How The Health Care Law Affects You

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While the law will eventually affect almost all Americans, many companies have already updated policies. Young people and older adults, particularly those on Medicare, will see some of the law's most immediate effects.

NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

The furious debate over health care in Congress may be behind us, but the package President Obama signed into law will take several years to fully unfold. Ultimately, it could mean big changes in how you buy insurance, how it's paid for, and what's covered.

Many companies have already begun to update their policies, and some of the most immediate changes will affect young people and older adults, particularly those on Medicare.

You may have heard about the new provision that will let many parents carry young adults on their plan until age 26. If you're a senior or a caregiver, you may know that some changes to Medicare plans and prescription drug coverage are also on the way.

If you're in any of those categories and have questions about how and what and where and when, give us a call: 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. Thats at npr.org. Click on TALK OF THE NATION.

Later in the program, we want to hear from drivers and bicyclists with stories about the idiots who won't share the road. You can email us now. That address, again, is talk@npr.org.

But first, upcoming changes to health care. We begin with Janet Adamy, a health policy writer for the Wall Street Journal who's with us here in Studio 3A. Nice to have you back on the program.

Ms. JANET ADAMY (Health Policy Writer, Wall Street Journal): My pleasure, Neal.

CONAN: And a lot of young adults, well, they may know about the new age limit, but they're does this take effect right away?

Ms. ADAMY: It's a good question. It's fairly complicated. One of the most popular provisions of the bill is this provision that would allow young adults to stay on their parents' insurance plans until their 26th birthday.

Under the law as it was written, it wasn't supposed to take effect until late September. But what a number of insurance companies have said is that they're willing to implement it early, as early as May. So college students who are graduated in the spring can go ahead and stay on their parents' plans, and they won't face any gap.

However, there are a number of wrinkles in how this will be applied. So for a certain subset of young adults, they will be able to stay on the plan, but for many of them, they won't.

CONAN: And will it make a difference if they live in another state or if they're married?

Ms. ADAMY: The difference is whether their parents have an insurance plan that's through a large employer, or whether it's an individual policy. So the majority of Americans have coverage through their employer. Large group plans, they don't necessarily have to follow this rule and implement it early, and what we're hearing from most large employers is that they're not going to implement it early. They are going to wait either until the fall or possibly until January 1st, when they have a new plan year start.

There have been about 65 insurance companies who have said that they will implement it early. However, that's only for people who have what's called an individual policy, where they're buying directly from the insurer. So for people, for children on those policies - yes, they would have the option of staying on the plan starting in May. But for people who have large group policies, they're likely to have to wait until the fall or possibly even the beginning of next year.

CONAN: Because most of those plans have - well, in September you decide on the options that you'll get in your plan that take effect January 1st.

Ms. ADAMY: Essentially, yeah. The difference is that for large group employers, they tend to do what's called self-insuring, which means that they have a health insurance administrator run the plan, but they actually pay out the claims themselves.

So the difference is that while an insurance company would say yes, we're going to make this change, for the companies that self-insure, it's really up to the company, and not the insurance company, whether they're going to rather the employer, it's up to them whether they're going to decide to implement this early. And what we're hearing is that most employers are not going to implement it early.

CONAN: And is this going to be free? Is this going to be charged for?

Ms. ADAMY: No, it's most likely going to be charged for unless you're in that small minority of people who have one of these zero-premium policies. What the White House has said is that they expect it will cost about $3,300 a year for each young adult who gets added to the plan.

Now, in a lot of cases, the employer will pick up a large portion of this, but most people should expect to have some premium that they'll have to cover for this.

CONAN: But that doesn't sound outrageous, though, $3,000-some.

Ms. ADAMY: No, young adults tend to be fairly inexpensive to insure. They tend to have fewer chronic conditions, and they're not particularly expensive to add to a policy.

CONAN: It's nice to hear there's one thing that they're relatively inexpensive for. Anyway, a big question: If a parent wants to take advantage of this position, well, you know, where do I go to find out about what my company's going to do or, if I have an individual policy, whether I can actually do this?

Ms. ADAMY: If you have insurance through your employer, the first thing you should do is call the HR department. What's confusing a lot of people is they're hearing that their insurance company is going to do this, but like I explained before, they have an employer plan, and it's really up to the employer.

