What People Need to Know About the New Obamacare Health Insurance Marketplaces Set to Open in 2014

The Patient Protection and Affordable Care Act, also known as the Affordable Care Act, PPACA, and Obamacare created health insurance marketplaces, or exchanges, that are set to open in 2014. These marketplaces are new, and as will all new things, there will be many questions asked. Here are some of the aspects that you will need to know in order to make a good decision about whether the exchanges are for you and your family.

What is a Health Insurance Marketplace?

A health insurance marketplace is an online website where individuals can compare plan designs and premiums from various medical insurance companies. Unlike today’s individual insurance market, where a person has to go through an online broker or shop for plans on their own, the marketplaces will have all the plans on the computer screen in front of them. The plans will be easy to read and understand. Once the decision has been made as to which plan to enroll in, the actual enrollment can be done instantly from the marketplace’s website.

Who Manages the Marketplaces?

The Affordable Care Act is a law passed by the United States government, but the responsibility of managing the health insurance marketplaces falls to each individual state. However, if a state does not want to open their own marketplace, they can defer to the Federal Marketplace.

What this means is that in order to enroll in a marketplace, an individual will need to go to his or her own state’s exchange, which can be found here.

When Do the Marketplaces Open?

The first effective date of plans purchased on a health insurance marketplace will be January 1, 2014. However, Open Enrollment begins on October 1, 2013. On that day, individuals will be eligible to purchase a medical plan.

It is important to note that not all online exchanges will be ready to roll on October 1. In that case, people will need to enroll via telephone.

What Kinds of Plans are Available in the Marketplaces?

The exchanges will not have the same number of plans available as an individual insurance company offers outside of the exchange. However, there will be a good spread of plan benefits.

The marketplaces will offer 4 levels of plans. These plans will be called Platinum, Gold, Silver, and Bronze. The Platinum plan will offer the richest benefits, followed by Gold, Silver, and then Bronze.

Individuals that want low premiums can choose the Bronze plan, but their out of pocket exposure will be higher than the other plans. If someone is willing to pay high premiums in exchange for low out of pocket risk, they can purchase the Platinum plan.

What Will be the Cost of the Plans?

This is the question that everyone wants to know the answer to. The cost of the plans will of course vary by plan value, but will also vary by state. Insurance companies will be the ones providing the plans, and they will use their underwriting guidelines to develop premiums. The hope is that competition between the companies will keep the cost down.

Is Help Available to Pay for the Premiums?

Some people will be able to receive tax credits to help offset the cost of a plan purchased on the exchange. If an individual makes less than 400% of the poverty level and is not eligible for Medicaid, they can receive premium assistance. The health insurance marketplaces will be able to determine this assistance during the enrollment session.

Marketplaces can Ease the Burden of Purchasing Health Insurance

The health insurance marketplaces were designed to help people find affordable and comprehensive coverage for their healthcare needs. Inevitably, some tweaks will need to be made, but all-in-all, the exchanges will be a great place to find good insurance.

How Will the Health Insurance Marketplace (Exchange) Affect You?

Believe it or not, 2013 is half over. As we begin the 2nd half of the year, there are some big changes coming that may affect you whether you realize it or not. It wasn’t long ago when we had a big divide in our country over the healthcare reform and the passing of PPACA (Obama Care) in 2010. Since then, there have been small changes occurring in the health insurance industry, and most likely, your health insurance policy. However, a lot of these changes have gone unnoticed by most people.

That is all about to change! Starting January 1, 2014, four of the biggest changes in the reform legislation are set to be implemented. This is when the “rubber will meet the road” and it all goes from theory into practice. Whether or not this is a big success or another financial burden on our national debt, only time will tell. But, what’s important now is to understand what is expected of you and/or your business and which decisions are best for you.

The 4 biggest changes are:

  1. Individual Mandate- The PPACA requires all American citizens and legal residents to purchase qualified health insurance coverage. If not, then you will pay a minimum fine of $95 up to 1% of your household income. The fines increase in 2016 to $695 per person or 2.5% of income up to $2085.
  2. Guaranteed Coverage- Coverage cannot be declined due to pre-existing conditions. For persons who have been unable to get coverage on the individual market due to pre-existing health conditions, they will now be able to get the same coverage and price as a healthy person the same age (smokers are charged additional).
  3. Health Insurance Marketplace (Exchange)- For individuals and small businesses, the Federal government and some states will provide an Exchange to access health insurance in addition to the traditional method of an insurance agent/broker. In fact, some insurance agents/brokers will provide plans both inside and outside the Federal or State Exchange. The two important points are 1.) an individual can only qualify for a subsidy and 2.) a small business can only qualify for the small business tax credit through a Federal or State Exchange. The Enrollment for the Exchanges opens October 1st this year.
  4. Pay or Play Rule- For businesses with 50 (FTE/Full-Time Equivalent) employees or more, an affordable “minimum essential coverage” health plan must be provided to their employees or pay a fine. If a business does not provide qualified coverage, the penalty will be the lesser of ($2000 times the # of F/T employees minus 30) or ($3000 times the # of F/T employees that obtain a subsidy for coverage through the Exchange). This penalty is determined on a monthly basis so will pay 1/12 those amounts times the # of months they are not in compliance.

These are the biggest, but far from the only, changes that are coming in 2014. How will you be affected? Do you know the best approach to take? For some, you may not see much difference. For those individual and businesses who want answers to your questions, my suggestion is to speak with an agent/broker that will be providing coverage both inside and outside the Exchange to compare your options and help you make the best decision.

Obamacare Is The Law Of The Land, Not A Health Insurance Policy

Open enrollment started for the healthcare law for individual and family policies on October 1st, with a start date of January 1st, 2014. There are a lot of misconceptions out there and people will end up wasting time looking for something that is not true. Tens of thousands of people only pick up their information from the media or their dear friends. Sometimes this can leave you with unanswered questions. This can really cost you some money.

