Last updated: December 13. 2013 11:18AM - 1204 Views

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What is the Health Insurance Marketplace?


The Health Insurance Marketplaces were set up to facilitate the purchase of health-care plans as required by the Patient Protection and Affordable Care Act (ACA). An online marketplace exchange was established for each state where consumers can purchase ACA approved plans. Some states established their own exchanges, while other states deferred to the federally-operated exchange.

How much will individuals be charged?
Like any insurance, premium prices depend on household size and income, and where you live. Prices also depend on what kind of insurance you pick: A catastrophic plan covers less than 60 percent of the total average cost of care; a bronze plan covers 60 percent; a silver plan covers 70 percent; a gold plan 80 percent and a platinum plan 90 percent.
 
Households with yearly incomes up to $46,000 for individuals or up to $94,000 for a family of four qualify for lower costs. Tobacco use increases the cost.
What are my choices going to be like?
Based on your situation, a computer program will help you sort through the hundreds of plans available. It also will provide you with a list of insurance agencies in your area that can help you. All health plans will include coverage for things such as doctor visits, prescription drugs, hospitalization, maternity and newborn care and preventative care. Plans can also offer increased benefits or management programs for a specific disease or condition.

Do I have to change my insurance plan?
It depends. Most people covered by health-care plans prior to the ACA will be able to keep those plans. However, plans that do not meet the requirements of the ACA will only be allowed until 2015.

What are "grandfathered plans?"
These plans were purchased before the Affordable Care Act became law on March 23, 2010, and do not have to meet the minimum requirements of the ACA.

What information will I need to enroll?
Individuals enrolling will need their contact information, date of birth, social security number, employer's name and income information (pay stubs or W-2 forms or wag and tax statements.
 
Family enrollments will need that same information for all family members applying for coverage. Also needed will be policy numbers for any current health insurance, and information about any job related health insurance available to your family.

Will my doctor or hospital be on the health plan?
Purchasing health insurance through the marketplace will be just like purchasing health insurance in the individual market. The network of hospitals, doctors, specialists, pharmacies, and other health-care providers will depend on the marketplace plan you purchase.

What is the 80/20 rule?
Also known as the Medical Loss Ratio rule, the 80/20 rule is meant to keep down premium costs by requiring insurers to spend at least 80 percent of premium payments on medical care, leaving the remaining 20 percent to the insurer. Under the 80/20 rule, any insurer that does not meet the rule will be required to refund back to the consumer any amount not meeting the threshold.
What is an SBC?
Insurance companies must provide a Summary of Benefits and Coverage (SBC). This provides a plain-language summary of a health-care plan meant to allow consumers to compare coverage while choosing which plan to purchase. A link for SBCs can be found at each marketplace.

How will the marketplace affect those on Medicare?
The Health Insurance Marketplace offers qualified health insurance from private companies. Medicare and Medicaid are government sponsored health insurance plans. Those with Medicare will not be affected by Health Insurance Marketplace.
Marketplace is for individuals under the age of 65. Medicare Supplemental insurance (Medigap) or Part D prescription plans will not be available through the marketplace. People eligible for both Medicare and Medicaid will continue to receive them as normal.
How long can a child be under his/her parent's health insurance?
If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old. Children can join or remain on a plan even if they are married, not living with their parents, attending school, not financially dependent on their parents or eligible to enroll in their employer's plan.

What are the penalties if I don't purchase insurance?
For the year 2014, penalties for being without health insurance start at $95 per adults and $47.50 per child, up to $285 for a family, or 1 percent of family income, whichever is greater.
 
For 2015, it will be $325 per adults and $162.50 per child, up to $975 for a family, or 2percent of family income, whichever is greater.
The 2016 penalties will be $695 per adults and $347.50 per child, up to $2,085 for a family, or 2.5percent of family income, whichever is greater.
Where can I get more information?
Help is available online or by phone.
 
Online: HealthCare.gov.
 
Phone for individuals and families. 1-800-318-2596. Hearing impaired: 1-855-889-4325. Telephone support is available 24/7.
 
Phone for small businesses or insurance agents: 1-800-706-7893. Representatives are available Monday through Friday, from 9 a.m. to 5 p.m. (EST).

Sources: The Lima News and Troy Daily News in Ohio; Altus Times in Oklahoma; Stolly Insurance of Lima, Ohio; United Healthcare; Healthcare.gov

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