6 Tips About the Health Insurance Marketplace

Oct 24, 2013
Express Scripts shares tips for Americans enrolling in healthcare coverage through the Health Insurance Marketplace.
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Americans without health insurance is estimated at 48 million, or about 15% of the U.S. population. This number is equal to the entire populations of Missouri, New Jersey, Arizona, Ohio, Oregon, North Carolina and Nebraska combined. One of the main goals of the Affordable Care Act was to dramatically reduce the number of Americans without health insurance and to extend a minimum level of health coverage to everyone.

Oct. 1 marked the launch of the public health exchanges – also known as the Health Insurance Marketplace – which are part of the ACA and designed to provide affordable health insurance coverage for uninsured Americans.

The public health insurance exchanges may seem overwhelming, and recently reported technical difficulties have added to the confusion. But people under age 65 who do not have healthcare coverage through an employer or a spouse should not be intimidated by the process.

Here are six things to know as you prepare to shop for a plan on the health insurance marketplace:

1. Who is running the Marketplace in my state?

While all health insurance will be offered through health plans, the Marketplace is run by either the state or the federal government or a combination of both. Visit www.HealthCare.gov to find out who runs the marketplace in your state.

2. What is provided to me when I enroll in a plan?

Each insurance plan covers the same core essential health benefits. No plan can turn someone away or charge more because of an illness or pre-existing medical condition. They must cover treatments for these conditions. Health insurers can’t charge women more than men for the same plan. Many preventive services are covered at no cost. Also, premium and cost-sharing subsidies are available for certain individuals and families with lower household income levels. When you apply, you will learn if you qualify for Medicaid or the Children’s Health Insurance Program, or savings you can use right away to lower your health insurance premiums.

3. Where do I shop and compare plans?

HealthCare.gov is a website like Travelocity.com or Progressive.com, but instead of booking a flight or comparing auto insurance, you can shop for health insurance. With the Marketplace, consumers can learn if they can get lower costs based on income, compare coverage options side by side, and enroll.

It’s important to take the time to shop and compare based on your healthcare needs and your budget, but there is still plenty of time to make an informed decision.

4. When do I need to make a decision?

For this first Marketplace enrollment period, the deadline for enrollment is March 31, 2014. However, if you want coverage effective on Jan. 1, 2014, you need to enroll by Dec. 15.

5. How are the plans categorized?

The exchange offerings are categorized as bronze, silver, gold and platinum to designate the level of coverage based on projected cost sharing. The categories don’t reflect the quality or amount of care the plans provide — they simply reflect the amount of cost-sharing. Premiums are usually higher for plans that pay more of your out-of-pocket medical costs when you get care.

If you expect a lot of doctor visits (more than two or three per month) or need regular prescriptions, you may want to consider a Gold or Platinum plan. They likely have higher premiums, but you could pay lower out-of-pocket costs for each visit, prescription or other medical service. If you only see the doctor a few times in a year, you may prefer a Bronze or Silver plan. Your monthly premiums will likely be lower, but you’ll likely pay more of the cost when you see a doctor.

6. Why should I enroll?

For starters, it’s the law. With some exceptions, every American must have health coverage in 2014 or pay a fee of $95 per adult, $47.50 per child or 1% of your income (whichever is higher). And the fee increases every year. Most importantly, enrolling in a health plan can keep you healthy and improve your quality of life. Even if you are healthy now, having coverage provides access to preventive care and screenings that will keep you healthy and also provides coverage to you should you have unexpected medical expenses.

Ready to Enroll?

When you are ready to enroll, download this helpful checklist to ensure you have all of the information you need readily available to make the process easier.

You can enroll at HealthCare.gov, or call the Health Insurance Marketplace call center at 800.318.2596, 24 hours a day, seven days a week. TTY users call 855.889.4325.

At Express Scripts, we make sure our clients and members can successfully navigate through a complex healthcare marketplace. That’s been our job before the ACA and will continue to be our focus today and beyond.

Author Bio

Julie Huppert
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