“In about six weeks, Americans will have a new kind of open enrollment to consider.
Starting Oct. 1, people without health insurance can sign up for standardized coverage through new health-insurance marketplaces run either by their state, the federal government or a combination of the two—the centerpiece of the Patient Protection and Affordable Care Act.
The coverage will take effect Jan. 1. And people with incomes between 100% and 400% of the federal poverty level—about $23,500 to $94,000 for a family of four—can receive financial help on a sliding scale to offset the costs.
These marketplaces, also known as exchanges, will make shopping for health insurance easier than it is today, says Sarah Dash, a research fellow at Georgetown University who has studied the new marketplaces. “Consumers are going to get a much more transparent, apples-to-apples shopping experience.”
If you have affordable insurance through an employer, or if you have coverage through a government program such as Medicare or Medicaid, you won’t be affected by the exchanges.
Exchange shoppers will fill out a single insurance application, which will be used to “find out if they can get a tax credit on their premium, help with cost-sharing or if they’re eligible for Medicaid in their state,” Ms. Dash says.
You can calculate your potential premium assistance with an online tool from the Kaiser Family Foundation, which conducts health-care research.
This first open-enrollment period will last six months, from Oct. 1, 2013 to March 31, 2014. It generally takes two weeks for a policy to go into effect after enrolling, so you’ll need to sign up by Dec. 15 to get coverage starting Jan. 1.
You can sign up by using the Internet, phone, mail or in person at a designated center. The centers will have people trained to help with the enrollment process, according to the U.S. Department of Health and Human Services. Insurance agents and brokers may be there as well. In many states, people who enroll online can tap into a live chat window for customer-service troubleshooting.
Many state call centers already are running. Visit Healthcare.gov or call 1-800-318-2596 for more information.
The law states that people looking for insurance can’t be denied coverage or charged higher premiums because of pre-existing health conditions. However, premiums can vary based on four characteristics: age, tobacco use, geographic area and family size—though there are limits. Older people may be charged up to three times as much as younger people and smokers may be charged up to 50% more than nonsmokers.
The law also requires that health-insurance plans cover a set of 10 essential benefits such as hospitalization, doctors’ visits, prescription drugs, maternity care, pediatric care, and substance-abuse and mental-health care.
Before diving into the enrollment process, be sure to have the Social Security numbers of the people you’re looking to insure; employment and income information, such as pay stubs, tax return or W-2 form; and policy numbers if you currently have any health insurance. Eligibility for tax credits and subsidies is based on modified adjusted gross income.
Five different plan levels will be available on the new marketplaces. Four of the levels have metal names: bronze, silver, gold and platinum.
The bronze plan generally offers the lowest premium in exchange for the highest out-of-pocket costs. The silver level is the level you must choose if you want to get financial help with out-of-pocket costs such as copayments and deductibles. “I call the silver level a mid-range plan,” says Sarah Lueck, senior policy analyst for the Center on Budget and Policy Priorities, a public-policy research organization in Washington. Under the gold and platinum levels, premiums will be higher, but your share of costs when you get health care will be lower.
The fifth level, a catastrophic plan, is available for people younger than 30 and those suffering financial hardship.
Think about how much coverage you can afford and how much care you anticipate needing, says Carter Price, a mathematician with Rand, a nonprofit research group in Arlington, Va. “People will need to decide what level of coverage they want to take, whether it’s very bare-bones or very generous.””