So you should the first thing you should do is call your employer and figure out whether they're actually going to do this early or not, and if they aren't going to do it early, when they anticipate making the change.

CONAN: We're talking about changes to health coverage and when they take effect and how to go about obtaining them, 800-989-8255. Email us, talk@npr.org. Brad(ph) is on the line from South Bend in Indiana.

BRAD (Caller): Yes, hi.

CONAN: Hi, Brad, go ahead.

BRAD: Yeah, I have a son who is not graduating from college but who is 21 years old and out there without insurance. Does the rule apply similarly to those? Most of the conversation has been about kids graduating.

Ms. ADAMY: Brad, he will have some options. The way that this is structured is it doesn't necessarily have to be for a child who went to college or who is graduating from college. The question is, is if he had a gap in the coverage, then what you'll most likely have to do is go back and reapply to have him added.

There are different rules for different policies, but the bottom line is that yes, you will likely have the option of doing this. It's just a matter of whether your plan is going to be willing to do it or not.

BRAD: So because the pre-existing issues don't get taken care of until down the road - so we would run into that, is that part of the issue?

Ms. ADAMY: Does he have a pre-existing health condition?

BRAD: Well, not that I'm aware of, but I - having dealt with insurance companies, they seem to be pretty creative at finding them.

Ms. ADAMY: Well, most likely if you're not aware of a pre-existing health condition that he's had, and he's been relatively healthy, then in that regard, you shouldn't run into any problems. The question is, it's not necessarily clear that all insurers have to take all kids in this situation. So there may be some kind of a wrinkle that allows the insurer to say that they aren't going to take him on the policy. But based on the way the law has been structured and the rules have been written, just because he didn't go to college doesn't mean he wouldn't at least be eligible to possibly get the coverage.

BRAD: OK, thank you very much.

CONAN: Good luck to you and your son, Brad.

BRAD: OK.

CONAN: Older Americans will also see some early changes due to the health-care law, particularly for Medicare recipients. Also with us here in Studio 3A to help answer your questions on that is Mary Agnes Carey, senior correspondent with Kaiser Health News, which is a partner with NPR covering the health story. And thanks very much for being with us today.

Ms. MARY AGNES CAREY (Senior Correspondent, Kaiser Health News): It's great to be here.

CONAN: And changes to Medicare under the new law will phase in over the next several years. Which ones are expected sooner rather than later?

Ms. CAREY: The one that seniors will see right away if they have prescription drug coverage would be $250, a $250 check sent to them if they fall into what's known as the doughnut hole.

CONAN: Aha.

Ms. CAREY: This is that gap in the Medicare prescription drug coverage.

CONAN: In Plan D, yeah.

Ms. CAREY: Yes, in Part D. It starts at about $2,800, ends at about $4,500 where right now, a Medicare beneficiary is on his or her own to make those costs. So that is one change they'll see right away, this $250 check.

Starting next year, coverage...

CONAN: Next year, January 1?

Ms. CAREY: Yes, January 1st, 2011, for brand-name prescription drugs, they'll see a 50 percent discount when they're in the doughnut hole. They'll get a 7 percent discount off their generic drugs in the doughnut hole.

But the important thing here is over the next 10 years, that doughnut hole is going to be phased out. So when you get to 2020, the co-pay on brand name or generic will be 25 percent, and that will be a big change in the drug benefit.

CONAN: And is that primary, is that the biggest change that's coming right away?

Ms. CAREY: I think it is definitely one of the biggest changes coming right away. Now, next year, again starting January 1st, 2011, co-payments for preventative care services - certain ones including PAP smears, mammography, osteoporosis, prostate cancer - there will be no co-pay, no cost-sharing for beneficiaries.

This is to encourage preventative care. They'll be a way for beneficiaries to sort of get a preventative care plan for them, starting next year. So those are two key things for beneficiaries.

CONAN: Well, surely those things are going to be expensive.

Ms. CAREY: They will be expensive but the thought is, for example, sometimes folks in the doughnut hole don't get their prescriptions. They stop paying. They don't have the money. They can't take them. They become sicker. Medicare has to pay more to treat those conditions -

CONAN: Down the road.

