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HEALTHCARE Q & A

What an insurance exchange could do for you

Also: Who would be eligible for government subsidies? How do the House and Senate bills address medical bankruptcy?

January 17, 2010|By Kim Geiger
  • Talks are underway to merge the House and Senate healthcare bills. From left, House Democrats Chris Van Hollen, Speaker Nancy Pelosi, James E. Clyburn, Xavier Becerra and Majority Leader Steny H. Hoyer in Washington.
Talks are underway to merge the House and Senate healthcare bills. From… (Mark Wilson / Getty Images )

Reporting from Washington — A look at some reader questions on insurance options that would be available under the House and Senate healthcare bills:

My family's current policy costs more than $400 per month, which is not affordable for us. Will we be able to afford insurance under the healthcare bills?

If you get your insurance through your employer, the bills would require that your share of the premiums not exceed a certain amount of your income -- 9.8% under the Senate plan, and 12% under the House proposal. If your employer-sponsored insurance premiums are more than that, you could be eligible for government subsidies.

If you buy private insurance and your yearly income is below 400% of the federal poverty level, you also would be eligible for subsidized insurance.

After subsidies are applied, premiums for some consumers could be quite low. For example, a family of four with a yearly household income of $50,000 would pay just $285 per month under the House bill. That same family would pay $750 per month if their yearly household income increased to $80,000.

To find out the cost of insuring your family under the House and Senate bills, visit http://healthreform.kff.org for the Kaiser Family Foundation's interactive subsidy calculator.

I'm planning to retire before age 65, and I'm afraid I won't be able to afford the COBRA payments. What are my options if the health overhaul passes?

Under the bills in the House and Senate, at least one insurance exchange would be created to help you compare and purchase a policy. The exchange would function much like a travel website by allowing you to compare the costs and benefits of each plan.

The exchange also would limit insurers' ability to charge you extra based on your age. And if your income is below 400% of the federal poverty level, you would be eligible to buy subsidized insurance through the exchange.

Will the overhaul reduce or eliminate medical bankruptcy caused by long-term health expenses?

In some cases, but not all.

The government would regulate policies that are offered on the insurance exchange and set standards designed to protect consumers from incurring enormous medical bills. The exchanges would be open to those who do not get medical insurance through an employer or cannot afford their employer's coverage.

Under the House bill, yearly cost-sharing -- the amount the consumer must pay in out-of-pocket costs in addition to the cost of monthly premiums -- would be capped at $5,000 for an individual and $10,000 for a family. The Senate cap is $5,950 for an individual and $11,900 for a family. Cost-sharing limits would be lower for people whose policies are subsidized by the government.

Still, some critics say these provisions don't do enough to protect exchange consumers from medical bankruptcy, especially when suffering from an illness that requires costly treatment for many years. And though the legislation would offer more protection to other workers, not every contingency would be covered.

What happens if my employer decides to pay the fine rather than continue providing health benefits?

If your employer chooses not to offer health benefits, you would be eligible to purchase a policy on the insurance exchange -- and may qualify for government subsidies to help cover the cost.

kim.geiger@latimes.com

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