But if you are a low-income resident of one of 25 states, including Louisiana and South Carolina, you may miss out on financial help offered by the exchanges. That’s because those states haven’t expanded their offerings under Medicaid, the federal-state health program for low-income people, as the law envisioned. A list showing the expansion status of all 50 states and the District of Columbia is available on the Kaiser Family Foundation Web site.
A result is the frustrating situation in which you could qualify for financial help to buy coverage on the marketplaces — if only you made more money.
How did this happen? The health law aimed to cover as many people as possible in two main ways: creating marketplaces where people who don’t have insurance through an employer could buy affordable private policies; and expanding the number of people covered by Medicaid, which mostly has covered children and pregnant women.
In general, if you earn from one to four times the federal poverty level — about $11,500 to $46,000 for an individual — then you qualify for subsidies, given as tax credits, to lower the cost of policies bought on the exchanges.
Coverage for people earning below the poverty level was supposed to be handled by a federally funded expansion of Medicaid. But the Supreme Court ruled in June that expanding Medicaid was optional — and half the states chose not to do it, contending that the added costs would be too burdensome for taxpayers. The law didn’t anticipate the lack of Medicaid expansion, so there is a gap in coverage for those who don’t qualify for their state’s existing Medicaid plan, and who earn too little to qualify for financial help on the exchanges.
(It’s not clear precisely how many people are affected by the gap. But roughly seven million uninsured adults earn below the poverty level in the states that haven’t expanded Medicaid, according to the Kaiser Foundation.)
If you fall into the income gap, you can buy a policy on the exchanges — but you’ll pay the full premium. That’s “unrealistic” for someone making less than poverty income, said Ron Pollack, executive director of Families USA, which advocates for broader health care coverage. According to the Kaiser Foundation’s premium calculator, a 40-year-old man or woman who doesn’t smoke and earns $10,500 a year — below the poverty level — wouldn’t qualify for subsidies and would pay nearly $3,200 a year, or roughly a third of his or her income, for a “bronze” plan on the exchanges.
“The irony is that people with higher incomes can and will get help,” said Mr. Pollack.
One small consolation: If you would have qualified for Medicaid under the A.C.A. expansion, but your state isn’t participating, you’re exempt from the law’s requirement to buy coverage. So you won’t pay a penalty for not buying it.
Here are some questions to consider:
■ If my income is low and I’m uninsured, but I live in a state that didn’t expand Medicaid, should I apply for coverage on the marketplace anyway?
There’s no penalty for applying. And it may turn out that you qualify for coverage under your state’s existing Medicaid rules, but didn’t know it.
■ Could my state expand Medicaid coverage in the future?
Possibly. There’s no deadline for states to expand their programs, and some are still considering it.
■ Where can I seek medical treatment if I don’t have any insurance?
Check to see if there is a community health center near you; the cost of care at such clinics varies based on your income. You can search by ZIP code on the federal health care Web site: healthcare.gov/where-can-i-get-free-or-low-cost-care/
Article source: http://www.nytimes.com/2013/09/24/your-money/locked-out-of-the-insurance-marketplace.html?partner=rss&emc=rss