Ms. CAREY: Down the road, exactly. That could be a cost-saver, same thing if you waive the cost-sharing for preventive services. That could save, the hope is, Medicare money over time.

CONAN: Now there are cuts, though, to Medicare coming, and we heard a lot of rhetoric during the debate in Congress about seniors losing benefits.

Ms. CAREY: Well, one of the biggest changes for the payment reductions would be the Medicare Advantage plans. These are those private health insurers in the Medicare program. There's been a lot of government data to say Medicare pays up to 13, 14 percent per beneficiary in a Medicare Advantage plan versus if they were in private fee for service.

So they will - rather, traditional fee-for-service programs. So they will begin to phase those payments down. There's also going to be some changes, for example, to home health agencies on their payment rates, but government data has said some of these providers are overpaid. You can adjust those payments, and they are prohibited from cutting the benefits.

CONAN: Let's get a caller in on this. Let's go to Peter(ph), Peter with us from Bedford in Massachusetts.

PETER (Caller): Yes, I have a question regarding the Medicare Advantage program.

CONAN: Go right ahead.

PETER: In December of 2009 - I am currently on one - in December of 2009, I received a letter from the provider stating that the premium was going up due to the changes of health-care reform and how they were going to affect the Medicare Advantage.

CONAN: How much are they going up?

PETER: It went up from $53 to $83.

CONAN: Pretty substantial.

PETER: And my question is: Is that true? Because at that time, when the letter came out, the health-care reform bill had not even been signed into law.

CONAN: Is that what that -

Ms. CAREY: Well, I think you raise an excellent point. Oh, I wonder why they're raising them at that amount, and do they explain that? I mean, a Medicare Advantage plan is a private plan in Medicare. They can set they can charge different premiums. They can decide they have to cover a certain set of specific benefits. They can go beyond that if they want to. But I would look closely, and then I would shop around.

You're going to have a chance this fall to pick a different Medicare Advantage provider, and you might want to look to see what other choices are out there for you at what prices.

PETER: I do this every December.

Ms. CAREY: You do, exactly.

CONAN: Where do you go to shop for the different providers, Peter?

PETER: I call every provider and ask for all the layout - I mean, their brochures, etc., and we sit down and go through all the premiums and see what the benefits are.

CONAN: Is there a more convenient way other than calling, Mary Agnes?

Ms. CAREY: You can go to medicare.gov. You can type in what prescriptions you need to take, where you live, how far you want to go, travel, to a specific provider, and they should also give you an array of choices.

PETER: Well, are the benefits going to does the government control the benefits, or does the individual provider control the benefits?

Ms. CAREY: The government sets up a standard benefits package that Medicare Advantage, these private plans, have to make. They can go beyond it. They could add a gym membership, for example. They could decide they're going to pay for hearing aids, additional features, but they could also scale those back at any time, either before or after the health law became into effect.

PETER: OK.

CONAN: Good luck, Peter.

PETER: Thank you so much.

CONAN: More of your questions in a moment. Whether you're sick or healthy, if you're a parent, if you're covered by Medicare, what questions do you have about changes under the new health-care law? Also, more questions about the changes for young adults as well, 800-989-8255. Email us, talk@npr.org.

Janet Adamy of the Wall Street Journal is with us, also Mary Agnes Carey of Kaiser Health News. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION, from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. Im Neal Conan in Washington.

The full effect of the new health-care law won't be felt until 2014, but many people will see changes much sooner. Coverage for young adults, high-risk pools for people with pre-existing conditions, rebates for Medicare patients all take effect this year.

Chances are, you may have questions about how and what and where and when. Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website, at npr.org. Click on TALK OF THE NATION.

Janet Adamy is our guest, health policy reporter at the Wall Street Journal. Also with us, Mary Agnes Carey, senior correspondent at our partner, Kaiser Health News. Let's see if we can get another caller in. Let's go to Christie(ph), Christie calling from Ann Arbor.

CHRISTIE (Caller): Hi. My understanding is that a young adult, to stay on her parents' policy, has to live at home? Now, you asked your guest, what if the student is married? What if the student lives in another state? And she didnt answer you.

