This column will be an introduction to the new Health Insurance Market Place, also known as the health insurance exchange. I will be writing about Alaska and its income limits, however if you live in another state, you can get your financial information by going to http://www.medicare.gov on the Internet and looking up your state.
The Health Insurance Marketplace is a new way to find health coverage that fits your budget and meets your needs. With one application, you can see all your options and also enroll. When you use the Marketplace, you will fill out an application and find out if you can get lower costs on your monthly premiums for private insurance plans.
The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program (CHIP).
Open enrollment starts Oct. 1, 2013 and coverage starts Jan. 1, 2014.
There are four levels of coverage: Bronze, Silver, Gold and 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 copayments. With a platinum plan, the insurer will pay 60 percent of the costs, and you will pay the other 40 percent.
All insurance plans in the Marketplace are offered by private companies, and they cover the same essential health benefits. No plan can turn you away or charge you more because you have an illness or medical condition. Plans cannot charge women more than men.
The Marketplace simplifies your search for health coverage by gathering options available in your area in one place. With one application you can compare plans based on price, benefits, quality and other facts that are important to you before you make a choice. You can also get help on http://www.medicare.gov.
Prices of policies will be available Oct. 1, 2013 when open enrollment starts.
Do your homework ahead of time
To prepare for enrollment, you should learn about the different types of coverage, understand how coverage works, including things like premiums, deductibles, out-of-pocket maximums, copayments and co-insurance.
You will need to gather information about your household income, W-2 forms, current pay stubs, or your tax return. And then you will need to figure out how much you want to spend on premiums each month. There will be different types of health plans to meet a variety of needs and budgets.
If you run a small business, learn how you can prepare for the SHOP Marketplace to provide coverage for your employees. This option will not go into effect until 2015, according to the latest information.
If you don’t join, it will cost you
If someone can afford it but doesn’t carry health insurance in 2014, they may have to pay a fee and they may also pay for all of their care. They won’t be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.
The fee in 2014 is 1 percent of your yearly income, or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5 percent of income, or $695 per person, whichever is higher.
In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.
It is important to remember that someone who pays the fee instead of carrying insurance won’t get any insurance coverage and they will still be responsible for 100 percent of the cost of their medical care.
After open enrollment ends on March 31, 2014, they will not be able to get health coverage through the Marketplace until the next annual enrollment period, unless they have a qualifying life event.
To avoid the fee in 2014, you need insurance that qualifies as minimum, essential coverage such as:
• Any Marketplace plan, or any individual insurance you already have
• Any employer plan
• Medicare
• Medicaid
• The Children’s Health Insurance Plan (CHIP)
• TRICARE
• Veterans health care programs
• Peace Corps Voluntary plans
• Other plans may also qualify.
• Uninsured people won’t have to pay a fee if they:
• Are uninsured for less than three months of the year
• Are determined to have very low income
• Are not required to file a tax return because of low income
• Would qualify under Medicaid limits but their state has chosen not to expand Medicaid eligibility
• Are a member of a federally recognized Indian tribe
• Participate in a health care sharing ministry
• Are a member of a recognized religious sect with religious objections to health insurance.
Consider Medigap coverage
If you are on Medicare, you do not have to worry about all of the above information. However, if you do not have a supplemental insurance to Medicare, I urge you to get Medigap insurance, which will pay for some of the costs that Medicare does not pay for.
If you want to learn more about Medigap, please call me and I will send you more information on how to obtain it. I will also answer other questions about this article.
Rita Hatch volunteers for Older Persons Action Group’s Medicare Counseling and Assistance program. Call her at 276-1059 in Anchorage, or toll-free statewide outside of Anchorage at 1-800-478-1059. Her e-mail address is ritaopag@gci.net.
