Call us at 1-877-PREMERA. Our sales team is licensed by the state to enroll you through Washington’s health plan marketplace, so we can ensure you get the tax credits, or cost-sharing subsidies, you’re entitled to.
  2. Visit Washington Healthplanfinder, the official state marketplace. There you can compare plans, enroll in a Premera plan if you wish, and get access to the same tax-credit or cost-sharing subsidy that you would get if you call our sales team.
  3. Speak to your producer or broker. You can find a broker in your area through Washington Healthplanfinder.

What’s different about my out-of-pocket maximum next year?

Out-of-pocket maximum is the maximum amount you should have to pay each year toward your plan’s allowable healthcare costs. After you’ve reached this limit, Premera will pay for any additional medical services you use during the year. Previously, some costs, such as pharmacy cost-shares and co-pays for doctor’s office visits were exempt from this. Starting in 2014, all your allowable medical and pharmacy costs will go toward your out-of-pocket maximum, so once you reach that limit, you won’t have to contribute towards prescription drugs, doctor’s visits or other in-network treatment that you seek.

How do I know if I’ve become eligible for Medicaid?

Starting in 2014, many more Washington residents will become eligible for Medicaid. Washington is changing the name of its Medicaid Program to ‘Apple Health’. You can find out more about whether you qualify here. If you do qualify for Medicaid, you don’t have to purchase your own health plan; however you can still choose to do so if you prefer. It’s important to note that if you qualify for Medicaid but purchase your own health plan, you won’t be entitled to a premium tax credit. You can sign up for a Medicaid plan through Washington Healthplanfinder.

What happens if my income changes during the year? Do I have to pay back my tax credit?

If you qualify for help with your costs in the form of a tax credit, there are two ways you can choose to receive these funds:

  1. Have them paid each month to your health plan to lower your monthly rate, or
  2. Pay the full cost of your plan yourself and have your tax credit applied at the end of the tax year to lower the amount of taxes you owe or apply to any rebate you receive.

If you choose to have the tax credit paid each month to your health plan, and your income changes over the year, you may end up owing some money back. If that’s the case, that calculation will be done when you submit your tax return after the end of the year. However, you can help avoid this situation by updating your income estimate at any time during the year so that if you begin to earn more, or less, the amount of tax credits you receive will be adjusted.

Have more questions? Let us know by calling us at 1-877-PREMERA, leaving a comment or question on the blog, or on our Facebook or Twitter.

About Premera
Premera is a health benefits company serving almost 1.7 million people, from individuals to Fortune 100 companies. We provide health, life, vision, dental, stop-loss, disability, workforce wellness and other related products and services.

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