Healthcare Marketplace frequently asked questions
9/27/2013, 6 a.m.
Open enrollment for the Healthcare Marketplace runs Oct. 1 to March 31, 2014.
What is the Healthcare Exchange?
It’s a Web site designed to make it easy for people to find health coverage. Georgia’s exchange will be run by the federal government at http://www.hhs.gov/healthcare/facts/bystate/ga.html.
Who can use the exchanges?
The exchanges are for the uninsured people who will buy their own coverage and those whose employer-provided coverage that is too expensive or lacks important benefits. Initial open enrollment is Oct. 1 through March 31.
Who can’t use the exchanges?
People who are in the country illegally are barred from the exchanges. Most workers at bigger companies that provide health coverage won’t use them. Medicare and Medicaid beneficiaries aren’t eligible for the exchanges.
What if I have a pre-existing condition?
Insurance providers are prohibited from discriminating against you because of a pre-existing condition. On Oct. 1, an estimated 4,324,000 Georgians with a pre-existing health condition can start to enroll in coverage through the Health Insurance Marketplace without facing discrimination.
What kind of plans will I be able to buy?
All plans will offer “essential benefits” that include hospitalization, emergency care, maternity and pediatric care, mental health care, and prescription drug coverage. Plans must cover preventive care like flu shots, vaccinations and mammograms at no cost. Insurers will offer four tiers – bronze, silver, gold and platinum – based on deductibles, co-payments and other costs.
Bronze plans have the lowest monthly premiums but higher out-of-pocket costs.
What if I’m a small-business owner?
Businesses with up to 50 employees will have a Small Business Health Options program, or SHOP exchange, that will give employees more options than they now have. For more information, visit http://search.hhs.gov/search?q=SHOP&site=hhshealthcare&entqr=3&ud=1&sort=date%3AD%3AL%3Ad1&output=xml_no_dtd&ie=UTF-8&oe=UTF-8&lr=lang_en&client=hhshealthcare&proxystylesheet=hhshealthcare&btnG=Search
How will it work?
Consumers can create online accounts at www.healthcare.gov. Information like income and citizenship status is required.
The exchange will display a list of health plans, premiums and out-of-pocket costs, including deductibles and co-payments. After making a selection, you will be directed to the insurer’s Web site to make the payment.
The exchange will determine if you are eligible for Medicaid. If you are ineligible, it will tell you how much subsidy you can receive for a private health plan. In most cases, the government will send subsidies directly to the insurers to pay part of the premium.
What if I can’t afford the premiums?
The law provides sliding-scale subsidies to help people with incomes up to four times the federal poverty level – $11,490 (about $46,000 for an individual, $62,040 for a couple, and $94,200 for a family of four) – pay premiums. Additional help with co-payments and deductibles is available for people with incomes up to 250 percent of the poverty level ($28,725 for an individual or $58,875 for a family of four). People who receive subsidies will be required to pay 2 percent to 9.5 percent of their incomes toward premiums, depending on how much money they make.
What happens if I don’t buy insurance by March?
You will face a penalty of $95, or 1 percent of your income, whichever is greater, for the first year. The fine increases to $695, or 2.5 percent of income, in 2016.