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Jul 12

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Marketplace delivers on promises

It’s been six months since millions of American began to benefit from health insurance bought through the new federal marketplace, so it’s fair to ask: How is the coverage working?

Though analyzing the health care law remains a work in progress, the U.S.  Department of Health and Human Services has taken a close look at both the affordability and the availability of the insurance plans purchased during the marketplace’s initial enrollment period.

By the end of enrollment, 733,757 Texans had selected a health plan. Of those, 84 percent qualified for the tax credits available through the insurance marketplace.

That financial help has made a huge difference for many consumers. The government study found that Texans receiving tax credits are paying an average of $72 per month in premiums for their new health care coverage – one-fourth of what they would have paid without credits.

Many people stretched their financial help by selecting health plans with among-the-lowest premiums. More than seven out of 10 Texans receiving the subsidy are paying premiums of $100 per month or less. Half are paying $50 per month or less after the assistance.

Most people who shopped in a state with a federally facilitated marketplace had a range of health plans from which to select. On average, consumers had a choice of 47 plans, offered by five insurers. More than eight out of 10 people could pick from at least three insurers.

The government study found that the competition between insurance companies for the new marketplace business helped to keep premiums down. For every additional insurer selling health plans in a particular area, premiums were 4 percent lower on average.

Getting health care coverage through the marketplace won’t be possible again for most people until November, when the next open enrollment period starts. But there are a number of special circumstances that allow you to shop for insurance between now and then:

  • You’re getting married.
  • You’re having a baby or adopting a child.
  • You’re moving to another area.
  • You’re becoming a U.S. citizen.
  • You’re leaving prison.

Losing health care coverage may also qualify you for what’s called a “special enrollment period” in the marketplace. That loss of coverage may be because you’ve been laid off, or you’ve divorced, or you’ve aged off your parents’ health plan, or you’ve lost your Medicaid eligibility.

You’ll have 60 days after one of those events to enroll in a new health plan.

If you’re a member of a federally recognized Indian tribe, you have more latitude under the health care law. You have the right to sign up or change health plans in the marketplace throughout the year, though you’re limited to one change per month.

Also, Medicaid and the Children’s Health Insurance Program accept applications for their low-cost health care coverage at any time. Unlike the marketplace, there’s no restricted enrollment period.  If you qualify, you can sign up for benefits immediately.

To learn more about how to get health insurance outside the marketplace’s regular enrollment period, visit healthcare.gov or call 1-800-318-2596.

More details about the next open enrollment period will be known as fall approaches. But federal officials have already announced plans to simplify the process for the 8 million consumers who purchased insurance during the initial enrollment period last fall and winter.

If you’re now insured, you’ll have three months – from mid-November until mid-February – to re-evaluate your coverage and make any changes. If, on the other hand, you’re satisfied with your insurance, you’ll be “auto-enrolled” in your current plan with updated premiums and benefits.

That essentially will bring the marketplace in line with employer-based insurance, where most customers are automatically enrolled in their plans year after year. You’ll need to do very little if your income and covered family members aren’t changing and your health plan is offered again for 2015.

Six months after its launch, the marketplace’s health care coverage is off to a strong start.

Bob Moos is Southwest public affairs officer for the U.S. Centers for Medicare & Medicaid Services.

By Bob Moos

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