Ready, Set, Go…Into the ACA Marketplace
As you know, the Patient Protection and Affordable Care Act (PPACA or ACA) was enacted in 2010. The biggest change to our current-day healthcare will soon become operational October 1, 2013 with the implementation of the Health Insurance Marketplace (also known as Exchange). The Marketplace will be available on-line for all legal Americans to compare affordable, accessible health insurance plans. If you don’t have insurance, you have an individual plan you purchased on your own, or your employer does not provide affordable insurance, then the Marketplace may be the answer to your health insurance needs. We’ve talked previously about how the marketplace will work – tax premium credits, free or low-cost plans for low-income individuals, and who will be eligible.
1. Health Terms: Make sure you understand what the different terms mean, i.e. deductible, out-of-pocket expense, co-payments, premiums, etc. All of these will come into play when you choose an insurance plan. One plan may have higher premium payments but lower co-payments. One plan may have higher out-of-pocket expenses but lower premiums. (Look back at our previous blog on “Terms and Acronyms” for a definition of what these words.)
2. Health Insurance Plans: Learn about the different plans that the Marketplace will offer – Bronze, Silver, Gold, and Platinum plans. These Qualified Health Plans (QHPs) will have different deductibles, premiums etc. (Also, for more information, read our blog on the Metallic Plans.)
3. Questions: Make a list of questions before you choose a plan – Is staying with your Doctor important to you? What network is your hospital in? Will your plan cover you while you’re traveling?
4. The Application: Let’s talk about the Marketplace’s on-line, multi-page application. Everyone looking for assistance with their health insurance costs must fill out the application. Once completed, the application will then be vetted by the Department of Homeland Security and the Internal Revenue Service to verify you are who you say you are. But, before you can even complete the application for yourself and/or your family, you need to have all of your the necessary paperwork and information on hand. For everyone that will be included on your insurance plan (spouse, children, dependents), you will need their social security number, birthdates, AND W2s. Yep, if your 17 year old daughter works at the local bookstore, your 22 year old son works at the grocery store, and you are going to include both of them on your insurance plan, BOTH of their incomes must be included on the application as well as your own. Your reported income will determine what level of financial assistance you and your family may be eligible for.
5. Costs: Different plans will offer different things and at different costs. Have an idea of how much you can afford before selecting a plan. Make sure you include the costs for the premiums, out-of-pocket expenses, co-payments, prescription costs etc. You need to consider these combined costs before selecting a plan. All of these costs combined will ultimately affect which plan you can afford.
6. Options: Before selecting a plan through the Health Insurance Marketplace, make sure you take the time to check out the insurance plans that are available on the individual open market (without financial assistance and through an agent/insurance carrier). You may find that an open market plan better fits your needs over the long run. Do your due diligence and read, compare, and understand what the different plans have to offer before your purchase.
