FAQs: Currently Insured

With the individual mandate kicking in on January 1, 2014, most Americans will be required to have insurance coverage.  It's a confusing time for many and even those currently with insurance coverage have concerns.  Below are answers to some of the more frequently asked questions.

What if I have job-based insurance?

If you have job-based health insurance you like, you are considered covered and can keep your insurance. You may be able to switch to Marketplace coverage eventually if you want to.

Any job-based health plan you currently have qualifies as minimum essential coverage. You don't need to change to a Marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014. If you'd like to explore Marketplace coverage options, you can, but there are several important things to consider.

With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.

If you decide to check out Marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.

Whether you qualify for lower costs will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable and meets minimum value, you won't be able to get lower costs on premiums or out-of-pocket costs in the Marketplace. This is true no matter what your income and family size are.

Your employer can tell you whether the insurance plan it offers meets minimum value and help you determine whether the plan is considered affordable for you.

What if I have a grandfathered health insurance plan?

"Grandfathered” plans are those that were in existence on March 23, 2010, and have stayed basically the same since then. These plans can enroll people after that date and still maintain their grandfathered status. The status depends on when the plan was created, not when you joined it. If you are covered by a grandfathered plan, you may not get some rights and protections that other plans offer.

Like other health plans, all grandfathered plans are required to end lifetime limits on coverage, end arbitrary cancelations of health coverage, cover adult children up to age 26, provide a summary of benefits and coverage and spend at least 80 percent of premiums on health care.

But unlike plans created after March 23, 2010, grandfathered plans do not need to cover preventive care for free, guarantee your right to appeal, protect your choice of doctors and access to emergency care, or publicly justify premium increases of 10 percent or more.

Additionally, individual grandfathered plans do not have to end yearly limits on coverage or provide coverage to people with pre-existing health conditions.

What if I'm losing job-based insurance?

If you lose your job-based health insurance, you have two primary options for health insurance coverage:

  • Get an individual Marketplace plan. If you leave your job for any reason and lose your job-based coverage, you can choose to buy coverage from the Marketplace. This is true even if you leave your job outside the Marketplace open enrollment period of Oct. 1, 2013 to March 31, 2014. By using the Marketplace, you’ll learn whether you qualify for lower costs on your monthly premiums on private insurance or for lower out-of-pocket costs. Through the Marketplace you’ll also learn whether you qualify for free or low-cost coverage from Medicaid or the Children’s Health Insurance Program (CHIP).
  • Get COBRA coverage. You may be able to keep your job-based plan through COBRA continuation coverage. COBRA is a federal law that may let you pay to keep yourself and your family on your employee health insurance for a limited time (usually 18 months) after your employment ends or you otherwise lose coverage. If you buy COBRA continuation coverage, you won't be able to get any of the lower costs on premiums and out-of-pocket costs that people may get using the Marketplace. You’d also have to pay the full monthly premium, including any part of the premium that your employer had contributed.

Can children stay on a parent's plan through age 26?

Yes. If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old.

Children can join or remain on a plan even if they are:

  • Married
  • Not living with their parents
  • Attending school
  • Not financially dependent on their parents
  • Eligible to enroll in their employer’s plan

Adult children may be enrolled during a plan’s open enrollment period or during other special enrollment opportunities. Your employer or insurance company can provide enrollment details. Children under age 26 are also eligible for family coverage in Marketplace plans.

Source:  Healthcare.gov