- Health Care, Drugs & Insurance
How To Apply- New Online Health Insurance Marketplace
The Best Health Plan is Prevention
Obamas Online Health Insurance Marketplace Explained
Healthcare is becoming so confusing these days and most of us are just going with the flow until we fit in somewhere. How do we choose the best healthcare we can afford for our families? How does the Healthcare Reform affect us?
The way many have received health insurance up to now may change forever. Studies have estimated that approximately 19 million people will be getting their health insurance through a Health Insurance Exchange, which is an online insurance marketplace.
If you currently are receiving affordable health insurance from your employee or Medicaid/Medicare you may not qualify. Those that meet the requirements will choose their healthcare on an Online Health Insurance Exchange.
Every person that is not exempt must have Essential Minimum Coverage (Insurance Plan) in order not to potentially pay a penalty for not being insured.
Essential Minimum Coverage
- Employee insurance- Affordable insurance through your employer.
- Government Plans such as Medicaid/Medicare
- Private Market- such as Aetna
- Grandfathered Plans or Preexisting plans.
- State Health benefits risk pool. Associated by the Health and Human Services Sec
What is an Online Health Insurance Marketplace?
The Health Insurance Marketplace or Insurance Exchange is where you will apply for affordable health insurance that is determined by your specific financial and personal living situation. The healthcare plans are all mandated to offer essential core benefits.
Although certain medications are covered (formulary) under each plan which you can only get discounted from a "In-network pharmacy"; unless you have your own pharmacy discount card. However, if you are taking a medication that is not on your plan you can have it added by applying for an exemption if you can effectively prove there is no replacement without negative repercussions. During this process you should receive your current prescription until a decision is made.
- Preventive care
- Wellness services
- Prescription drugs
- Hospital stay coverage
If you currently have affordable healthcare or exempt you may not qualify. However you should see what the requirements are in your state to know where you qualify.
Once qualified you will be assigned a specific level for your income status letting you know what percentage of your healthcare is paid and what percentage comes out of your pockets.
Your state has the option to officiate a Health Insurance Exchange. If they do not, the federal government will administer one for them.
How to apply at the Health Insurance Marketplace
Health Insurance exchanges are meant to give consumers and small businesses options for affordable healthcare. The health plans sold on an exchange or marketplace are separated into four health plan categories or metallic levels; Bronze, Silver, Gold, or Platinum.
Cost sharing among members and tax credit subsidies allows the number of member to decrease the cost of out of pocket expense. The household income will determine what level you qualify.
- You will go to www.Healthcare.gov and fill out an application.
- Your specific state, income and familial status will determine you choices.
- Select from predetermined choices.
- Inspect your healthcare plan
Health Plan Categories (Metallic Plan Levels)
The percentage the plan pays of the average overall cost of providing essential health benefits to members is determined by the level they qualify for.
The healthcare plan category you choose affects the total percentage of money your likely to spend on necessary health care during the year.
- 60 % (Bronze)
- 70 % (Silver)
- 80 % (Gold)
- 90 % (Platinum)
There is a specific time period when you must enroll. The new reform starts in 2014. The open enrollment period is October 1, 2013 to March 31, 2014. For plans that begin 2015 or later, the open enrollment period will be October 15 to December 7, 2014, with a penalty for not being insured after the third month.
How Does Obama Healthcare Reform or Affordable Care Act Affect Us?
Because of the new changes, your cost could end up being more or less; because the prices are set regardless of your health status.
- Your company may drop your insurance plan due bottom line increase.
- Your medication may not be covered under new changes.
- Your premium could decrease.
- Your premium could increase.
- You may be able to afford insurance.
The insurance cost can also go up because all insurance must have essential coverage such as, women’s health services and preventive care.
These changes can cause companies to drop your insurance plans due to extra expenses for their bottom line; affecting millions.
Cost are affected by:
- Guaranteed Issue (No one can be denied)
- Health insurer fees (taxes and fees)
- Essential coverage (taxes and fees)
- Rating Changes (preexisting health status)
- Reinsurance contributions (temporary)
A plus is preventive care such as cancer screenings or immunizations for children will have no coinsurance of deductible payments for these services and the insurance is more attainable for more people than ever before.
No one that is not exempt, will be denied health coverage or charge more for health status or preexisting health issues. Your insurance premiums will be determined by your:
- Family size
- Smoking (tobacco)
Starting in 2014, there will be penalties for not having Essential Minimum Coverage. The penalty for individuals are:
- 2014, $95 per uninsured person or 1% of their household income, whichever is greater.
- 2015, $325 per uninsured person or 2 % of household income, whichever is greater.
- 2016, $695 per uninsured person or 2.5% of their household income, whichever is greater.
There will be no penalty for United States citizens living outside of the country and those without insurance for less than 3 months.
While the many changes affects millions of people in the United States there are some that are exempt such as:
- Illegal residents
- Incarcerated individuals
- Indian tribes
- Certain Religious Group
As you can see there is a lot to learn. This is only a general guideline to help you adjust to the upcoming changes. Hopefully this hub has made the new reform a little more understandable. Remember there are penalties to not applying and benefits you may not have had before.
The new health reform is happening. The Health Insurance Exchanges are starting in every state in the United States. Open enrollment begins October 1, 2013. This change will affect millions. It will save lives. There are penalties for not joining for more than 3 months. There are people who are exempt.
The Healthcare Reform will be uncomfortable and nuisance for some and a blessing for many, hopefully we can adjust with ease. The Affordable Care Act is happening now regardless of how we feel. You have to admit, it is time to have affordable health care that many countries have had for their residents as a norm. Hopefully we can adjust with grace. God Bless America!
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