|
This message is applicable to full-time
AmeriCorps members serving in programs receiving AmeriCorps State and National grants. (It is not applicable to members enrolled in Professional Corps or Education Award Only grant programs). If you
have specific questions that aren't answered below, please follow up with your
program manager.
Health Care
Coverage Options for AmeriCorps Members
Beginning
in 2014, AmeriCorps members will have new options for quality, affordable
health insurance made available by the Affordable Care Act (ACA).
Like
all Americans, AmeriCorps members can now access comprehensive, affordable
health insurance coverage through a variety of means. You can shop for plans in the Health
Insurance Marketplaces at HealthCare.gov where you may
be eligible for financial assistance; if you are under 26 you may be able to
stay on your parent’s health insurance plan; or you may be able to obtain
coverage through Medicaid, military health benefits, or Medicare. These health
insurance options meet the new consumer protection standards under the
Affordable Care Act.
Over
the next year, AmeriCorps will be working to improve the quality of health care
for its members and to provide insurance that meets the requirements of the ACA
in the near future.
At
this time, AmeriCorps programs must continue to offer a health plan to full-time
AmeriCorps members, but these plans may not meet the standards of the
Affordable Care Act. For example, these
plans may exclude coverage of pre-existing conditions. If the plan does not meet the new consumer
protection standards of the ACA, and you do not have other coverage, you may be
required to pay a tax payment at the end of the year under the individual
responsibility provision. Therefore,
you should make sure to review your options carefully and make the choice that
is right for you.
That
is why we are reaching out to you directly to ensure you understand your health
insurance options during your service as an AmeriCorps member. We are also
communicating with leaders of your programs so they have a complete
understanding of their options for providing health coverage to their members.
They will be able to help answer your questions as well.
Overview: What
Are Your Options?
It
is important that you have information to help you learn what health care
coverage is available to you so you can choose what works best for you. Your options
might be different depending on your program or the state where you are
serving. Please review the following information, and be sure to discuss this
with your program. Whether you are already serving or just beginning your
service, you should review this essential information.
-
Family health care
coverage:
Under the Affordable Care Act, you can stay on your parent’s health insurance
policy until your 26th birthday.
You can even remain on your parent’s plan if you are married, not living
with your parent(s), attending school, or not financially dependent on your
parent(s). For more information about this option, please see: https://www.healthcare.gov/can-i-keep-my-child-on-my-insurance-until-age-26/. In addition,
if you are married you may be able to get coverage on your spouse’s plan.
-
Health care
coverage purchased through the Health Insurance Marketplace: You may be
eligible to obtain health care coverage through the Health Insurance
Marketplaces where you are serving, and you may qualify for financial
assistance to lower the costs of insurance.
In some cases, insurance may be available with no monthly premium. Learn more at HealthCare.gov. In addition, your program may be able to help
you pay for coverage you obtain through the Health Insurance Marketplace. If they do so, this assistance may be
considered taxable income.
-
Medicaid coverage: Under the
Affordable Care Act, many states are expanding their Medicaid program. Depending
on the amount of your stipend and where you serving, you may be eligible for
Medicaid. For more information, please see: HealthCare.gov.
-
Current health plan
offered by your AmeriCorps Program: Currently serving full time AmeriCorps members
already receive insurance through their programs. Your program may elect to continue
to offer you the same plan they are offering you now, even if it does not meet
all of the requirements under the ACA so long as it meets the requirements for
AmeriCorps programs (you can find what is required for AmeriCorps programs on
page 11 of the document found here: http://www.nationalservice.gov/sites/default/files/documents/FinalProvisions6-25-13.pdf)
-
For
example, your current plan may exclude coverage of pre-existing
conditions. If your current AmeriCorps
health plan does not meet the new consumer protection standards of the ACA and you
do not have other coverage, you may be required to pay a tax payment at the end
of the year under the individual responsibility provision. Before deciding to forego other coverage that
may be available to you, you should review your options at HealthCare.gov because you may qualify for free
or low cost health insurance. See the
question-and-answer section below for more details.
Questions and
Answers
ACA Requirements
What does the
existing insurance cover?
- There
is no one type of health plan covering all AmeriCorps members. AmeriCorps requires that programs provide a
minimum level of coverage to their members. At a minimum, AmeriCorps programs
are required to provide health plans that were short-term, limited duration (no
more than 364 days) plans that include physician services for injury or illness,
cover emergency room and hospital room and board, have an annual deductible of
not more than $250, require members to pay no more than $1,000 out of pocket
per year, and cover up to a maximum of $50,000 per event (the equivalent of an
annual limit of $50,000). They are not
required to cover preventive care or pre-existing conditions.
Will I have to pay a fine?
-
The
minimum benefits AmeriCorps programs must provide do not
meet all of the requirements under the ACA. For
example, AmeriCorps programs may offer plans that do not cover people with pre-existing
conditions, do not include access to preventive care without cost sharing, and have
dollar limits on essential health benefits. Plans like these will not satisfy the individual
responsibility requirement.
-
Therefore, if you only have the type of coverage described above and
do not have other coverage that meets the individual responsibility
requirement, you may be subject to a payment under the individual responsibility
provision, depending on your individual circumstances. However, in some
instances, you may not be subject to the individual responsibility payment. You
can receive an exemption from coverage for different reasons. For example, you
may be exempt if you do not have to file a tax return because your
income is too low or you are affected by your state’s decision not to expand
Medicaid coverage under the health care law. For a complete list of exemptions
and information on how to apply, please visit: https://www.healthcare.gov/exemptions.
Medicaid and
the Marketplace
Will I qualify for
free or reduced price health insurance?
- Under the Affordable Care Act, many states are
expanding their Medicaid program. Eligibility depends on your state and is based
on your income. Single individuals with incomes up to about $15,000 per year
may qualify for Medicaid. For example,
if your living allowance is below a certain income level and you do not have
other income, you may be eligible for Medicaid.
The income level varies by family size, other family members’ income,
and other factors. To see if you qualify for Medicaid, please visit: https://www.healthcare.gov/do-i-qualify-for-medicaid/.
- You can also find a private health insurance
plan through the Health Insurance Marketplace. Based on your income you can
qualify for lower costs on your monthly premiums, and may even be able to find
a plan with no monthly premium.
Financial assistance is based on your income, and a single individual
with incomes below about $46,000 per year may qualify.
What if I am in a
state that didn’t expand its Medicaid program?
- You qualify for an exemption from the individual
responsibility payment if you were determined ineligible for Medicaid because
your state didn’t expand eligibility for Medicaid under the ACA. You can keep your current health insurance
without being subject to a fee.
Communicating with AmeriCorps Programs
What options did you
give my program?
- As you know, AmeriCorps programs operate across
the country. Therefore, we wanted to provide our grantees with options that
could best meet their needs and those of members like you.
- Organizations that get funding for AmeriCorps
members have been made aware of the options available to you. These options
include organizations offering health insurance that provides the new consumer
protections, staying on your parent’s or spouse’s health insurance plan,
enrolling in a private health insurance plan in the Marketplace or Medicaid if
you qualify, or continuing to offer the health plan they have used for many
years (keeping in mind that coverage may not be considered minimum essential
coverage).
- We
are committed to working with your programs to make sure AmeriCorps members get
quality, affordable health coverage.
|
