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Questions Rise As Health Care Exchange Draws Near

Audio

Aired 9/24/13

Enrollment in the Affordable Care Act health exchanges is set to begin Oct. 1. But many eligible Americans still have questions.

Tell Me More reached out to listeners via Facebook and Twitter in an attempt to help answer their questions about the law. Host Michel Martin spoke with Mary Agnes Carey, a senior correspondent at Kaiser Health News -- a news service not affiliated with Kaiser Permanente.

On searching for other affordable care options

Listener Caitlin Stevenson: "When the Affordable Care Act goes into effect, if I'm already covered by an employer's health plan, am I still eligible to shop for more affordable care? The plan that my job offers costs more than $350 a month for my husband and me -- that's more than a car payment! Will we -- healthy adults, 26 and 31-- be able to find a plan that costs less than this?"

Carey answers: "Anyone can shop on the exchange. The question here is whether or not they can qualify for a subsidy of purchased coverage. ... In order to qualify for a subsidy, two things have to happen. No. 1: The ... health insurance offered by her husband's employer has to cost more than 9.5 percent of their household income or the plan, if it covers at least 60 percent of the covered medical expenses. [What] I mean is that if it pays for 60 percent of the medical expenses, they could not get into the exchange. So it either costs more than 9.5 percent of the income or it doesn't pay for 60 percent of the covered services. If one of those things happen, they might be able to qualify for a subsidy."

On options for graduating students

Graduate student Lorrie Guess: "I obviously don't know yet if I'm going to have a job that offers me coverage and I don't want to pay a fine if I don't buy the coverage in case I get a job that offers me health insurance. On the other hand, I don't want to buy coverage only to get a job that ends up covering me and then find out that I'm paying for no reason."

Carey answers: "Well here's a couple of ideas. No. 1, is there any way to extend her student health insurance for a period of time after graduation as she decides where she's going to go and what job she has and whether or not she has coverage? That's one thing. Secondly, while the enrollment period for the first year of the Affordable Care Act ends at the end of March, there are things called qualifying life events -- you lose your insurance at work, you get married, you have a child. I think graduating from college would be one of these. ... [And she] could get coverage on her parents' health insurance plan for a period of time. As we know, the Affordable Care Act allows that up to age 26."

On mental health options

Carey says, "As part of the Affordable Care Act ... there will be more coverage of mental health services. ... And also there has to be parity between what a plan offers on health services and what they offer on mental health services. But this is an area where I would urge caution, for people to look at and see how parity is defined, how it's implemented in a particular policy. Because this has been a concern -- the mental health parity law passed a few years ago, [and while] some of the regulations have come through with it others have not. But it's definitely an area worth watching for people that are enrolling in the exchange coverage."

Copyright 2013 NPR. To see more, visit www.npr.org.

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