We're here to protect insurance consumers
Washington State Office of the Insurance Commissioner
Click to go to Health Care Reform section homepage.

FAQ on health care reform

Families and individuals

Q. What about my costs - will my premium continue to go up?

A. Unfortunately, medical costs likely will continue to rise. Some individuals and families with health problems may see their rates decrease. The new law prohibits unreasonable and unexpected spikes in premiums, and over time, should slow overall health care spending.

Q. Can I still have an Health Savings Account (HSA)?

A. Yes. Nothing in the new law prohibits you from contributing to an HSA.

Uninsured

Q. I don't have insurance now, how and when will the new law help me get coverage?

A. It depends on your situation. If you haven't had insurance for six months, and you can't afford or don't qualify for coverage because of a pre-existing condition, you may be eligible for coverage under the Pre-existing Condition Insurance Plan. Contact the plan directly to see if you qualify.

Q. I don't have insurance. Will I have to get it and what happens if I don't?

A. All individuals will be required to have health insurance, with some exceptions, beginning in 2014. Some also may qualify for subsidies. Those who don't get insurance will have to pay an annual penalty based on their income.

Exceptions will be given for:

  • financial hardship.
  • religious objections.
  • American Indians.
  • those without coverage for less than three months.
  • undocumented immigrants.
  • incarcerated individuals.
  • those for whom the lowest cost plan option exceeds 8% of an individual’s income.
  • those with incomes below the tax filing threshold.

Q. How will the new law affect the kind of insurance I can buy? Will it make it easier for me to get coverage, even if I have health problems?

A. Yes. The new law creates a temporary high-risk pool for people with medical conditions who have been denied insurance and who have been uninsured for at least six months. And beginning in 2014, you cannot be denied coverage because of your health.

Q. When can people get coverage through the new high risk pool?

A. The new, temporary high risk pool is up and running now.

Young adults

Q. Can I add my adult child to my health plan?

A. It depends on what type of plan you have and when you enrolled. If you have an individual plan or ennrolled in an employer plan that has dependent coverage after March 23, 2010, you can add your adult child up to age 26 after Sept. 23, 2010 when your plan renews.

After Jan.1, 2014, all employer plans with dependent coverage must allow parents to put their children under age 26 on their plans, regardless of whether the child is eligible for other employer coverage.

Q. Do young adults who qualify for this benefit have to live in the same state as the parent whose insurer will be providing the coverage?

A. No.

Q. Do young adults have to be students to qualify?

A. No.

Q. Do they have to live with their parents to be eligible for coverage?

A. No.

Q. I've heard that anyone under 30 will be able to choose a health plan designed just for their age group. When does this take effect?

A. Beginning in 2014, anyone under age 30 can purchase a comprehensive coverage plan or a catastrophic plan designed just for their age group.

Children

Q. Can I get coverage for my child, even if they have a pre-existing condition?

A. Yes. During March 15-April 30 and Sept. 15-Oct. 31 every year, you can buy a health plan for your child without having to fill out a health questionnaire. Also, you may qualify for buying coverage outside of these two open-enrollment periods.

Seniors

Q. I heard I get free preventive services under the new law. When does this start and what does it cover?

A. As of Jan. 1, 2011, proven preventive services will be free. Also, Medicare will provide a new annual wellness visit that includes a health risk assessment.

Small businesses

Q. I own a small business. Will I have to buy insurance for my employees? What help can I get now?

A. It depends on the size of your business. Companies with fewer than 51 employees won't be penalized if they don't offer health insurance. But effective now, businesses can get tax credits if they have 25 or fewer employees and a workforce with an average wage of up to $50,000. Tax credits of 35 percent of the premium costs are available this year and will increase up to 50 percent in 2014.

In 2014, business with more than 50 employees that do not offer health insurance must pay a fee of up to $2,000 per full-time employee if any of their employees get government-subsidized coverage through the exchange. The first 30 employees will be excluded from the assessment.

Q. What is the small business tax credit and how do I know if I'm eligible?

A. Tax credits are available to qualified small businesses that provide their employees with health insurance as of Jan. 1, 2011. To qualify, your business must cover 50 percent of the cost of health care coverage for your employees, pay an average annual wage below $50,000, and have less than the equivalent of 25 full-time employees. The size of the credit depends on your average wages and the number of employees you have. Still not sure? The IRS can help.

Q. Will I have to buy insurance through the Exchange or can I continue to use my insurance agent?

A. Businesses are not required to buy coverage through the small business exchange.

Q. Can I continue to contribute to my employees through flexible spending accounts?

A. Yes. Nothing in the new law eliminates or discourages this option.

 

 

 





Updated 03/20/2012

Tell a friend |

Need more help? Call our FREE Insurance Consumer Hotline at 1-800-562-6900
or Email us at cap@oic.wa.gov.