Here & Now

Bobby Peterson Answers Question on Healthcare.gov Coverage

Frederica Freyberg:

Ten days remain until the enrollment window for healthcare coverage through the marketplace, otherwise known as Obamacare, closes. If there's one guy who knows the ins and outs of the Affordable Care Act it’s attorney Bobby Peterson, from ABC for Health, here in Madison. We have some last-minute questions for him. Thanks for being here.

Bobby Peterson:

Sure. Glad to be here.

Frederica Freyberg:

Well, first of all, what happens if a person who wants to enroll in the marketplace, the federal healthcare marketplace, fails to do so by March 31st.

Bobby Peterson:

Well, there's opportunities to enroll for certain people with exceptions, if they've lost their job or got married or changes in circumstances, after that deadline. They’ll have to wait until the open enrollment period, which is, you know, next fall. But for a lot of folks, you know, getting out there, getting enrolled now, is a good idea, to get coverage to start up as soon possible.

Frederica Freyberg:

As we near this deadline we have solicited some questions from people, because we’ve been hearing questions. Again, some people have not yet signed up, but because they’re still trying to figure things out.

Bobby Peterson:

Yeah.

Frederica Freyberg:

One so-called Young Invincible that we spoke to tells us this. He says, I want to get away as cheap as possible but also get something for my money. He says, My biggest general question is which carrier to choose, and then which plan to choose. He goes on to say, I rarely use medical services and I don’t know to get the plan with a $5,000 or $500 deductible. So, you know, that’s a lot of questions.

Bobby Peterson:

Yeah.

Frederica Freyberg:

But a lot of these navigators and counselors out there seem to be kind of saying, well, go for the silver plan, because that’s kind of in the middle. But what about for a young guy who doesn’t really go to the doctor very much. Does he need that much of a plan?

Bobby Peterson:

Yeah, and I think that there are catastrophic plans that might be available for people under age 30. That’s an option to consider. You know, I mean, the bigger thing is which plan to select, and if they have any history, medical history, doctors they work with. Looking at those considerations are important as well. A lot of people get directed to the silver plan because that’s where you qualify for some of the cost sharing reductions. If you’re below a certain percentage of the income, 250% of the federal poverty limit, you get some additional cost-sharing reductions that you're eligible for. It's up to 400% where you get some of the premium reductions. So it can be advantageous then to select the silver plan.

Frederica Freyberg:

And you're saying, in terms of which plan to choose, it kind of depends, as you say, if you’re already going to a clinic or had a check-up somewhere, if you like those people, check what plans are connected with that group.

Bobby Peterson:

Right, right. There’s the metal level plan, and then there's actually the health plan that you want to get your care at. So those are two different questions, but equally important questions.

Frederica Freyberg:

Okay, that same guy had a question similar to the next one that we’re about to pose. And that is, how to deal with these tax credits that help subsidize the plan premiums.

Bobby Peterson:

Yes, well, I think that the

Frederica Freyberg:

Go ahead.

Bobby Peterson:

Okay.

Frederica Freyberg:

Well, what we were going to do was show you this question from this woman.

Bobby Peterson:

I'm sorry.

Frederica Freyberg:

No, that's all right.

Let’s see what she says.

Katie Ackley:

Do I take all these tax credits at the beginning and not pay a premium, or do I continue to pay the full amount of the premium and then hope to receive a refund at the end of the year?

Bobby Peterson:

That is a great question. I think that, you know, there’s so much more that you really need to know to help her, but I think generally, people have to look at their financial situation. The tax credits are typically advanceable tax credits, so what people do is they designate it right away for their health care coverage to be paid to the carrier that they choose. Other people can select how much of their tax credit they want now or later. So if you’re self-employed and your income fluctuates, if you take all the tax credit now and you do really well, you may have a penalty to pay at the end of the year. If you’re a seasonal worker, so your income is low now but you're going to make a lot more in the summer, spring and fall, you can have possible payments to make later on. So you have you to evaluate your financial situation, and you do have some choices in how much of the credit you want to allocate to your provider right away, or health plan right away.

Frederica Freyberg:

So it is really complicated.

Bobby Peterson:

Yeah, you know, this stuff is. And a lot of people are making mistakes. And we’ve made mistakes. I mean, we’re all human, but I think the point is that a lot of this stuff you need to really look at it carefully, confirm it, reconfirm it. If it doesn’t feel right in your gut, keep asking questions. That's usually our sign that there's something else out there.

Frederica Freyberg:

We've another question for you, and again, this one is also about the tax credits.

Karen Connor:

How long do they last? Is it a permanent thing as long as you declare initial eligibility? Does it change when your income changes?

Bobby Peterson:

Another good question. It will change when your income changes. And there’s a mechanism to call in and to report changes in your income. Again, if you’re seasonally employed and suddenly your income jumps up and you don’t want to be on the hook for all that at the end of year, you might report a change in your income so that it’s a higher level. You get a new job, you get a promotion, you’re self-employment work really skyrockets and the money is rolling in, those are situations where you need to let them know about those changes. They're going to be there as long that’s law is the way it is now and continue throughout the year, but you’re really in charge of how that premium is taxable– that tax credit is allocated.

Frederica Freyberg:

All right, one really quick final question. That has to do with whether or not people like yourself are really busy right now coming into this deadline.

Bobby Peterson:

Yeah. I think it’s a crazy time. We’re leaving the polar vortex behind, but have a health care vortex. There's a lot of coverage information. Families are losing BadgerCare Plus. Those families need to enroll in the new healthcare marketplace. They've got some opportunity to do it even after March 31. There’s a whole group of people that are being added to BadgerCare plus, the childless adults who haven't had coverage in a long time. It's a great opportunity for folks with mental health issues or physical issues. If they haven’t had coverage, now’s the time to reach out to family, friends, neighbors, to help identify those folk and make sure they've signed up for coverage. There's even back-dated opportunities. If they miss doing it before April 1, there’s some opportunities to have back-dated coverage in certain circumstances.

Frederica Freyberg:

That's really interesting. Bobby Peterson, thank you.

Bobby Peterson:

Thank you.