The newly opened Health Insurance Marketplace intends to offer consumers and small business employees access to affordable health insurance. The system is designed to provide consumers with an easy way to compare plans and choose from the options available to them. Affordability is crucial and, after enrolling, consumers will see if they are entitled to a subsidy that will reduce the cost of their insurance.
Changes to the program will undoubtedly occur over time, but it is essential for consumers to understand the basics of the Health Insurance Marketplace and how it affects (or does not affect) them.
Who has to enroll on the Marketplace?
While everyone was required, in 2014, to have health insurance, most Americans will not need to purchase a policy through the Marketplace. Anyone who has insurance through an employer or who has Medicare, Medicaid or coverage through the Veterans Administration will not need to purchase a policy.
How will the policies work?
All policies sold on the Health Insurance Marketplace must offer "essential benefits" which include things such as outpatient services, emergency services, hospitalization, maternity, and newborn coverage, mental health coverage, pediatric coverage, and prescription drug coverage. Plans can offer additional benefits beyond the required essentials.
In addition to benefits, insurers may also impose restrictions on those enrolled in the plans. For example, customers may be required to see specific providers who are part of the plan's network and may have co-pays or co-insurances associated with use of services. Plans will also have different premiums and may have deductibles.
What do plans cost?
Plans will have a monthly premium, like any insurance plan, that will be set by the insurance provider. There are four levels of coverage offered: Bronze, Silver, Gold, and Platinum. The difference in the levels is the premium and the co-pays that consumers will pay. For example, a Bronze plan will have the lowest premium, but someone with a Bronze plan will pay higher co-pays than those with the other plans. The Platinum plans have the highest premiums and the lowest co-pays. Income is considered when calculating the cost of plans and those with low incomes will receive a subsidy, which will reduce their costs.
When does enrollment begin and end?
Annual enrollment will be from October 15 through December 7. Of course, anyone who loses their health insurance during the year through retirement, layoff or moving to a new marketplace area will have a special enrollment period in which to purchase a policy on the marketplace.
What is the enrollment process?
The Marketplace was set up to take applications online, by phone, by mail or in person. When enrolling, consumers must provide necessary information on household members. To determine if an individual is entitled to any subsidy that will reduce the cost of their policy, income information will also be required.
What is the penalty for not enrolling?
An essential provision of the Affordable Care Act is that all citizens must have health insurance. Anyone who has not enrolled in a plan by the deadline will be penalized, with the penalty assessed at tax time. Penalties will be low initially and escalate over time for those going without insurance for multiple years.
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