Buying Health Insurance? There's a Marketplace for That
Horizons in Hemophilia, October 2013
By Michelle Putnam, Associate Director of Research and Advocacy
What if buying and comparing health insurance policies were more like buying and comparing plane tickets? Imagine if we had an online health marketplace that would allow you to compare plans and buy coverage. Well, guess what? We do!
As of October 1, 2013, the Health Marketplace allows you to compare health insurance policies, find out if you are eligible for programs like Medicaid, CHIP, or premium tax credit, and enroll in a health plan. You will be able to easily compare the costs of coverage, and even see examples of how various plans will cover things like doctor’s visits, specialists, and prescription drugs. All plans sold on the Health Marketplace will be approved by the state insurance department and certified as a qualified health plan. Consider it an online one-stop shop for health insurance.
Open enrollment in the Health Marketplace began on October 1, 2013 and will run through March 31, 2014. You can access the marketplace at www.healthcare.gov. You will be asked to create an account in order to explore your health plan options. Plans are categorized into different tiers based on how much of your health costs the plan will cover. Once you purchase a health plan, coverage will begin January 1, 2014.
Remember, some people will not use the Health Marketplace to buy coverage. Generally, people who get coverage from an employer will not use the Marketplace. Similarly, people on Medicare will not use the Marketplace, but will continue to enroll in Medicare the same way that they do now.
Many people who do use the Marketplace will qualify for premium tax credits that will lower the cost of their monthly premiums (remember, if you already have coverage through an employer, you do not qualify for these tax credits). How much you save depends on your household income and the size of your family. Individuals who make $11,490 to $45,960 per year will qualify for these health plan savings. A family of four, earning from $23,550 to $94,200 will also qualify for premium tax credits and lower health plan costs. In order to figure out if a person qualifies for these credits, the Marketplace will ask you for some information about your income (generally, this information is available in your latest tax return or can be estimated through pay stubs).
Here is how these subsidies break down by income:
- $11,490 to $45,960 for individuals
- $15,510 to $62,040 for a family of 2
- $19,530 to $78,120 for a family of 3
- $23,550 to $94,200 for a family of 4
- $27,570 to $110,280 for a family of 5
- $31,590 to $126,360 for a family of 6
- $35,610 to $142,440 for a family of 7
- $39,630 to $158,520 for a family of 8
In some states, people who make less than these amounts will qualify for Medicaid. The Affordable Care Act gave states the option to expand their Medicaid programs to cover lower-income adults (right now, people in Georgia only qualify for Medicaid if they are aged, blind, disabled, under nineteen, or pregnant). Georgia has decided not to expand this program, which means that individuals who earn less than $11,490 will not be eligible for Medicaid or any premium tax credits or health plan savings.
These two videos walk you through applying for premium tax credits and enrolling in a health plan in the Marketplace:
You can find more videos, fact sheets, and even a glossary of important health insurance terms at www.healthcare.gov.
Small businesses will have their own health marketplaces, called SHOP Exchanges, which allow them to compare health plans and enroll their workers in coverage.
Health insurance companies will still offer plans outside of the Marketplace, but those plans will not be subject to the same consumer requirements as plans sold within the Marketplace.
The Health Marketplace will help make purchasing health insurance easier. However, this doesn’t mean that you won’t have questions. You can always talk to your social worker about any questions that you have. Also, Georgia has certified Health Marketplace Navigators that can help answer questions as well. In general, it is best to make sure that you direct questions only to people who are certified Navigators, licensed insurance agents, or your HoG social worker. Learn how to protect yourself from consumer fraud in the Marketplace here https://goo.gl/9UFLQI .
If you have any questions about the Marketplace, feel free to contact Michelle Putnam at mputnam@hog.org.