baby boomers, older adults, healthy habits

What the Supreme Court case on health care subsidies means to you

Jun 25 2015
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The U.S. Supreme Court announced its long-anticipated decision in the  King v. Burwell case on June 25, 2015. The Court ruled in favor of Burwell, effectively preserving the availability of subsidies for health care coverage purchased on public exchanges, regardless of whether they are state-run or federally facilitated. Subsidies include premium tax credits, which lower a consumer’s monthly premium. HealthCare.gov serves 34 states currently, with about 6.4 million consumers receiving subsidies.

To help consumers understand the implications of this decision on health care subsidies, we have assembled these commonly asked questions.

I have a plan through the federal marketplace. Are there any changes to my health insurance benefits, subsidies or plan premium right now?

No, there are no changes to your health insurance benefits, subsidies or plan premium for 2015.

I have a state-based marketplace plan. Are there any changes to my health insurance benefits, subsidies or plan premium now?

No, there are no changes to your health insurance benefits, subsidies or plan premium for 2015.

Are there any changes to my 2016 health insurance benefits, subsidies or plan premium?

That depends on whether the marketplace confirms that you are still eligible for enrollment and subsidies in 2016 and which plan you choose during the 2016 open enrollment period. Keep in mind that once you have health insurance through the federal marketplace, it is your responsibility to report changes to your income, household, address and health coverage eligibility to the marketplace as soon as possible. These updates may change the coverage or savings you’re eligible for in the marketplace.

Which changes do I have to report to the marketplace?

You must report changes to your income, household, address, and health coverage eligibility to the marketplace as soon as possible. These updates may change the coverage or savings you’re eligible for in the marketplace. For example:

  • If your income goes up or you lose a member of your household: You may qualify for less savings than you’re getting now. If you don’t report the changes, you could wind up having to pay money back when you file your federal tax return for the year.
  • If your income goes down or you gain a household member: You could qualify for more savings than you’re getting now. This could lower the amount you pay in monthly premiums. You could also qualify for Medicaid or CHIP coverage.
  • If your change qualifies you for a special enrollment period: Some life changes – like getting married, having a baby, or losing other health coverage – qualify you for a special enrollment period. This means you can change health plans outside the annual open enrollment period.
  • If you become eligible for Medicare or enroll in Medicare Part A: You may qualify for less savings than you’re getting now. If you don’t report the changes, you could wind up having to pay money back when you file your federal tax return for the year.

For more information on which changes to report and how to report the changes to the marketplace, go to HealthCare.gov.

When is the 2016 open enrollment period?

Open enrollment for 2016 starts on November 1, 2015 and ends on January 31, 2016.