Whether you’re uninsured or just want to explore your options, you’ll soon have a new way to find health care coverage that fits your needs and budget.
The Health Insurance Marketplace will give you access to affordable, comprehensive coverage. You’ll be able to go to one website to learn about insurance plans available to you, check on their benefits and out-of-pocket costs and then comparison shop. Most workers will still get coverage through their employer, and older people will still have Medicare. But if you’re one of the many Americans who have had difficulty buying insurance for themselves because of cost or poor health, you’ll welcome the Marketplace.
The private, individual health plans sold through the online exchange will provide a package of 10 essential benefits, including emergency services, hospital care, lab services, prescription drugs, doctor visits, preventive care, rehab services and maternity care.
The benefits are similar to what’s typically covered in an employer-provided plan. Yet many individual insurance plans currently don’t offer such an array of services. You’ll also choose one of four levels of coverage: bronze, silver, gold or platinum. Bronze plans will have the lowest premiums but
the highest out-of-pocket costs. Platinum plans will have the highest premiums but the lowest deductibles and co-payments.
With a bronze plan, for example, the insurer will pay 60 percent of the costs, while you’ll be responsible for the other 40 percent. With a platinum plan, the insurer will pay 90 percent of the costs, and you’ll be expected to take care of the remaining 10 percent.
When you’re shopping at the Marketplace, everything will be clearly spelled out for you. You’ll see what your monthly premiums, annual deductibles and other out-of-pocket costs will be before you decide to enroll. You’ll make apples-to-apples comparisons between health plans. You’ll have guaranteed coverage regardless of a preexisting medical condition. Insurers won’t be able to deny you coverage or charge you more because you have, say, cancer or diabetes. It will also be illegal to charge women more simply because they’re women.
When enrollment through the Marketplace begins on Oct. 1, you’ll use a single application to figure out whether you or your family are eligible for a low-cost plan through Medicaid or the Children’s Health Insurance Program or qualify for a new kind of tax credit. With most tax credits, you must wait until you file your income taxes to get a break. But the credit available through the Marketplace can be used right away to lower your monthly premiums. It will be sent directly to your insurer, so you’ll pay less out of your own pocket. Generally, the premium tax credit will be available to individuals and families with incomes between 100 percent and 400 percent of the federal poverty level. That’s between $23,550 and $94,200 per year for a family of four.
You also may qualify for other breaks on your out-of-pocket expenses, depending on your income. It’s not too early to find out more about how you can make the Marketplace work for you. Visit www.healthcare.gov today to learn about the advantages of health insurance and how to choose a plan to fit your needs and lifestyle. In the fall, you’ll be able to get information about all the plans in your area. You’ll enroll yourself directly through the website or, if you have questions, you can call a toll-free hotline.
There will also be specially trained people in your community to give you personalized help. These “navigators,” as they’ll be called, won’t be associated with any particular insurance plan, and they won’t receive any sales commission from insurers, so you’ll be assured of completely unbiased help. They’ll have only your best interests at heart.
The Marketplace will give you control over your health insurance options and, for many people, offer a break on costs. Coverage starts on Jan. 1.
By Bob Moos