CONAN: Well, we apologize for that. We'll get that answer now.

Ms. ADAMY: I'm glad you came back to that, Christie. The law does spell this out. It does not matter whether the child lives at home with the parent. Even if they don't live at home with the parent, they can be eligible for this coverage. Even if, for tax purposes, they're no longer a dependent of the parent, they're still eligible for the coverage. If they're married - even if they're married, they can still be eligible for this coverage.

CHRISTIE: That's amazing.

CONAN: Another reason to move out of the basement.

CHRISTIE: Whoa, thank you.

CONAN: Christie, thanks very much for the phone call. Here's an email from Mark(ph) in St. Louis: I'm a recent, 24-year-old grad. I just took a job with an employer that does offer insurance. Could I decline coverage and remain on my father's policy, as it's much better than the one offered to me currently?

Ms. ADAMY: That's a good question. I'm sorry, she said she does have coverage through the employer?

CONAN: She would be offered. She just got a job and is offered coverage.

Ms. ADAMY: For most people, if you have an offer of another, of coverage through your new employer, you are not likely to be eligible for it. It it's a bit complicated in how the regulation is written but basically, if you're in a plan - if your parent is in a plan that was in place, and it's a group plan that took effect before the health bill went into law on March 23rd - which is probably going to be the majority of people - if you have an offer of coverage through the new employer and it's affordable coverage, no, then you are not likely to be eligible for this benefit. You would have to take the coverage through the new employer.

CONAN: And here's an email from Gil(ph) in Washington, D.C. Here's my scenario: self-employed, 64-year-old artist with no reported wages income, has no health insurance. He is on home mortgage title but does not pay anything. Where does he go to get insurance?

Ms. CAREY: Right now, I think you're going to hold still until you turn 65, and get Medicare. You could try to buy in the individual market. It might be fairly costly. There is a provision, separately, on early retiree coverage, but that doesn't sound like it applies to you because you don't have any coverage from a former employer - where you retired. So I think you're going to have to hold on for Medicare.

CONAN: Let's go next to Glen(ph), Glen calling from Fairfax, Virginia.

GLEN (Caller): Hi, my question is regarding TRICARE coverage. My girlfriend's currently - wouldn't be covered by the new Obama statute, but because her parents are government employees and she has TRICARE, she's currently I was told that there needs to be additional legislation passed before she could be covered.

CONAN: Well, TRICARE is for government workers and former military, right?

GLEN: That's my understanding, correct.

CONAN: All right. Janet Adamy, can you help him out?

Ms. ADAMY: Yeah, this I think this is still somewhat up in the air. There were some questions early on about whether this actually would apply to people who have - who are government employees, and my understanding is that some new legislation has been introduced to clarify that these folks will be able to stay on the plan.

But I think at this point, it's a bit unclear. The best thing to do is talk to whatever benefits representative you have, and find out what your specific situation is.

GLEN: All right, thank you.

CONAN: Good luck, Glen. Let's go next to this is Stephen(ph), Stephen with us from Little Rock.

STEPHEN (Caller): Hello, Neal, thank you for taking my call.

CONAN: Sure, thanks for calling.

STEPHEN: My wife and I are both 56, and I lost my job about a year ago. I had to drop my COBRA because I couldn't afford the $900 a month fee for that. We're still both unemployed. I mean, I'm still unemployed. She's working at far less than she was getting before. We have no benefits, and we're just wondering where in this legislation are we going to be able to get some insurance?

Ms. CAREY: Your best bet is going to be in 2014. I know that's four years from now, but that's when you might qualify for a subsidy, and you might be able to purchase through what are going to be called health insurance exchanges.

These are going to be marketplaces of choices. Now, that doesn't give you much comfort now. My first thought is, you talked about how COBRA was too expensive for you. Is there any kind of a high-deductible plan that you could get for catastrophic coverage, that you could afford? That is my very first thought.

You can use various Internet shopping sites to try to attain that. It doesn't sound so you don't have any retiree health coverage, right?

STEPHEN: I do not. I'm not retired.

Ms. CAREY: You do not, OK.

STEPHEN: The biggest thing is medications.

Ms. CAREY: Right.

