Ten things to know about the Health Insurance Marketplace




The six-month open enrollment period for healthcare through the Health Insurance Marketplace has begun. Americans can now shop for family or individual benefits through the marketplace and compare plans to find the coverage that is right for them under the Affordable Care Act, also known as “Obamacare.” The open enrollment period ends March 31, 2014.

As families and individuals begin to shop the marketplace for health coverage, many people are searching for answers to common questions about how the new laws will affect them. This article seeks to answer some of those questions using information from the Department of Health and Human Services’ official healthcare website, www.healthcare.gov.

Where do I go to enroll?

Virginia left the federal government in charge of handling the state’s healthcare exchange, so Virginians must use the government’s official Health Insurance Marketplace website, www.healthcare.gov. The site helps with the enrollment process by allowing users to compare plans and options, answering questions about buying care plans under the new healthcare law, and collecting the information needed to complete the process.

What if I’m unemployed?

Unemployed individuals may qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or lower costs based on income. Coverage eligibility and options are dictated by household size and income, rather than employment status. Some people with very low incomes may qualify for lower premiums on coverage, which can begin as soon as Jan. 1, 2014.

What if I can’t afford benefits?

People who fall into a certain income range may qualify for lower premiums or assistance programs, such as Medicaid. Eligible people will get free or low-cost care and will not have to purchase a Marketplace plan. Virginia is among a group of states that is not expanding Medicaid programs beginning Jan. 1. In these states, says healthcare.gov, some people with limited incomes may have fewer coverage options. Coverage will depend strictly upon income level, however, you may qualify for Medicaid under the state’s existing rules.

People who can’t afford or do not have coverage in 2014 may have to pay a fee, which will increase every year. According to healthcare.gov, “the fee in 2014 is one percent of a person’s yearly income or $95 per person for the year, whichever is higher. 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.” One important point to remember is that people paying the fee won’t get any health insurance coverage, but will still be responsible for 100 percent of the cost of their medical care. To avoid the fee in 2014, you need “minimum essential coverage,” which includes any Marketplace plan or individual insurance plan, any employer plan or retiree plan, Medicare, Medicaid, CHIP or TRICARE (for service members, retirees, their families and/or survivors).

I have a pre-existing condition. Can I still get coverage?

Under the Affordable Care Act, health insurance plans can no longer refuse coverage or charge more because of pre-existing conditions. They also can not refuse to cover treatment for said pre-existing conditions, with one exception: grandfathered individual health insurance plans not purchased through an employer, which do not have to cover pre-existing conditions. People with these plans can switch to a Marketplace plan and immediately receive coverage for pre-existing conditions.

If you can not buy health coverage and qualify for Medicaid or CHIP, the same rules apply as in the Marketplace. You can not be refused or charged more for coverage because of a pre-existing condition.

You must apply for coverage through the Marketplace during the open enrollment period. The open enrollment period ends March 31, 2014 and will not begin again until October 2014.

Is coverage mandatory for children? How do I enroll them?

Yes, coverage for children is mandatory. If children in your family are not covered, then you may have to pay a fee of $47.50 per child. According to the Marketplace website, the most a family would have to pay in 2014 for uninsured children is $285.

The enrollment process for children is wrapped into the process for enrolling a family for a health plan. Depending on family size and income levels, children may qualify for the Children’s Health Insurance Program (CHIP). If they qualify, you won’t need to purchase a plan to cover them.

How long can children remain covered by a parent’s plan?

According to information from the Marketplace, adult children can be added or kept on a plan that covers children until they turn 26 years old, even if they are married, not living with parents, not financially dependent on parents or are eligible to enroll in an employer’s plan. They may be enrolled during an open enrollment period or “during other special enrollment opportunities.”

I own a small business. How do I provide coverage for my employees?

No employer is required to offer coverage. Businesses that employ less than 50 full-time equivalent (FTE) employees are not subject to the Employer Shared Responsibility parts of the law. Small businesses may use the federal government’s Small Business Health Options Program (SHOP) Marketplace to offer coverage to employees.

If you own a small business, you may qualify for a small business health care tax credit worth up to 50 percent of your premium costs, according to healthcare.gov. SHOP lets employers compare price, coverage and quality of plans that begin any time after Jan. 1, 2014. Employers can decide what to pay toward employee premiums and then employees can enroll.

I am retired. What does the Affordable Care Act require of me?

Retired people or those who retire before age 65 who are without coverage may use the Health Insurance Marketplace to buy coverage, and if not covered, may have to pay a fee. When applying for coverage through the Marketplace, you will find out if you are eligible for Medicaid.

Individuals with retiree health benefits are considered covered and will not have to pay the fees some uninsured people must pay. Marketplace plans are open options for these individuals. If you are retired but not receiving retiree benefits, you may qualify for lower monthly premiums and out-of-pocket costs, says healthcare.gov, based on household size and income.

Can I choose my doctor?

Getting to choose or keep your own doctor depends on the plan you choose in the insurance marketplace. Most plans have networks of health care providers, and depending on the type of policy you buy, says healthcare.gov, you may be covered only when you receive care from a network provider.

Lists of providers in each plan’s network can be found while comparing plans in the Marketplace. When comparing coverage, you may choose a network that includes your doctors if the plan is right for you.

I’m already covered by Medicaid. Do I need to buy a health plan?

No. According to healthcare.gov, if you receive Medicaid based on income and family size, you get free or low-cost care and don’t need to purchase a plan through the Marketplace. Also, those who have Medicare are considered covered.



2 Responses to Ten things to know about the Health Insurance Marketplace

  1. Elesha Bemis

    October 4, 2013 at 10:06 pm

    What is the site so I can look and see what it would cost to have health insurance thru any insurance company~ I have not had that choice since I am with a pre-existing condition~ thank you!

    • Phoebe

      October 7, 2013 at 4:14 pm

      The website is healthcare.gov!

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