When you wake up Tuesday morning, the world will be a little bit different. The Obamacare marketplace for individual health plans is going live. Most uninsured Americans will need to get health insurance by Jan. 1 under the Affordable Care Act.
Florida is one of 27 states using a federally run health insurance marketplace — also known as an online exchange — to let residents compare and shop for coverage. You can access it at healthcare.gov. The open enrollment period runs from Oct. 1 through March 31, 2014. To have your coverage in place by Jan. 1, you must enroll in their plans by Dec. 15.
The Herald's Evan Benn prepared these 10 essential things to know about the new marketplace:
When you enroll on healthcare.gov, you'll be asked for information like age, location, gender, Social Security number and current policy number (if applicable). You'll be shown a list of available plans, as well as coverage details and pricing, and eligibility for federal subsidies or Medicaid. You can then choose to purchase a plan from the ones available.
Plans are split into five tiers: platinum, gold, silver, bronze and catastrophic.
The four “metal” tiers come with different costs and benefits. Platinum plans will carry the highest monthly premiums and the lowest out-of-pocket costs like co-payments and deductibles. Bronze plans will have the lowest monthly costs but higher out-of-pocket costs.
The fifth option, catastrophic coverage, is for people 30 or under and certain low-income residents. These are high-deductible, low-premium plans, and aren't eligible for tax credits.
The cost of the health plans will depend on many variables, including age, gender, location, income, smoking habits, coverage networks, deductibles, co-payments, etc. — it's mpossible to predict exactly how much someone might pay.
However, the U.S. Department of Health and Human Services announced last week that, on average, health insurance premiums for plans purchased through the online exchanges will be about 16 percent less than originally projected. In Florida, that means a 27-year-old making $25,000 a year would, on average, pay a $218 monthly premium for a middle-tier plan, before any tax credits. If you qualify for a tax credit -- see #6 -- your cost could be reduced dramatically.
The Affordable Care Act requires that all health insurance plans offered through the online exchanges provide at least 10 “essential benefits.”They are: hospitalization, emergency treatment, outpatient services, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services and devices, laboratory services, preventative and wellness services and chronic-disease management, and pediatric services with dental and vision care.
The federal government will defray some costs of health insurance coverage through subsidies — tax credits — that it will pay directly to insurance companies. Individuals and families who earn between 100 percent and 400 percent of the federal poverty level ($11,490 to $45,960 for an individual, and $23,550 to $94,200 for a family of four in 2013) may be eligible for sliding-scale subsidies to help pay for premiums.
Two caveats: You may not be eligible for a subsidy — even if you fall within the income requirements — if your employer offers affordable coverage that meets federal requirements. And, the only way to qualify for and receive a subsidy is if you enroll for a health insurance plan through the online exchanges, healthcare.gov.
Under the Affordable Care Act, insurance companies are no longer allowed to deny coverage based on pre-existing medical conditions. But smokers should expect to pay a surcharge for their coverage. When signing up through the online exchanges, people will be prompted to answer whether they smoke, and prices will change depending on how they answer.
“Like any law, like any big product launch, there are going to be some glitches as this thing unfolds,” President Barack Obama said last Thursday. Earlier that day, administration officials announced that at least two elements of the exchanges — a portal for small-business owners and a Spanish-language site —would be delayed.
Owners of businesses with fewer than 50 employees will still be able to compare plans and coverage options starting Tuesday, but they won’t be able to sign up workers until at least Nov. 1. And the Spanish-language site, CuidadoDeSalud.gov, will not be able to enroll people for another few weeks.
Hundreds of people and organizations in Florida have received federal funding and training to serve as “navigators,” helping consumers and businesses sort through the online exchanges and make sense of their options. Navigators must provide free assistance and may not recommend specific plans.
In addition to navigators, more than 40,000 insurance brokers and agents have gotten federal certification to help walk people through the enrollment process on the federal exchanges. Humana, for instance, is beefing up its retail centers and co-sponsoring community events where information about the exchanges is available. Florida Blue has nearly doubled its agent workforce in the state and expects heavy traffic in its retail centers.
Americans who choose not to carry health insurance will have to pay a penalty unless they meet one of a handful of exceptions, such as being a member of a federally recognized Native American tribe or have such a low income that they are not required to file an income tax return. Also, Floridians who would have qualified for Medicaid under the Affordable Care Act’s new income limits will not pay a penalty because the state refused to expand Medicaid coverage.
For the rest, the penalty next year for not having health insurance is 1 percent of a person’s annual income or $95 per person per year, whichever is higher. The penalty increases every year; in 2016 it will be 2.5 percent of income or $695 per person.
Children also must have coverage. The fee for uninsured children is $47.50 per child in 2014, up to $285.
The exchanges are mainly for the uninsured and people who can't get affordable coverage through their employer. The majority of Americans, about 85 percent, already have coverage through their jobs, and they likely will not buy policies on the exchanges.
Others who won’t need to shop for insurance on the exchanges include the roughly 12 percent of Americans covered through Medicaid and the Children’s Health Insurance Program. Also, people 65 or older on Medicare do not have to enroll. Undocumented immigrants are not eligible for coverage.