Today’s the day many of the uninsured and self-employed have been waiting for. They can apply for health insurance on an online state marketplace and likely become eligible for subsidies to help pay for the premiums – due to the Affordable Care Act, commonly known as Obamacare.
We’ve done our best to prepare you for this. Now we’re going to walk you through the step-by-step process of how it actually works.
Because I live in Montana, I’ll share my experience on the Montana marketplace, which is actually administered by the federal government. Some states are running their own. (Businesses with 50 or fewer employees can also buy health insurance on a state marketplace.)
All of the marketplaces provide online access to compare and purchase health insurance policies offered by major insurance companies as well as some nonprofits and cooperatives. The beauty of these marketplaces is that they organize your options and make shopping for insurance a less vexing experience.
But keep in mind that my experience will be somewhat different from yours. Each state marketplace has its own offerings. And the cost for insurance plans will vary based on which type of plan you pick, your age, where you live and whether you smoke. Also, the subsidies, in the form of a tax credit applied directly to your monthly premiums, will vary based upon your income. Those who make more than $45,960 ($94,200 for a family of four) will not be eligible.
Also note: If your employer is providing health care to you next year through a work-based group plan, you’ll likely have no interest in this – unless you want to help an uninsured family member find the right insurance plan. Also, if you already have a government health insurance plan, such as Medicare or Medicaid, you’re already covered.
I’m ready to apply
As a guide, we’ll compare The Washington Post’s preview of how the marketplaces will work with my actual experience today.
First, you go to HealthCare.gov, where you can create an account and be directed to your state’s insurance marketplace. Then you’ll be asked to provide some personal information to prove you are who you say you are, like your Social Security number and date of birth.
My results: After several unsuccessful attempts to access my marketplace, I finally got in. But then I got this message: “Your attempt to verify your identity was unsuccessful. Review your information, and try again.” I did, and I tried again. This time I was told my identity could not be verified and that I should call a customer service representative. Wait time: 30 minutes. I hung up.
I was also given the option to continue my application. I clicked on that and got a blank page. Apparently some glitches need to be worked out.
The Post says I’ll be asked for information about my income, family size, where I live and my citizenship status. Then, I’ll be told whether I’m eligible for Medicaid, the government insurance program for the poor.
Since I’m not, I’ll next be told how much of a subsidy in the form of a tax credit I’ll get to offset part of the cost of my monthly premiums when I purchase insurance on the marketplace. I expect to make too much money to qualify for that. (If I’m wrong, this will be rectified when I file my 2014 taxes.)
A look at my choice of plans
Next, the Post says, I’ll be shown the health insurance plans available in my state in such a way that I can easily compare what’s being offered and how much they’ll cost. The choices on the marketplaces are called the “metal plans” — bronze, silver, gold and platinum. Bronze has the cheapest premiums but requires the most out-of-pocket costs. Platinum has the most expensive premiums but requires the insured person to pay only 10 percent of his or her health care costs. (I can guarantee that plan is too rich for my blood.)
However, all of the metal plans must offer 10 “essential health benefits” that many plans on the individual health insurance market currently do not offer — prescription coverage, maternity, etc. — as well as free access to a number of preventive-care procedures and tests. And, unlike the past, no one can be turned down or charged more because of a pre-existing health condition.
After you chose your metal plan, you may be offered the option of an HMO, PPO, POS or high-deductible plan. Some low-income people and those under 30 will have the option of a catastrophic plan, but no subsidies will be allowed for those.
Here in Montana, all plans are being offered by Blue Cross Blue Shield of Montana, PacificSource Health Plans and the Montana Health CO-OP. Montana’s insurance commissioner has said that the average cost on the marketplace will be $273 (for a 40-year-old), $17 less than what a similar policy would have cost without Obamacare. (Remember that the premiums will vary based on where you live, how old you are and whether you smoke.)
Don’t worry about buying your insurance today. As long you purchase a plan by mid-December, your insurance will be place by Jan. 1. The marketplaces will have open enrollment through March 31. Anyone who has insurance by April 1 will not pay a penalty for not having coverage next year.
Also, if you have a life-changing event like a divorce or loss of insurance through work, you can buy insurance on a marketplace at any time.
Will my health insurance on the marketplace cost less than the policy I have now through a small group plan? That policy is for a $5,000 deductible and costs my employer more than $850 a month. We’ll find out when I get to make my online application.
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