A marketplace like no other is opening soon.
Beginning Oct. 1, people without health insurance will be able to shop for what is promised to be affordable coverage.
It's all part of the rollout of the Patient Protection and Affordable Care Act, which was passed by Congress and signed by President Obama in 2010. For the past three years, various parts of the law have been implemented: Young adults can stay on their parents' health insurance until they turn 26; insurance companies are prohibited from imposing lifetime dollar limits on essential services such as hospital stays; people with Medicare get free preventive services.
Next up is a part of the law that requires most Americans to maintain “minimum essential” health insurance coverage. It's one of the more controversial provisions of the law commonly referred to as Obamacare.
Remember all the fuss about the Supreme Court weighing in on this mandate? The court ruled last year that the government can make people purchase insurance. So unless you are exempt or you are covered through your employer or a government program, you must purchase insurance from a private company or face a penalty. Open enrollment runs from Oct. 1 to March 31.
This is the first in a series of columns explaining the provisions of the law that are due to take effect next year. But ultimately, you're going to have to do some research yourself. Don't be informed by rumors or the political discourse surrounding this law. There's enough complication in the application of the provisions that you don't need to add to your fears or frustrations by getting advice that is politically motivated.
Thankfully, you have help. Your first stop should be HealthCare.gov (or CuidadoDeSalud.gov for Spanish speakers). It's an easy site to navigate. The information is nicely broken down in various sections. Each state and the District of Columbia will have access to a health insurance marketplace. Your state may have set up its own exchange, or maybe it plans to join with other states to create a regional exchange. Or perhaps your state opted to let the federal government establish an exchange.
Once you're at HealthCare.gov, click on the link for “Get Insurance.” You want to do this first so you can see if you need to stay on the site or go to a similar state-run site to apply for coverage, compare plans and enroll once the marketplace is open.
If you don't want to go online or you don't have easy access to a computer, you can call for help in figuring out how you are affected. The government has set up a call center with staff members who speak 150 languages. You can reach them 24 hours a day, seven days a week toll-free at 800-318-2596, and hearing impaired callers using TTY/TDD technology can dial 855-889-4325 for assistance. Workers called navigators also are being trained around the country to assist folks.
To encourage the uninsured to purchase essential coverage for themselves and their dependents, the government put in place a penalty for those who refuse. The Henry J. Kaiser Family Foundation (www.kff.org) has a great graph to illustrate the requirement to buy insurance and the penalties. Search for: “The Requirement to Buy Coverage Under the Affordable Care Act.” If you can afford coverage and still don't seek it, the fee starts at $95 for an individual up to $285 for a family or 1 percent of a family's income, depending on which is higher. The fee increases every year. By 2016 it rises to $695 per adult or 2.5 percent, whichever is higher.
Here's the thing. If the government determines that your income is such that you can or should be able to pay for your own insurance and you don't fall under an exemption, you'll be responsible for 100 percent of any medical care you might need.
So how do you know if the mandate includes you? There are a number of ways to avoid paying a penalty, including coverage through an employer, a veterans plan, Medicare or Medicaid. If you don't fall into the various categories to avoid a fee, you can still request an exemption.
The health insurance exchange will allow you to compare plans sold by different insurance companies. The big question is what you will have to pay. The answer is, it depends. That information won't be available until Oct. 1.
With government subsidies, you may be able to lower your monthly premiums based on your income. It is also possible that you'll fall into a gap where the health insurance plans offered are still too costly.
I know. It's a lot to take in and I've just covered the basics. But if you're uninsured, you won't know if you can or cannot afford health insurance if you don't investigate what the new marketplace has to offer. Please go shopping beginning Oct. 1 and find out. We all need medical care at some point and this may make it more affordable.
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