Questions about the ACA’s health insurance exchange and adult child coverage provisions

Following the Supreme Court’s ruling Thursday on the constitutionality of the Affordable Care Act, health care consumers are more often than not being left with more questions than answers. We tried to answer a few of them Thursday, and more are coming in.

Here’s one, from NewsWorks reader Jim, about the cost of an insurance policy:

Say someone has some money but is not working — i.e., age 55-64 and can’t find a job. What is the determining factor in pricing his or her health insurance policy?

Under the new law, buyers in the individual market will be able to purchase insurance through a health exchange starting in 2014. Individual premium levels vary, but in the exchange, insurance companies will be able to use only the four following criteria for setting premium rates:

geographic area
age
family size
whether or not you smoke

In addition, those under 400 percent of the federal poverty line — that’s an income of about $45,000 a year for an individual, or $92,200 for a family of four — will be eligible for subsidies to make insurance more affordable.

Here’s another question from NewsWorks reader Peggy:

Does a parent have to carry an adult child over the age of 19 on their coverage if they don’t want to? If they are made to carry them, who pays for the adult child’s premiums — the parent or the adult child?

No, parents are not required to carry adult children on their plans. Under the new health law, employers are required to offer coverage to children up to age 26 on their parents’ plans, but parents are not required to accept that offer.