Insurance Marketplace Opens; Multiple Options for Consumers

By Hilary Appelman • Anna Cordella has paid thousands of dollars to keep her health insurance coverage since she was laid off in 2012. Her eligibility runs out Dec. 31, but she’s not panicked. The next day, her coverage will begin under the Affordable Care Act (ACA).

The law, which prohibits insurers from denying coverage or charging higher premiums based on preexisting medical conditions, “is the best thing that ever happened,” said the Norristown resident, who turns 64 this month.

Cordella said health problems, including migraines and high cholesterol, would have kept her from qualifying to buy new insurance if not for the ACA.

Beginning this month, Pennsylvania residents and small businesses are able to choose from among several plans offered through the health insurance marketplace, also called an exchange, where consumers can compare coverage and premiums and sign up for a policy.

People who enroll by Dec. 15 will have coverage on Jan. 1. People who enroll later will receive coverage about a month after they sign up.

Anyone can buy a policy in the marketplace, although it is aimed at uninsured individuals and businesses with 50 or fewer employees.

More than 254,000 Pennsylvania residents ages 50 to 64 don’t have coverage, according to a study by the AARP Public Policy Institute.

Tele-town hall

To make sure people are aware of the marketplace and enrollment process, several dozen AARP Pennsylvania volunteers are speaking at community centers, health fairs and other events.

A tele-town hall is scheduled, and AARP Pennsylvania will call or email its 1.8 million members with information about the insurance marketplace and how to get more information.

Consumers can call a 24-hour telephone hotline—800-318-2596—for more information or visit HealthCare.gov to learn about the enrollment process and the insurance plans. Trained “navigators” and certified counselors provide one-on-one assistance.

The plans come in four levels: Bronze offers basic coverage; silver provides standard coverage; and gold and platinum policies have higher coverage with higher premiums. There are variations within each level.

All plans must cover basic health care such as doctor visits, hospital stays and prescription drugs. Plans sold through the exchange can’t charge a copayment for preventive care such as mammograms, Pap smears and blood pressure or cancer screenings.

The ACA allows adult children to stay on their parents’ insurance until age 26 and eventually will eliminate most annual and lifetime coverage caps.

Older people who buy private insurance before they are eligible for Medicare at 65 cannot be charged more than three times the rate of younger customers’ premiums.

Subsidies for some

Individuals with income less than about $46,000 or a family of four with income less than about $94,000 may qualify for a subsidy that can be used to lower monthly premiums or taken as a credit on their federal income tax return.

The ACA requires most Americans to have health insurance beginning next year or pay a penalty of at least $95 on their federal tax return.

Cordella said she and her husband, Dennis, worked hard, lived frugally and planned carefully for retirement. But her husband got sick at 59 and eventually needed kidney and liver transplants. The couple emptied their savings to pay their ballooning share of health insurance premiums.

For them, the ACA prevents economic catastrophe, Cordella said, because “if I cannot get health insurance, I could lose everything.”