If you’re one of the nearly 60 million people in the U.S. who work at small businesses, the nation’s new health care law likely will affect you in some way. Starting this week, public exchanges, or marketplaces, are opening up in each state to sell health insurance.
Bryan Shaw has coverage from his employer 3dcart, a software company in Tamarac, Fla., but plans to shop on an exchange. Shaw says he’s excited about the fact that insurance companies large and small will be competing for customers on the exchanges. He expects that competition will lead to a better price for the insurance he needs.
Here’s what you need to know about the law:
Q. How do I find out what coverage my company is offering?
A. Companies with fewer than 50 workers aren’t required to provide insurance. Those with more than 50 must provide affordable coverage. Ask your company about its plans to provide insurance, including details about premiums, deductibles and other costs, says Zoe Barry, CEO of ZappRx, a Boston-based company that manages patients’ prescription information.
Q. My company isn’t required to offer coverage and isn’t going to do it. What are my options?
A. Public exchanges set up in each state under the new law are designed to sell affordable coverage. Each exchange offers insurance plans from several companies. Coverage is divided into four levels: bronze, silver, gold and platinum, with premiums at the bronze level being the cheapest and platinum the most expensive. Deductibles and out-of-pocket costs are larger with bronze plans, and shrink as you go up the scale and pay higher monthly premiums. The government will subsidize coverage on the exchanges if an individual’s income is no more than $45,960 and up to $94,200 for a family of four. You can also buy insurance through a broker, on a private exchange or directly from an insurer, but it’s likely to be more expensive and it won’t be subsidized.
Q. My employer isn’t required to buy coverage, but is going to give me money to help me buy my own insurance. Is this money taxable?
A. Yes. The government considers the money part of your compensation. It will be subject to federal, state and local taxes.
Q. My employer is providing insurance, but I don’t like my choices. What can I do?
A. You can buy your own coverage. But if you use a public exchange, you could lose the right to any possible subsidies that are available. The government will subsidize coverage on the exchanges if an individual’s income is no more than $45,960. For a family of four, the threshold is $94,200. You can also buy insurance privately, but it won’t be subsidized.
Q. My company has more than 50 workers. Does it have to cover my spouse and kids?
A. The new law requires that employers with 50 or more workers offer insurance to staffers’ dependents. Employers don’t have to pay for that insurance, however, and they’re not required to offer coverage to spouses.
Q. How much more is this going to cost me?
A. It’s hard to say. But workers are likely to find that their out-of-pocket costs will be higher if they choose a plan with low monthly premiums, says Allen Wishner, CEO of Flexible Benefit Service Corp., a Rosemont, Ill.-based benefits broker and administrator.
Q. Will I have to change doctors?
A. Possibly. Insurers might include fewer doctors in the plans they sell on exchanges to keep the costs of the insurance down, Wishner says.
Q. Can someone help me figure out what to do?
A. A health insurance broker can help you decide which insurance plan is best. So can a financial planner or attorney with expertise in health care law. Exchanges will have help available through toll-free numbers and online chats. But you’ll only get information about plans on the exchange, not other options available to you, notes Joel Ohman, a financial planner in Tampa, Fla., and founder of InsuranceProviders.com.
Q. Where can I find information online?
A. www.healthcare.gov is the government’s main source of information about insurance on the exchanges and has links to the exchanges. State websites also have information and links to exchanges. The Kaiser Family Foundation, which researches health care issues, has information at https://kff.org/aca-consumer-resources.