Getting Covered: Expert Q & A
More than 600,000 Pennsylvanians are expected to be shopping for health insurance on a new federally-facilitated exchange during open enrollment. And, there are a lot of questions.
We reached out toJohn DeLorenzo, Director for Legal Services at PinnacleHealth, for some expert answers to some questions from our own community. You’ll find his wisdom on health insurance, Medicaid, and the Affordable Care Act in the Q & A below.
These are just some of the Q & A’s that you’ll find in our new multimedia guide, Getting Covered: The Affordable Care Act in PA.
This multimedia tool is a one-stop-shop for expert tips, tools, videos and personal stories, designed to help Pennsylvanians understand their coverage options, costs, and how to access insurance.
Divorce
Q. Mary from Lancaster, PA asks, “What provisions are available between divorced and/or separated people?”
A: The Affordable Care Act only applies to individuals in terms of the mandate. So it doesn’t matter if a person is single, married, divorced, or separated, he/she is required to have a qualified health plan by January 1, 2014. A person can either obtain an individual plan that only covers his/herself or one that covers the family as well.
Pamela Parson
Medicaid gap in PA
Q: Pamela Parson asks,”There are some people who will not be covered because Governor Corbett has chosen NOT to expand Medicaid. I am one of those people. So what do I do now? I was able to get on the site in the first few weeks and completed the process. My eligibility letter states that I do not qualify for Medicaid or subsidy or the marketplace. I have the eligibility letter to prove it. The letter also states I’ll be exempt from tax penalties. So what do I do now? The cheapest bronze plan is too expensive for me.”
A: Pamela you are caught in the gap between where the subsidies start under the Affordable Care Act (ACA) and where the limits for Medicaid were before the ACA. This is the perfect storm that was caused by the US Supreme Court’s decision that vacated the part of the ACA that would have forced states to increase the Medicaid eligibility. Unfortunately, there are no good answers for you. However, there is a light at the end of the tunnel (and it isn’t an oncoming train).
The Governor has proposed an expansion of Medicaid in PA that is different from what other states are doing, but none-the-less would increase the income limits for Medicaid to roughly $16,000 for an individual or $32,000 for a family of four. Hopefully, this will be approved by the Federal Government, and you will become eligible for Medicaid.
Anticipating salary
Q: Janelle emails, “I have heard that insurance costs will be based on 2014 anticipated income of the individual but as a student graduating in May how am I supposed to know how much money I will make ? Should I try to base my insurance costs on estimated salary expectations?”
A: Yes. You should, to the best of your ability, estimate what you think you will make in 2014.
Catastrophic plans
Q: Mark asks, “Since the exchange does not include “catastrophic” plans like the one I currently can afford, what options do I have for comparison shopping for this level of insurance? Is it likely that the insurance companies will lower the prices of catastrophic plans because of competition, or will this level of insurance become rarer, and hence more expensive?
I spent about three hours on the healthcare.gov site, including attempted online chats (pretty funny, but not helpful.) and telephone conversations. Ultimately, I discovered that I don’t meet the MINIMUM annual salary (in Pennsylvania) to take advantage of any subsidies to purchase insurance.”
A: To meet the requirements under the Affordable Care Act, specifically the Individual Mandate, a person must have health insurance coverage under a Qualified Health Plan (QHP) by January 1, 2014. Most catastrophic plans don’t meet the requirements of a QHP (although there are exceptions). Therefore, since most catastrophic plans don’t qualify they are being eliminated by insurance carriers.
The ACA & retirement planning
Q: Crystal in Carlisle asks via the Public Insight Network, “How does the law impact retirement planning for young people? Before the act I remember being advised as a person in my 20s that I should save 300K for retiree health insurance premiums, to cover time between retirement and Medicare, if a gap exists.”

A: The Affordable Care Act (ACA) really has very little impact on Medicare (which covers older retired individuals and some people with disabilities). Once a person is eligible for Medicare, he/she is no longer eligible for policies on the Exchange. So the ACA should have little to no impact on retirement planning.
Affordable insurance
Q: Robert in Harrisburg asks,”Insurance costs are rising every year, why is that? Why can’t the insurance companies provide AFFORDABLE insurance to those that need it?I need dental work and I cannot afford dental insurance or health insurance. I am concerned that if I am seen today I will go further into debt. Also why can’t the good doctors still be forced to see you if you have no insurance. I have to go to clinics and most of those are ran by PA’s and not Doctors.”
A: There really isn’t an easy answer to your questions. While insurance companies take most of the blame for the increase in rates, it is really caused by many complex factors. The hope is that the Affordable Care Act will build up a larger risk pool that will stabilize rates and keep premiums down. But this is yet to be seen. Dental insurance is not addressed in the Affordable Care Act except for children. So the Act will not help you with your dental costs. You may find a health insurance policy on the Exchange that you may be able to afford though. It may be helpful to look into the options there. When you look at the plans, don’t just look at the premium. Look at the network for each plan. Some plan networks are very narrow (meaning very few doctors to choose from). Others are more robust. This should definitely be considered based upon your own particular needs.
Take a look atGetting Coveredto explore your specific coverage options!
Do you have an insurance question that you’d like an expert to answer? Ask your question in a comment below and we’ll do our best to have an expert answer it.
