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Readers Ask About Contraceptive Coverage And Medicare Enrollment

Jul 15, 2014

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This week I answer some questions from readers.

Q. How will my health insurance change now that the Supreme Court has ruled that some employers that have religious objections to contraceptives don't have to provide birth control coverage?

A. Although the recent decision in Burwell v. Hobby Lobby Stores allows a "closely held” company to decline to cover contraception, the health law requirement that most plans provide such coverage without cost to consumers remains in effect and will continue to apply to women in most plans, say experts.

All FDA-approved methods of birth control are considered preventive care, and the health law requires nearly all health plans sold on the individual and group markets to cover preventive care without any out-of-pocket cost to consumers. The Supreme Court decision didn't change that.

The only exemptions are for plans that were in place when the law took effect and have not changed substantially and for religious employers such as churches. In addition, nonprofit religious organizations that object to covering birth control, such as some Catholic charities or universities, can elect instead to have their insurer or third party administrator pay for the workers’ contraceptive coverage, although that accommodation is also being litigated and the outcome for female employees is unclear.

In its 5-4 decision last month, the court ruled that if closely held, for-profit corporations offer health plans to their workers, the companies can’t be required to provide contraceptive coverage if they have religious objections to some or all forms of contraception.

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The court didn't define "closely held," leading to speculation about the number of companies that are affected by the ruling. But even if large numbers fit the definition, women's health advocates say they don't expect that large numbers would assert a religious argument. In addition, many firms see a benefit in providing coverage for contraceptives, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a research and policy organization that focuses on reproductive health.

"There are many incentives for companies to cover contraception," says Sonfield, including cost savings to insurers and self-funded employer plans because birth control is much cheaper to cover than maternity and delivery.

Most companies provided contraceptive coverage even before the health law passed: 85 percent of companies with more than 200 workers and 63 percent of companies overall, according to the Kaiser Family Foundation's 2010 annual employer health benefits survey. Before the health law passed, companies offering plans could generally choose which contraceptive methods they would cover. In the Supreme Court case, for example, the Hobby Lobby craft store chain offered workers birth control coverage. The chain, however, objected to FDA-approved emergency methods such as Plan B and Ella that can prevent pregnancy if taken shortly after unprotected sex because, the company said, the contraceptives are abortifacients.

Q. Do I have to sign up for Medicare Part B when I turn 65 even if I already have coverage through my spouse’s current job? What about Social Security payments? If I'm insured through my wife's job and I start getting Social Security, will that affect Medicare Part B requirements?

A. Medicare has stiff late enrollment penalties, but you should be protected. For every full year that someone is eligible for Medicare Part B but doesn't sign up, he or she faces a late enrollment premium penalty of 10 percent. (Part B covers medical services and supplies. Most people get Part A, which covers hospital services, at no cost.) However, since you'll have insurance through your wife’s job when you turn 65, you won’t be penalized. Once your job-based coverage ends, you'll have eight months to sign up for Medicare.

Also, keep in mind Medicare Part D, which covers prescription drugs, says Tricia Neuman, director of the Program on Medicare Policy at the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) It also has a late enrollment penalty, but if the employer plan you’re enrolled in provides drug coverage that's comparable to a Medicare drug plan, you won't be penalized for not signing up right away.

As for Social Security, if you start taking payments while you're covered by an employer plan, it won't affect your Medicare status, according to Dorothy Clark, a spokeswoman for the Social Security Administration.

Q. We are a family of four, with two children. My husband was mostly unemployed through June, and we qualified for a considerable discount on an excellent marketplace plan with a deductible of $1,400. Now my husband has been offered a new job, but when I checked online to get a premium quote it looks like the plan we currently have is not even an option. What’s going on?

A. Changes in your financial situation likely are changing the cost estimates of the plans you are reviewing. The plan you currently have is likely still available but it will cost you more.

When you report a change in income to the marketplace it creates a special enrollment period that allows you to switch plans. This can be important if, as appears to be the case here, your increased income means that you no longer qualify for the same level of cost-sharing assistance as you did when your income was lower. Deductibles, copayments and the out-of-pocket maximum you're responsible for may all change.

Under the health law, families with household incomes up to 400 percent of the federal poverty level (currently $94,200 for a family of four) can qualify for premium tax credits, and those with incomes up to 250 percent of poverty ($58,875 for a family of four) can qualify for cost-sharing subsidies that reduce their deductibles, copayments and other out-of-pocket costs.

At your family's new, higher income, even though the insurer is still likely offering the same plan, "the deductible and cost-sharing amounts will be a whole lot different in addition to the family owing a higher premium," says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

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This article was produced by Kaiser Health News with support from The SCAN Foundation.

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