10 things to know about health insurance marketplace

10 things to know about health insurance marketplace

CHAMPAIGN — The start of enrollment in Illinois' new health insurance marketplace is six weeks away, and perhaps you've got questions.

Such as: How will it affect you, and should you be doing anything to get ready now?

Jen Tayabji, a community organizer with Champaign County Health Care Consumers, shared her answers to what people have been asking about the start of enrollment in the marketplace, set for Oct. 1, in some of these 10 basic things to know:

1. The Affordable Care Act requires nearly everyone to have health insurance starting Jan. 1, 2014, or pay a financial penalty.

This applies to you, unless you are:

— In prison.

— An undocumented immigrant.

— Earning too little to file a tax return.

— Accepting health insurance is against your religion.

— You'd have to pay more than 8 percent of your income for insurance after counting what your employer contributes and any tax credits you'd receive for a health plan through the state marketplace.

2. Coverage for the uninsured will be accessed through the new online marketplace.

Formerly called the health exchange, this is the umbrella under which different health plans are being made available to individuals, families and small businesses. Through the marketplace, you can review health plans that are available and access coverage and subsidies.

3. Who needs to pay attention to the marketplace and upcoming enrollment?

Basically, anyone who is uninsured and under 65.

Most people are covered under employer health plans and will continue with that form of coverage.

If you're on Medicare, note: It isn't part of the health insurance marketplace, and the marketplace won't affect Medicare choices and benefits.

4. How much will marketplace plan rates cost?

That is still unknown. Information on rates and plans hasn't been released, and there isn't a date yet for when it will be available, according to state Department of Insurance spokeswoman Kimberly Parker.

5. What financial assistance is available for health coverage?

Tax credits will be available to help anyone with a household income at 139-400 percent of the federal poverty level. That's an income of $15,500 to $44,680 for an individual and $32,000 to $92,200 for a family of four.

Tayabji said applicants will have three options for subsidy payments. They'll be able to take them monthly to be directly applied toward their premium payments or at the end of the year, or have them applied toward partial monthly premium assistance, with the rest paid at the end of the year.

Health plans will be available in four categories of cost-sharing levels called bronze, silver, gold and platinum. People with an income at the low end, 139-200 percent of the federal poverty level, will also eligible to apply for cost sharing on one of the silver-level plans that will lower their out-of-pocket costs.

6. What if your income is even less than 138 percent of the federal poverty level?

You will be directed to apply for coverage under the expanded state Medicaid (public insurance) program.

Don't worry about which one you qualify for, marketplace or Medicaid. You apply for both through the marketplace, and once you provide your income information, you'll be directed accordingly.

NOTE: If you qualify for Medicaid, you won't be able to receive financial assistance for a marketplace health plan.

7. Can you still apply for marketplace coverage if you earn more than 400 percent of the federal poverty level?

Yes, but you won't be eligible for financial assistance.

People with coverage meeting certain standards through their employers are also ineligible for the tax credits.

Tayabji urges people currently buying individual coverage (not through their employers) to check out the plans and rates on the marketplace, even if they are going to be ineligible for subsidies. The coverage and rates on plans in the marketplace may be a better deal, and comparisons should be simple to make online, she said.

8. I am an adult with a pre-existing health condition. Can I enroll in a marketplace plan?

Yes. Under the Affordable Care Act, it is already illegal for insurers to discriminate against children with pre-existing conditions, and starting next year, the same protection will be in effect for adults.

9. What should you do to get ready now?

— Take a look at your budget.

— Prepare what questions you may have about coverage. Help will be available on the phone and through in-person assistance being made available starting Oct. 1 at various locations, among them public health departments.

Health Care Consumers will also be available to answer questions, Tayabji said.

— Start gathering your financial paperwork. Among what you'll need: Family members' Social Security numbers and information about your family income, such as pay stubs.

10. Where can I learn more?

— Check out sample applications and learn more about the marketplace at http://1.usa.gov/136plNA.

— Sign up for emailed and text message updates on the marketplace: http://1.usa.gov/1523aGG

— Come to Health Care Consumers' community meeting on the health insurance marketplace from 7 to 9 p.m. Sept. 12 at the Champaign Public Library, 200 W. Green St., C.

It will cover the types of insurance to be offered, financial assistance, essential benefits that must be covered in health plans and more about how to get ready for enrollment.

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jackkim213 wrote on August 19, 2013 at 5:08 pm

There are a few mistakes in this article: 1) 400% of the poverty line is $45,960, 2) It was originally talked about that Medicaid would be expanded to 138%, but it has only been expanded to 133% (Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid.  quoted from Medicaid.gov). And because many states have not expanded Medicaid there can be huge gaps of those not covered. In some states those that fall within 33%-100% of FPL would not qualify and therefore be left without insurance. I don't mean to be picky, but I think these two points are very important for American citizens. 

Deb Pressey wrote on August 20, 2013 at 9:08 am

Thanks for your comment; however, that wasn't an error. Federal law does say states taking the federal Medicaid expansion must set the level at 133 percent. But 5 percent of the recipient's income will be disregarded in calculating the effective minimum threshold for eligibility.