By Kim Boyer
The 2010 Affordable Care Act (“ACA”) requires individuals to have health insurance starting in January 2014, called the individual mandate. Under the ACA, the Medicaid expansion was optional, and Nevada has chosen the Medicaid expansion. In addition, Nevada has received approval from the U.S. Department of Health and Human Services to run its own exchange, which is called theSilver State Health Insurance Exchange. The following are some common questions that I hear in my practice as an elder law attorney.
What is the Medicaid expansion in Nevada? Medicaid will be expanded to provide health insurance for more low-income Nevadans, by making it available to those with incomes up to 138% of federal poverty level.
Does the ACA change long-term care? The ACA has no effect on institutional Medicaid in Nevada, which is the Medicaid program for the aged, blind and disabled to pay for the cost of long-term care.
How will the ACA affect Medicare? The ACA includes one significant improvement, but makes Medicare a target for spending cuts. Under the ACA, the infamous “donut hole” in Medicare’s prescription drug coverage will be slowly phased out and will close in 2020. Seniors are wondering who is going to pay for the ACA. According to the Congressional Budget Office, hundreds of billions of dollars in funding for ACA will be generated by cuts in Medicare’s budget over the next decade. The biggest spending cuts will come in reduced number of plans available, reduced benefits in the Medicare Advantage program, and reduced payment rates to doctors who care for Medicare patients. Perhaps of more concern for seniors is the presidential commission called the Independent Payment Advisory Board. This board will be given significant power to cut Medicare spending in the future because its decisions will automatically take effect unless counteracted by Congress.
What does the exchange have to do with Medicare?The exchange does not offer enrollment in Medicare. The exchange offers qualified health plans for those people age 64 and under.
What is the penalty if I don’t have health insurance? The IRS will enforce a tax penalty of $95.00 or 1% of your income (whichever is greater) in calendar year 2014. The penalty will increase to $695.00 or 2.5% of your income (whichever is greater) in calendar year 2016. There are exemptions from the individual mandate for certain religious groups, Native Americans and for people who face a financial hardship that precludes them from purchasing health insurance.
Can I purchase a qualified health plan outside of the exchange?Insurance carriers that offer qualified health plans on the exchange will offer the same product outside the exchange. The exchange is the only place that you can receive premium assistance in the form of an advance premium tax credit or cost sharing reductions. The advance premium tax credit is not available if you earn more than 400% of poverty level ($44,680.00 in 2012); the cost sharing reduction is not available if you earn more than 250% of poverty level ($27,925.00 in 2012).
When can I enroll in a qualified health plan?Open enrollment starts on October 1, 2013, and ends on March 31, 2014.
Disclaimer: Information provided as a service of Kim Boyer, Certified Elder Law Attorney, updated as of 03/30/13. It does not constitute legal advice. For specific questions you should consult a qualified attorney.