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Must insurers notify smokers of ways to lower premiums?

The open enrollment season has ended, but readers continue to have questions about coverage under the health law.

The open enrollment season has ended, but readers continue to have questions about coverage under the health law.

Q. Do employers and insurers that charge employees extra for tobacco use in small group health plans have any responsibility to inform employees directly that they can avoid the premium surcharge by enrolling in a smoking cessation program?

A. Yes, under the health law both insurers and employers are required to tell workers in small group health plans what they can do to avoid paying a higher premium for smoking, such as participating in a smoking cessation program, says Kirsten Sloan, senior policy director at the American Cancer Society's Cancer Action Network.

Further, the rules prohibit insurers in the small group market from imposing a tobacco surcharge unless they also offer a wellness program that eliminates the surcharge if workers participate in stop-smoking programs.

Under the health law, insurers that sell plans in the individual and small group markets can no longer turn people down or charge them more because they have pre-existing medical conditions. However, the law allows insurers to vary premiums based on four factors: whether people smoke, their age, family size and where they live.

Smokers can be charged 50 percent more than non-smokers under the law. But a number of states have prohibited insurers from imposing higher premiums on smokers, arguing that by making coverage less affordable it reduces the chance that smokers will participate in programs to quit smoking.

In addition, the health law requires that methods approved by the Food and Drug Administration to quit smoking be covered without any out-of-pocket costs to individuals in non-grandfathered plans. But a study commissioned by the Campaign for Tobacco-Free Kids found that coverage varies widely by plan.

"We have urged HHS to provide further clarification to insurers about the scope of tobacco cessation services they must provide," says Brian Hickey, the group's director of federal government relations.

Q. Do we have to carry our 24-year-old daughter on our health insurance policy? She is employed and has two degrees. We informed her that we would be dropping her at the end of the year because it's costing us a fortune, and she told us today that we are required by law to cover her. We do not claim her on our taxes.

A. It's your decision whether to keep your daughter on your plan. Under the health law, insurers are required to make coverage available to dependent children until age 26, "but it's up to the policyholder if they want to cover her," says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. Since you no longer claim your daughter on your taxes, you won't be responsible for paying the penalty if she doesn't have coverage.

Q. My wife and I are both over 65 and on Medicare. We have custody of a 6-year-old child who is on Medicaid. We live in Indiana and claim him on our federal and state taxes. The state is reviewing our grandchild's Medicaid status, and we would like to know whether our income is included in the Medicaid eligibility decision.

A. Since you claim your grandson on your taxes, the state will probably consider your income in determining whether he's eligible for Medicaid or the Children's Health Insurance Program (CHIP). In Indiana, the income limits vary depending on which program you are in but at the top end of the scale if your modified adjusted gross income is more than 255 percent of the federal poverty level, or $50,465 for a family of three, he may not qualify, says Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service.

If he's no longer eligible, you could enroll your grandson in a child-only plan on the health insurance marketplace.

"A Medicaid denial creates a special enrollment opportunity, and the child could be newly eligible for premium tax credits on the marketplace," says Haile.


Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.