Many Americans are trying to get a glimpse look at an Obamacare plan to see what all the hype is about. Through all of their fruitless searches, they end up empty-handed.

Obamacare is the nickname for the actual Healthcare Law signed in March of 2010. Some people are offended when people use this term because it was smeared by some opposing parties. However, the President himself actually endorsed the term. With his endorsement, it no longer a negative impression to the naked eye.

Obamacare created the infrastructure to change the way health insurance policies are bought and sold in the marketplace. That’s it! They built a big shopping plaza similar to Amazon.comĀ®. This is called the Health Insurance Marketplace, formally the health insurance exchange. The theory behind it is the health insurance companies can compete for pricing inside one Marketplace, or shopping plaza. At the time of this writing, health insurance companies are not required to participate inside the Marketplace. Without the requirement to participate, it will lack the original idea of the health insurance companies competing for the business in one place.

This is because an insurance company can choose NOT to participate inside the Marketplace and sell plans outside of it. This will be no different from all of us purchased plans in the past, except the plans must include all healthcare reform mandates.

This infrastructure created a series of health plan models to simplify the process for consumers picking plans and clearly seeing what is covered. It was very confusing in the past. Now it is just a little confusing. We still have mud on our windshield.

The idea behind this is when a consumer is reviewing a health plan with one carrier against another, they can see they are VERY similar in coverage. Each carrier has their own personality to things such as the amount of co-pay, co-insurance and out-of-pocket expenses on a health plan. This will, in theory, make it easier for consumers to shop health plans.

The playing field has definitely changed forever as we know it. Any time there is change, it creates short-term turmoil in the marketplace with the consumer. Obamacare is a prime example of this.

The Health Insurance Marketplace is the only place where an individual or family can receive a tax credit for purchasing a health insurance plan. There are certain things that are required for you to qualify for a health insurance tax credit with the new law.

Just briefly, it will depend on what is indicated on your tax return. This will include your income, family status, and age. There may be other requirements that can change your eligibility status. The purpose of healthcare.gov is to determine your eligibility status. You will still be applying for coverage with the carrier that you choose, not the government website.

It is not required to purchase a health insurance plan inside the Marketplace. It is a HUGE misconception about making a move with the new health plans. If someone, or a family, does not qualify for any tax credit, there is absolutely no reason to purchase a plan inside the Health Insurance Marketplace.

Outside the Marketplace will have a few more options to choose from, along with the same, exact, health plans inside the Marketplace. The same plans inside and outside of the Marketplace will have the same premium. There is no difference in coverage or cost.

The health insurance carrier is the same, inside and outside the Marketplace. The plans and the price are the same (When comparing the same ones) inside and outside the Marketplace. When you purchase a plan, you will be paying the health insurance company, not the Federal government.

Obamacare is just the law of the land. That is it. There is no health plan sold through the Federal or State government. You are still purchasing a plan from a Major health insurance carrier that is authorized to sell a policy in your state. Obamacare just wrote the rules on what would be required by insurance companies in order to sell a health insurance plan in the future and how an individual or family will purchase that plan to protect everything they have worked so hard for.

Have You Signed Up For Marketplace Health Insurance Yet?

What Is The Health Insurance Marketplace?

If you visit HealthCare.gov, you will find the portal to the new marketplace for individual, family, and small business health insurance plans. There is not actually only one marketplace. Several states run their own exchanges, but the website will direct you to the right solution for your location.

Yes, there was certainly a lot of frustration, and a few I-told-you-so’s, when the Affordable Care Act’s site failed to function properly. It is possible that Teddy Roosevelt and Richard Nixon, famous Republican supporters of health reform, were spinning in their graves. Of course, it is possible that they never really knew what a website was.

The U.S. Healthcare Marketplace Is Open

While somebody should probably look into that particular issue, other people might be very wise to take advantage of the functioning website to consider their options. The site is fairly simple and intuitive. It walks the user through a series of basic questions that are much less intrusive than old health insurance applications ever were.

Set aside an hour or more to answer the questions and browse different marketplace health insurance options. You can stop at any time and resume your session. You might even want to call the private companies that offer exchange plans to ask questions. You are also free to call the toll-free government help line at any time for assistance.

Also, give the system a few minutes to send out your confirmation email after you register. Some users were confused by the fact that they did not get that email for almost 30 minutes, and they wondered if they had done something wrong.

Who Can Find Coverage Under The New Exchanges?

This site is mostly for people who are not covered by employer-based group plans and small businesses. People with any income level can apply for medical coverage here, as long as they satisfy the other criteria. However, the system will automatically calculate tax credits or other subsidies. If you want, you can even automatically apply those credits to the premium of your plan.

What Type Of Medical Insurance Plans Are offered?

Remember that these are private health insurers. However, all plans have to conform to established Bronze, Silver, Gold, and Platinum levels. Bronze plans are cheapest, and they provide lower levels of coverage. Platinum plans are more expensive, and they provide the most generous coverage. You can still find a lot of variation within those levels.

There are typical types of U.S. medical policies. These include HSAs, PPOs, and HMOs. It might be prudent to research these different types of plans before you simply select one based upon the price.

Here’s the short summary of the differences between these types of health policies. PPOs and HMOs are both network plans. Typically, you will find that PPO plans are less restrictive, but they may be more expensive and provide less coverage than HMO plans. HSAs might be good for people who can take advantage of tax deductions.

Why Not Consider Your Marketplace Options?

As long as the website is functioning, this is a good time to register for free and find out what your own options are. If Teddy Roosevelt is aware of our current problems, it seems likely that is what he would expect out of Americans.