The Online Health Insurance Marketplace: What You Need to Know.
The headlines and news reports about the Affordable Care Act (ACA)—also known as Obamacare—have been confusing for many individuals. We hope to make the new healthcare law easier for you to understand and take part in.
The ACA is making it possible for all individuals to have access to healthcare insurance through The Online Health Insurance Marketplace. Depending on household income, some individuals may qualify for subsidies toward the cost of the premium.
New peace of mind.
Being without health insurance is stressful. Knowing you have access to insurance when you have a medical emergency or event provides peace of mind.
Enrollment and coverage.
Open enrollment began October 1, 2013, and runs through March 31, 2014.
Coverage begins as early as January 1, 2014.
As a condition of this law, individuals who don’t have insurance by the deadline are subject to penalties. Next year, those penalties more than triple.
Lower premiums and payments?
Your monthly premiums are based on household income and size. You may also qualify for an Advanced Premium Tax Credit that can be directly applied to your monthly premiums, to lower your costs immediately. Check The Online Health Insurance Marketplace at HealthCare.gov/Marketplace to calculate your premiums and costs. Or, check your state’s health exchange website, if your state is offering a healthcare exchange marketplace separate from the national HealthCare.gov site.
Call for help.
This is your opportunity to enroll in a qualified healthcare plan. If you’re more comfortable having a partner in this process, contact one of our Certified Application Counselors at 479-441-4000. We can help you navigate the insurance exchanges, selection process and enroll in the program of your choice.
Improve your health and well-being.
Once you’re covered, you can schedule well visits with your new primary care physician, pediatrician, internal medicine specialist or family doctor.
What is the Affordable Care Act?
Also known as the Patient Protection and Affordable Care Act (ACA) or Obamacare, this law aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare.
The law requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or gender. The ACA also does away with lifetime or annual limits on coverage.
What are health insurance Marketplaces?
The ACA requires competing insurance companies to list their products on a new website called the Marketplace or health insurance exchanges. These new ways to shop for health coverage allow anyone to make side-by-side comparisons of private insurance benefits. Individuals, families and small business owners can choose their health coverage based on options, cost, benefits and other features, and ultimately enroll in the plan.
There are three types of Marketplace operations:
State Operated Exchange (specific state Marketplace websites)
Federally Operated Exchange (federal Marketplace website)
Partnership (state and federal) Exchange
Which does my state have: a state, federal or partnership exchange?
Visit hhs.gov/healthcare/facts/bystate/statebystate.html to click on your particular state.
What are Qualified Health Plans (QHPs)?
These are the health plans guaranteed to provide essential health benefits such as preventative care, prescription drugs and maternity care. Plans are defined by categories based on the percentage of expenses covered by the health plan. There are five levels of cost-sharing, also referred to as metal levels.
*On average, the plan will pay this percentage of the total cost of the policy’s benefits
For 2014, annual out-of-pocket costs for most plans are capped at estimated amounts of $6,350/individual and $12,700/family. Non-network and non-covered services are not included in these amounts.
What healthcare services and benefits are covered by the Essential Health Benefits (EHB) package?
- Ambulatory patient services
- Emergency services
- Laboratory services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Pediatric services, including oral and vision care
- Prescription drug coverage
- Preventative and wellness services and chronic disease management
- Rehabilitative services and devices
When is the open enrollment period?
October 1, 2013, to March 31, 2014. If you enroll in a private health insurance plan and make your first premium payment by December 23, 2013, your health coverage starts January 1, 2014.
After that, if you enroll and pay your premium between the first and 15th day of the month, coverage begins the first day of the next month. For someone enrolling on February 10, 2014, coverage begins March 1, 2014.
If you enroll and pay your premium between the 16th and last day of the month, coverage begins the first day of the second following month. For an individual enrolling on February 16, 2014, coverage begins on April 1, 2014.
Is there a penalty for not enrolling or for not carrying coverage if eligible?
Yes. The 2014 penalty is $95 per adult and $47.50 per child; up to $285 per family or 1% of family income, whichever is greater. Penalties increase substantially in 2015 and again in 2016.
What if I don’t have access to a computer or the Internet?
Information is accessible through call centers and in-person assistance, as well as the website. Public libraries provide free Internet access. Anyone can call the federally facilitated Marketplace Call Center for Individuals at 1-800-318-2596. Business owners with 50 employees or fewer may call the federally facilitated Marketplace Call Center for Small Businesses at 1-800-706-7893.
How can Sparks Regional Medical Center help me navigate this insurance marketplace?
The hospital has trained personnel, known as Certified Application Counselors, to help answer questions and guide individuals through the insurance selection and enrollment process. To get help, call 479-441-4000.