STEPHEN: Since I have no prescription plans, my minimum medications are costing me out of pocket $120, $130 a month just for my basic, minimum medications.

Ms. CAREY: Here's what I would do. You could - excuse me for interrupting. You can contact a specific drug manufacturer that provides that - prescriptions. There might be state programs for you. PhRMA, which is the Pharmaceutical Care Manufacturers Association, the big drug industry representative group, if you go to their website, they have a partnership for pharmaceutical assistance. They might be able to help you.

There are some programs out there that could help you as you wait to see if 2014 is a good year for you.

STEPHEN: Thank you very much. I appreciate it.

CONAN: All right, Stephen, good luck. Hang in there. Here's an email from Rebecca(ph) in Ann Arbor. My daughter just graduated. My employer will not implement the changes until January 1st. Do I have to COBRA her, or can we finish the benefit year? How do you come back to your employer's health care after COBRA? She will be serving with WorldTeach and will continue to be a dependent. And Janet Adamy, if you could help us out and describe COBRA as something other than a venomous Indian snake.

Ms. ADAMY: COBRA is the government program that allows people to stay on an insurance policy. It's often used for people who have lost a job or are between jobs. It's aimed at filling a gap.

It's one option, but it tends to be fairly expensive. I would suggest another thing you might want to look at is getting her an individual plan. If she's healthy, and she doesn't have a pre-existing condition, you could go for something that is, like Mary Agnes said, sort of a catastrophic coverage.

Your main thing is if you want to just if you just want to make sure that if she gets sick, it doesn't get you into significant financial trouble, you could probably get a cheaper, high-deductible plan that's catastrophic that you could use for the rest of the year, and then you could reassess the situation starting in January.

CONAN: And here's another email, this one from Carol(ph): I keep hearing minors are covered until 26 well, obviously, they're not minors - kids are covered until they're 26 but the bill reads the coverage is until their 27th birthday. Which is it?

Ms. ADAMY: It's actually until their 26th birthday - is the way that it works.

CONAN: Until they are 26.

Ms. ADAMY: Correct.

CONAN: OK. Also, as an employer, I called our health plan. They told me they could not implement the change at this time. You said the employer decides. Which is it?

Ms. ADAMY: That's exactly right. This is the situation we were talking about before. It's for people who are on employer plans, and if it's a larger employer, and they do what's called self-insuring, it's really up to the insurer. So for instance, maybe you have coverage - maybe your benefits are managed by Aetna. You get a statement from Aetna. You think of Aetna as being your insurer. Aetna's one of the companies that's come out and said that they're going to do this early, while in fact, if it's a large employer, Aetna is just managing the benefit. They're not actually your insurer. Your insurer is effectively your employer.

So if you call your employer, and they say that they're not doing this, your employer is correct. They're not doing it, and they have the power to make that decision.

CONAN: Let's go next to Andy(ph), Andy with us from Tulsa.

ANDY (Caller): Yeah, hi, I had a question about the home health benefits you were referring to earlier. I'm an occupational therapist that provides home health benefits to a number of elderly patients right now, and I know you mentioned that the reimbursement rate for the companies could be challenged or changed by the new health-care legislation. But I was wondering if any of those services themselves are going to be cut and if my job's going to be on the line, providing home health for these elderly patients.

CONAN: Mary Agnes?

Ms. CAREY: I have a feeling that you'll be working pretty hard for the next few years because you've got a lot of folks going into the Medicare program.

Here's what the bill does. Over the next decade, next 10 years, it's a $40 billion reduction in home health expenditures. Now, that sounds like a lot of money, and I'm sure to the home health agencies, it is; but there is government data saying, in the opinion of these folks that have evaluated what the government is paying home health agencies, that there can be reductions in that spending amount without harming services.

They're not allowed to cut services, and they're not allowed to reduce them in any way. And so I don't think you have anything to worry about as far as your job goes.

ANDY: Great, I appreciate it. Thank you very much.

CONAN: All right. Let's go next to this is Theresa(ph), Theresa with us from Princeton, Kentucky.

