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Health plans that do not meet the standards of the Affordable Care Act. Work requirements for Medicaid coverage. Changes to Medicare's approved drug lists. As the healthcare situation continues to shift, this week I answer readers' questions about these three different types of plans:
I lost my job last year and my employer coverage ended in January. I bought a new plan through the marketplace that went into effect last month. I have just received political information and it is said that because the plan does not cover important medical services, I may have to pay the government additional taxes. I was told that the plan did not cover a primary medical care but was not informed about taxes. Will I get a fine next year?
It may sound like you have bought a plan that does not meet the requirements of the Affordable Care Act, and if so, you will in fact have to pay a fine if you do not have comprehensive coverage of your taxes next year.
The Tax Reform Act abolished the individual sanction for non-existence of health insurance, but this provision does not enter into force until 2019. So, for 2018, you can claim a higher amount of $ 695 or 2.5 percent of your household income
The federal and state marketplaces set up by the ACA only sell comprehensive plans covering 10 key health benefits, including "major medical" services such as hospitalization and prescription drugs
But some insurance brokerage sites also call themselves marketplaces, Sabrina Corlette says. Research Professor at the Center for Health Insurance Reform at Georgetown University. And that can be confusing. In addition to comprehensive, legally compliant plans, these companies can also sell other insurance products, such as short-term or accident insurance.
Since the adoption of the Health Act, "there are opportunistic companies trying to exploit consumers' confusion. Earn money," says Corlette.
If you are not satisfied with your plan, you may still be able to change. If you lose your employer coverage, you qualify for a 60-day special enrollment period to select a new plan. Since it seems you are still in this window, you may be able to choose a comprehensive plan.
To make sure you're using the official marketplace of your state, go to healthcare.gov and click "see if I can make any changes." This will take you to your state's marketplace, even if you're in one of about live a dozen states that run their own stock exchanges.
I am in a state that is investigating the work requirements for Medicaid. When registering, can I simply state that I intend to be out of the question for Medicaid by refusing to work and getting the tax credit to buy a private plan in the insurance marketplace?
Federal health law legislation is not clear on the situation you describe, but according to analysts, the short answer is probably not.
In general, people who are eligible for employer protection or Medicaid – the Federal Health Program for low-income people – may qualify for federal tax credits that contribute to the payment of premiums for plans sold on the health insurance exchanges.
This year, Kentucky and Indiana became the first states to require paid work, school, or volunteer work (among other activities) by some Medicaid beneficiaries 80 hours a month to gain benefits.Almost a dozen other states have similar demands
If you refuse to work, are you not eligible for Medicaid? The rules are not clear, says Judith Solomon, vice president of health policy at the center for budget and policy priorities.
States may argue that someone in your situation is eligible for Medicaid – you just have to meet the work requirements, says Timothy Jost, an emeritus professor of law at Washington and Lee University in Virginia, who is an expert for the health law is.
There are other measures that people could take – or not problem could crop up. "You could argue that someone is not eligible because they did not complete the Medicaid application or provided the documentation they needed," says Jost. "There are a number of requirements, but I can not imagine anyone saying they did not do those things, and that's why they're not suitable for Medicaid."
Whatever the rules are, it is unlikely that many people will be in one position to consider taking that stance. In order to qualify for premium tax credits, your income must be between 100 and 400 percent of the federal poverty line (approximately $ 12,000 to $ 48,500 for one person in 2018). But you also have to be eligible for Medicaid, usually with an income limit of 138 percent of poverty (about 16,750 US dollars) in states that extends coverage for adults. In addition, the Medicaid labor requirements in your state would have to apply to you.
I chose a Medicare Part D drug plan that covered all the drugs I take. But as soon as I received my first Novolin R prescription, they notified me that they no longer covered it. Can you just change it like this?
Medicare drug plans can change their list of covered drugs, called formies. If this is the case at the beginning of the new calendar year, as seems to be the case in your case, the plan may inform you of the change when you fill out the recipe for the first time in the new year. At that time, the plan would usually give you a 30-day transitional refill, allowing you to take another drug based on the formula or start the appointment procedure to get your current insulin drug, Novolin R.
If you and your doctor think it's important that you have Novolin R and no other similar drug, you can Applying for a Plan to Make an Exception to Keep You on The Drug
To follow this path, you would have to get your doctor to "argue for the reason why this formula drug is not the right drug," says Casey Schwarz, Senior Counsel for Education and Federal Policy at the Medicare Rights Center, an interest group.