We’ve reached Year Two of the Health Insurance Marketplace created under the Affordable Care Act. Millions of previously uninsured – and uninsurable – people got coverage in the first year. My friend Kathy was one of them.
Kathy lost coverage on the last day of 2013, while at the tail end of treatment for breast cancer. Because of the Affordable Care Act, Kathy was able to get an affordable plan that started on January 1, 2014. The two life saving infusions she had in January – at a cost of several thousands dollars – were covered in full. For Kathy, the coverage meant she could finish her cancer treatments and remain self-employed. She’s doing great, and so is her business.
If you don’t have insurance currently, or if you purchased a plan through the Marketplace last year, now’s the time to act. Here are some important things to know:
- Open enrollment began on November 15, 2014 and ends on February 15, 2015. This means that if you want insurance and you don’t act now, you can’t purchase coverage through the Marketplace until next year’s open enrollment. There are some very limited exceptions to this. For example, if you lose coverage because of a job change, you will be eligible for a special enrollment period.
- You can apply for coverage online, by mail, by phone or in person. Call Health Insurance Marketplace Call Center number 1-800-318-2596 or visit www.healthcare.gov. Once you sign up and pay for your first month of coverage (your premium), you’ll be enrolled in the plan you chose. If you need assistance to figure out how to apply or what to choose, there is help available through Navigators. Navigators are trained and able to lend a hand as you explore your health coverage options through the Marketplace and complete the enrollment forms. They are unbiased and most importantly, free! So use the information above and ask for help if you need it.
- While you can buy health insurance outside of the Marketplace, it’s only through the Marketplace that you are eligible for financial help to pay your premiums. (Kathy was eligible for about $85 a month toward paying her premiums.) The help comes in the form of a tax subsidy that you can apply toward each month’s premium. Or you can receive it as a tax credit when you file your tax return. Individuals with incomes of up to about $46,700 or a family of four with incomes up to about $95,400 may be eligible for the subsidy.
- The marketplace offers five categories of coverage — Bronze, Silver, Gold, Platinum, and Catastrophic. The category you choose affects your monthly premium and what you pay out of pocket. The higher your monthly premium, the lower your out-of-pocket costs, and vice versa. You can rest assured that any plan you select will cover essential health benefits such as doctor visits, hospital care, prescription drugs, maternity and newborn care, and laboratory services—just to name a few.
- If you purchased coverage through the Marketplace last year, you’ll want to go back and compare plans. Your plan may have changed, as well as your circumstances. For example, Kathy went with Platinum coverage for 2014 since she knew she still had expensive treatments to get through. Now that she’s done with the treatments, she switched to a plan with a lower monthly premium, figuring she can now better handle her out-of-pocket costs.
- You only need to buy coverage through the Marketplace if you don’t have insurance. If you have coverage through Medicare or a military program or through your job, you don’t need to do anything.
- If you have kids under age 26, you can include them on your insurance plan. For older kids who may need a nudge to sign up for health insurance during open enrollment, send them a funny e-card from www.momsmeanit.org.
To learn more about the Health Insurance Marketplace and the health care law’s benefits and protections, visit www.HealthLawAnswers.org or for Spanish speakers, www.MiLeyDeSalud.org. While you are at Health Law Answers, be sure to use the ACA Financial Help Calculator. Simply enter some basic information and you will get an estimate of the costs and financial help you may qualify for if you buy coverage through the Health Insurance Marketplace.
Join my friend Kathy and millions of other Americans who now have the safety net of health insurance. But act by February 15, before it’s too late!
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Nicole Duritz is Vice President of the Health & Family issues team in the Education and Outreach group at AARP. She leads AARP’s educational and outreach efforts on health education issues, including Medicare, the health law, prescription drug affordability, long-term care, and prevention and wellness. She can be reached at firstname.lastname@example.org.