The Center on Health Insurance Reforms (CHIR) held its first-ever Tweetchat to highlight the release of our updated Navigator Resource Guide. We asked navigators, assisters, and consumers to ask us questions they had about Open Enrollment or health insurance generally. Here are five questions participants had about health insurance:
1. Johanna’s question on employer-sponsored insurance coverage
— Johanna Jochum (@JohannaBandana) November 16, 2018
Employers are not required to cover spouses – if they do, they aren’t required to subsidize the coverage. It’s likely that the extra $100 isn’t a penalty, but that they’re subsidizing your spouse less than they’re subsidizing you.
2. Joyce’s question about her gold plan’s actuarial value (AV)
Our first #PathToCoverage question came from Joyce from Facebook: Does the actuarial value (AV) directly correlate to the coinsurance between deductible and out of pocket? I have a gold plan with a 70/30 AV. Should that be 80/20 for expenses, or is there no direct relationship?
— Center on Health Insurance Reforms (@GtownCHIR) November 16, 2018
The answer to the first question is that actuarial value reflects the amount a health plan covers for the average enrollee. So if you’re in a Gold plan, the plan would cover, on average, 80 percent of costs. Consumer cost-sharing (i.e. deductible, coinsurance) would be, on average, 20 percent. This can be confusing for a consumer who has a Gold plan, but sees 30 percent coinsurance for a drug or service on their Summary of Benefits. But the coinsurance amount for a specific drug or service doesn’t mean your plan doesn’t meet the AV requirements. AV is determined by the total amount a plan spends on services, not the amount it covers for a specific item or service.
3. Gabriel’s question on giving advice to consumers about pending federal policy
How can you give reliable actionable advice when you don’t have a final rule?
— Gabriel McGlamery (@jgmcglamery) November 16, 2018
Although proposed rules do have hypothetical implications, assisters cannot give reliable advice to a consumer without a final rule. Assisters can explain the rule if the consumer is worried, but should emphasize that the rule is not final and may change.
4. Andrew’s question on predicting income when you have a health savings account (HSA)
.@GtownChir If you enroll in a HDHP plan w/ HSA, how do you take your planned HSA contribution off MAGI if you're using https://t.co/4eDVJEdxxT ? I hear you can do this on CO exchange, but a lot of hc..gov enrollees reconcile after the fact b/c nowhere to report. #PathtoCoverage
— xpostfactoid (@xpostfactoid) November 16, 2018
When calculating your income for your healthcare.gov application, you should subtract from your projected 2019 income the amount you expect to contribute to your HSA if you have one. However, if at end of year, you didn’t contribute what you thought you would, you may owe money back through reconciliation, which is the requirement to pay back any tax credits that you would not have received with a correctly reported income. To avoid owing money at tax time, you can update your income throughout the year by reporting a life change.
5. Melissa’s question about preventive services like the flu shot
— Melissa Ryan (@ms_melissaryan) November 16, 2018
Under an ACA-compliant plan, flu shots must be covered without cost-sharing if provided by an in-network provider because it is an essential health benefit. If the appointment is for another reason, however, the insurer doesn’t have to cover the office visit, but the vaccination itself should be free.
We thank all of our participants for their thoughtful questions. For more information on Open Enrollment and other health insurance questions, please visit our Navigator Resource Guide. Can’t find what you need? Tweet us or email us your questions! We will be monitoring questions until the end of Open Enrollment on December 15, 2018.