THERESA (Caller): That's right. I have a question about adult coverage for continuing adult children. My son went off our policy, and we COBRAed him because of a pre-existing ankle condition. Do you think we'll have any difficulty getting him back onto federal Blue Cross Blue Shield when they say they're going to do this, possibly in January?

Ms. ADAMY: That's a good question. I'm sorry, he's still on the COBRA?

THERESA: He is COBRAed, uh-huh.

Ms. ADAMY: I think in theory that you should - he should still be considered that there's no gap in coverage, and that you would be able to put him on as soon as the plan adopts the rule. But again, I don't think there's a guarantee of that.

There is - for people who have been considered dropped off the policy, they do have to re-apply, and there is sort of an application waiting period. I believe it's 30 days. And so it's possible that could apply to you, and because he does have a pre-existing condition, it's also possible that that could complicate things.

THERESA: Right, I'm worried about that.

Ms. ADAMY: I think can you talk to your employer yet?

TERESA: Yeah. They haven't been too helpful. They're not sure, either.

Ms. ADAMY: Yeah. I would continue to try to get some answers from them about that.

TERESA: OK.

Ms. ADAMY: But I think just because - you should still have the option of getting on this plan even though he's on COBRA. Just because he's on COBRA doesn't mean that you would be locked out of this. And again, for people who've even dropped off of a policy, they'll have the opportunity to reapply and get back on the plan. So you have that avenue open to you.

TERESA: OK. We'll keep our fingers crossed. Thanks, though.

CONAN: Bye-bye. And good luck, Teresa. Steve(ph) in Bemus Point, New York, writes: My wife and I are 62, both laid off. We have COBRA until early 2011. I have diabetes 2 and high blood pressure, so I will probably be dropped at the end of my COBRA. Can I get insurance under the new law? It appears I may have to go six months without insurance in order to apply for a federal or state program. Is that the only option, or is there a way I don't have to gap my insurance?

Ms. CAREY: Well, here's another unknown we talked about; it involves Congress. Congress has taken action over the last year to extend the period under which people can enroll in COBRA as part of the economic downturn subsidy - the issue - the economic stimulus package. So I'm wondering - I would keep my eye on Capitol Hill to see if they extend your COBRA period - if you could do that. And then secondly, if that doesn't happen for you - and I think you said he's 62, is that...

CONAN: Sixty-two, yeah.

Ms. CAREY: Sixty-two, OK. And then - so you've got 2014 down the road. That's - you've got a few years to wait there before the exchanges happen. By that time, you will qualify for Medicare. So maybe I would reference you back to the prior caller, who talked about his high drug costs. There may be some programs locally or nationally, with the drug manufacturer, perhaps a state program that could help you with some of your health-care bills.

CONAN: OK. And here's another email question, this one from Vernon(ph). Is it correct there's a $3,500 cap on the income a young adult can make and stay on the health-care coverage of his or her parent?

Ms. ADAMY: I'm not aware of an income cap. Where you get the figure 3,500, that's sort of the range of what the policy will cost for a young adult. It starts at $3,300 in 2011, goes up to 3,500 in 2012, and then goes up to 3,700 in 2013. So if you've heard that figure in conjunction with this policy, I think that may be what it's talking about instead of an income. I'm not familiar with an income...

CONAN: So theoretically, you could be a 24-year-old billionaire and still qualify under your parents' plan?

Ms. ADAMY: I suppose it's possible.

CONAN: Well, if there are any of those and - but I bet they're still living at home. We're talking with Janet Adamy of the Wall Street Journal, and Mary Agnes Carey of Kaiser Health News. You're listening to TALK OF THE NATION from NPR News.

And let's go to Julie(ph), Julie with us from Oklahoma City.

JULIE (Caller): Hi. I have a very healthy family of five, covered under a high-deductible health plan and a fully funded health savings account that we got on the individual market. And I want to keep this coverage. But I thought - I understood that because of the high deductible, this type of plan will be going away.

CONAN: Is that right, Janet?

Ms. ADAMY: I'm not aware that...

CONAN: You want to pay for that, that's up to you, isn't it?

Ms. ADAMY: I believe so. I'm not aware of any specific provision that would mean your plan is going away. Is there a certain reason that you think the plan would be going away?

