Health Care 4 You: What you should know about the health insurance marketplace

Published On: Dec 24 2013 09:06:17 AM EST
Updated On: Sep 30 2013 06:36:09 AM EDT

Americans who are uninsured or do not purchase insurance through an employer will get their first opportunity Tuesday to see what plans will be available to them through Obamacare.

Tuesday. October, 1 is when the Health Insurance Marketplace will list the plans and the costs of those plans to consumers.  That is also the day the open enrollment period begins.

"I'm apprehensive, yeah, but I am going to research it and if I can get better coverage and a better deal, I will, definitely" Julie Myszenski who lives in Madison Heights.

"I'm excited. my worries are is it going to be affordable? is everybody going to be able to afford it?  But other than that I think it's a pretty good idea," said Kelly McCain who lives in Macomb and doesn't currently have health insurance.

Some metro Detroiters are excited about the plans, others are confused about what to expect or whether it affects them.

"The people who are most impacted are really people who currently buy insurance on their own or who are uninsured. People who get insurance at work, people who are covered by medicare or medicaid really don't need to take action at this time, it's mostly for people who are on their own when it comes to health insurance" said Lisa Zamosky, the chief medical editor of WebMD.

Under the Affordable Care Act, consumers can go to an online marketplace or exchange to see what plans are available to them.

"The Affordable Care Act allows individuals to go on and shop for health insurance in the marketplace. If you don't have coverage you can now compare different plans, apples to apples," said Nicole Duritz, Vice President of Health, Education and Outreach.  "It makes it a lot easier and nobody can be turned away because of a pre-existing medical condition."

Insurance experts tell Ruth to the Rescue that shopping in the marketplace will help people find the best possible coverage for them.  The Health Insurance Marketplace or exchange as it's been called, can be found at healthcare.gov.   Michigan residents need to go to that website to see the comparison of plans.   The prices for the plans will not be listed until October 1.

According to Blue Cross Blue Shield of Michigan, 14 Michigan health insurance companies will be listing plans on the exchange:
Alliance Health and Life Insurance Company
Blue Care Network of Michigan
Blue Cross Blue Shield of Michigan
Consumers Mutual Insurance of Michigan
Health Alliance Plan
Humana Medical Plan of Michigan, Inc.
McLaren Health Plan
Meridian Health Plan of Michigan, Inc.
Molina Healthcare of Michigan
Physicians Health Plan
Priority Health
Priority Health Insurance Company
Total Health Care USA
United Healthcare Life Insurance Company

The insurance marketplace will be divided into four levels of coverage; platinum, gold, silver and bronze.

With the platinum plans, people will pay the highest monthly bill, but only 10 percent out of pocket for medical services.

Under the gold plans, the month costs are lower, but people pay 20 percent out of pocket, for silver plans the monthly costs are lower again, but people pay 30 percent out of pocket.  Then at the bronze level, people have the lowest monthly costs, but will pay 40 percent out of pocket.

Duritz wants people to know about possible cost-saving benefits to shopping in the marketplace.

"You're going to need to shop in the marketplace, because if you shop in the marketplace, then you're eligible for the subsidies, the assistance in paying for the costs of your coverage" said  Duritz.

While using the exchange, people will learn whether they qualify for tax credits and reduced cost sharing.  The assistance is based on income level.

According to healthcare.gov, insurance companies "offering coverage through the Marketplace must lower the amount you pay out of pocket for essential health benefits if your household income is below the following amounts."

Up to $28,725 for individuals
Up to $38,775 for a family of 2
Up to $48,825 for a family of 3
Up to $58,875 for a family of 4
Up to $68,925 for a family of 5
Up to $78,975 for a family of 6
Up to $89,025 for a family of 7
Up to $99,075 for a family of 8

It is important to note, that the marketplace is the only place people can receive assistance to help paying for their health care plans.  The government hopes that the subsidies will make the coverage more affordable for some.

"The law requires everyone to carry health insurance. If you don't, you will face a penalty," said Duritz. "The money is not the big issue here, one never knows when you're going to have an accident, you might be riding your bike and hit a stone, you might get appendicitis and those bills follow you out of the hospital and that's why coverage is so important.

The penalty, which is $95 or one percent of income, will be collected on tax returns beginning in 2015.

There are, however, a few exemptions to paying the penalty.  According to healthcare.gov people could qualify for an exemption if:

You're uninsured for less than 3 months of the year
The lowest-priced coverage available to you would cost more than 8% of your household income
You don't have to file a tax return because your income is too low (Learn about the filing limit.)
You're a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
You're a member of a recognized health care sharing ministry
You're a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
You're incarcerated, and not awaiting the disposition of charges against you
You're not lawfully present in the U.S.

Here are the key dates once open enrollment begins:

October 1, 2013: Open enrollment starts
January 1, 2014: Health coverage can start
March 31, 2014: Open enrollment ends

The health insurance plans offered in the Marketplace must offer the same set of benefits which include:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services including behavioral health treatment
Prescription drugs
Rehabilitative services and devices
Laboratory services
Preventative and wellness services and chronic

For more information on how the Affordable Care Act could affect you, click here.

You can also call  1-800-318-2596

TTY: 1-855-889-4325

Special Section: Health Care Reform

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