On Oct. 1, the uninsured and those looking for affordable health insurance will come face to face with a plan that’s been talked about (and some would say misunderstood) for years now: Obamacare. Come fall, this mammoth health policy initiative will finally reach consumers in the form of a online shopping centers called health insurance marketplaces.
These government-run websites are the place to compare a range of insurance plans offered by private companies, and to enroll in the best health plan for you, your family or your small business. Here’s a quick and easy guide for how to use them.
What Is It?
This national network of online health insurance shopping markets was set up to help the uninsured comply with new the new law requiring all Americans to have health insurance by Jan. 1, 2014—or face fines. It’s also a place where those who are already covered can shop around for new policies that better fit their budgets.
Now, here’s the confusing part: some states will be operating their own marketplaces, while others are allowing the federal government to manage theirs. They also have different names in different places. Sometimes they are called insurance exchanges, sometimes marketplaces, and some states have come up with their own names such as “Covered California” and “NY State of Health” (was there a Billy Joel fan in the health department?).
Here’s the simple part: the government has created a central portal to guide you directly to the plans or network available in your state. It’s called the Health Insurance Marketplace or healthcare.gov. So that’s the easiest place to start.
The key dates and deadlines to know are:
- October 1, 2013: Open enrollment begins
- January 1, 2014: Coverage starts for marketplace insurance plans
- March 31, 2014: Open enrollment closes
How it works
Starting Oct. 1, you can use the Health Insurance Marketplace to shop for the insurance plans available in your area. If you’re uninsured, you’ll be able to choose a plan. If you already have private or employer coverage, you’ll be able to see if you can get a plan with lower premiums and lower out-of-pocket expenses.
What You’ll Need to Do
Anytime after the start date, you can visit healthcare.gov (which is currently live but not yet offering plan or pricing details) and enter your basic personal information, location, health care coverage status, family size and income levels.
This will take you to a list of health plan options with cost information. You will also be able to find out whether you qualify for a discounted plan or Medicaid. That will depend on your reported income from 2012.
One big consumer-friendly change from our current health system is that all the plans will have to meet specific standards, whether they are sold by Cigna, Aetna or UnitedHealth. You’ll can choose from a “bronze “silver,” “gold” or platinum plan, and they should all offer similar features—no matter which company is selling them. That means no more fine print or hidden costs.
Another huge change is that no company can reject your application or charge you higher rates because you have a pre-existing condition, nor can they charge women more than men or deny treatment for certain illnesses.
What You Can Do Right Now
Between now and Oct. 1 there are some things you can do to get all your ducks in a row. First, you can visit the site to learn about the different types of health care coverage. If you’ve shopped for health insurance in the past, whether privately or through an employer, you’re already up to speed on HMOs, PPOs, Point-of-Service (POS) plans and so on. If not, the next few weeks would be a good time to research these options based on the needs of you and your family.
Next, you’ll want to familiarize yourself with how health insurance plans work, and understand basics like premiums, deductibles, copayments and out-of-pocket maximums. For example, you may find a plan with a lower premium or monthly costs, but a higher deductible. A high deductible means you’ll be paying a chunk of your medical expenses before the insurance even kicks in, so if you end up needing a lot of care it could get expensive. If you’re wading into the health insurance waters for the first time you’ll want to understand these terms fairly well before making a decision.
It would also be a wise move to circle back and check on your finances. To find out if you’ll be eligible for discounts on health coverage you’ll need to make a checklist of pay stubs, W-2 forms and any other sources of household income. Keep these numbers handy for when you start selecting options in the Marketplace, and you might also want to try and set a budget ahead of time so you know what you can afford to pay for monthly premiums, deductibles and out-of-pocket expenses.
You can also sign up for email and text alerts that will automatically inform you about new information or deadlines. Another resource is the Health Insurance Marketplace Facebook page at facebook.com/healthcare.gov, and Twitter stream @healthcare.gov.
More questions? Try the marketplace’s search window and scroll through the many articles which can answer your questions about part-time employees, COBRA and other special situations you might have.
What About My Small Business?
If you have a small business with fewer than 50 employees, you’re not required to offer health insurance to their employees. Yet, starting in October, you’ll be able to use the Small Business Health Options Program (SHOP), a marketplace tailored to small businesses. As in the individual marketplaces, you’ll want to take some time to figure out the plan that fits your business, employees and budget. You’ll answer a few questions and receive a list of options from which you can easily compare prices, coverage and quality.
If you already provide insurance and use a broker, check with them to see if they offer coverage through SHOP. If not, you can ask them to try it out or follow the SHOP steps on your own.
If you’re self-employed without employees, unfortunately you’re not considered a small business. However, you can click right over to the Health Insurance Marketplace.
If you decide to use SHOP, you’ll be required to offer a health plan to all of your full-time employees, and in many states, 70% of your full-time employees must enroll in your SHOP health plan. Also, you may qualify for a small business tax credit for health care. Starting in 2014, this credit is only available for plans purchased through the SHOP program.
As a business owner, once you choose a health care plan through SHOP, your employees will receive a notification with instructions for signing up and tools to make an employee roster and a distribution list, or you can print up the information and distribute it by hand.
Find out more about how to shop for plans and what documents you’ll need by visiting Rocket Lawyer’s Affordable Care Act Center.