JULIE: I thought that there - the government was going to put limits on the deductibles. We pay the first 10,000 out of pocket, and then all of the rest comes from our catastrophic coverage.

Ms. ADAMY: What you may have been hearing was that, for health savings accounts -do you have a health savings account?

JULIE: Yes. Yes, we do.

Ms. ADAMY: OK.

JULIE: And what happens to that? Do I get to keep it?

Ms. ADAMY: What you may have heard - and this could be what's can - it's fairly confusing - is that there are some new restrictions on health savings accounts. That they're basically intended to keep people from using health savings accounts to pay for things that they shouldn't have been paying for in the first place. So what you can spend those health savings accounts on is a little bit tighter, but I'm not aware of anything that would mean that your type of plan would go away.

JULIE: So I'll be able to keep our individual coverage, and we won't have to go to an employer-sponsored plan?

Ms. ADAMY: No, I don't think - under the legislation, no one will have to go to an employer-sponsored plan.

JULIE: OK, great.

CONAN: All right. Julie, thanks.

JULIE: Thank you.

CONAN: Bye-bye. Glad we can help out. Let's go next to Cynthia(ph), Cynthia with us from Lawrence, Kansas.

CYNTHIA: Hi, Neal. Thanks for taking my call.

CONAN: Hi.

CYNTHIA: I am 30 years old and I've got three jobs, but all of them are part time. One I'm close to getting full time, about 30 hours. What can I do for health insurance because I've got nothing right now?

CONAN: Well, that falls in between the areas of expertise we've laid for you two, but Mary Agnes, we'll turn to you.

Ms. CAREY: My first thought would be - we've talked about these very high-deductible plans. The premiums - monthly premiums tends to be lower but the out-of-pockets you have to make is high before your coverage kicks in. They're known as catastrophic. That would be my first line of defense for you, to search for one of those plans to see if you can afford it so you've got some coverage just in case, heaven forbid, you have a car accident or...

CYNTHIA: Right.

Ms. CAREY: ...a major health emergency.

CYNTHIA: Which is my main concern. What happens if I go - if I end up going full time and I'm offered health insurance through my employer, do I have to take it? Or could I go with another option, public option or something like that?

Ms. CAREY: Well, it will depend on how big your employer is. The exchanges are going to be limited to smaller employers and people who are self-employed. There'll be some restrains for that. If you get a job with a large company - I think over a hundred workers - and you have health insurance through that, you will not be able to go into the exchanges.

CYNTHIA: OK.

CONAN: Thanks, Cynthia. Let's see if we can squeeze one more caller in. Mark(ph), Mark with us from Salt Lake City.

MARK (Caller): Hi. Yeah. My question is, I am 25 years old. I'll be turning 26 this fall. I'm on my father's health insurance plan currently.

CONAN: Mm-hmm.

MARK: I'm HIV positive. And I - as far as I know, that's going to kind of make things difficult looking for health coverage.

CONAN: Pre-existing condition, sure, yeah. And so what happens, Janet Adamy, when he turns 26?

Ms. ADAMY: Well, until - obviously, until your 26th birthday, you can stay on this plan. When you turn 26, probably your best option, in the near term, would be these high-risk pools that are being developed under the legislation. They are targeted toward people who have a pre-existing health condition and have a hard time getting coverage on the individual market. The only problem would be that you would need to be uninsured for a period of six months. So if you're -it's probably - it would probably be risky for you to go for that six months' period without having any insurance. If for whatever reason you end up doing that, then you would be eligible for the high-risk pool, and you could get into that.

In the meantime, I think employer-sponsored coverage would be your best bet. And if you had that option, that that would be something you would certainly want to explore.

MARK: OK, thank you.

CONAN: Good luck, Mark.

MARK: Yeah. Thanks. Bye.

CONAN: Bye-bye. And thanks so much to you two. I know this is not the last time we're going to be turning to you as these benefits and changes all change over the next few years, but thank you very much for your time today. Janet Adamy, the health policy reporter for the Wall Street Journal, as always. And Mary Agnes Carey, senior correspondent for our partner Kaiser Health News. They were both kind enough to join us here in Studio 3A.

Coming up, bikes versus cars. Is there room on the roads for both? Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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