By Katherine Scheirman, MD
Oklahoma State Director, Doctors for America
Thanks to the Affordable Care Act, for the first time ever, many people who have been unable to get high quality, low-cost health insurance will soon be able to do so.
Unfortunately, due to misinformation, the very people who stand to benefit the most and who may qualify for financial assistance don’t even know about this opportunity. This might even be you or someone you know.
Beginning October 1, 2013 until March 31, 2014, there will be new Health Insurance Marketplaces that will allow people to compare prices and shop for health insurance where they live. During this open enrollment period, millions of Americans will finally have the opportunity to buy quality, affordable private health insurance.
If you enroll in a plan before December 15, 2013, your new health insurance will begin on January 1, 2014.
You will be able to compare prices for different health insurance plans online at the Health Insurance Marketplace (www.healthcare.gov/marketplace), by phone (1-800-318-2596), or in person. There, you can choose a health insurance plan that fits your lifestyle and budget.
All these insurance plans will have to cover the basics called essential health benefits. From doctor visits, emergency rooms, medications, and preventive care, this all means better quality care for you and your family. All the plans will cover preventive care, such as vaccines and mammograms with no co-pays or deductibles.
The Marketplace will allow you to compare several plans, with differing co-pays and deductibles in a simple, easy format. You will also be able to find out whether or not you can get a subsidy to help you afford the premiums.
Your premiums are based on your age, number and ages of family members, what state you live in and whether or not anyone in the family uses tobacco. Subsidies are based on your family size and income.
There is an excellent subsidy calculator at www.kff.org/interactive/subsidy-calculator, which will let you calculate the approximate subsidy for yourself and your family for a typical silver plan offered in the Marketplace.
For example, a 29-year-old single, non-tobacco user who earns $20,000 per year would have an estimated total premium of $3,377 per year. However, because he or she would be eligible for a subsidy of $2,356, the yearly premium would be just $1,021 (approximately $85 per month), equal to 5.11% of his or her household income.
If that same person earned $40,000 per year, he would no longer be eligible for a subsidy, so he would pay the full premium of $3,377.
A 58-year-old couple who earn $50,000 per year would have a premium of $15,380, would be able to get a subsidy of $10,630, and would have to pay $4,750 ($396 per month) for coverage for both of them.
Let’s look at a family of 5 where the parents are both 35, with 3 children under age 21, with annual income of $50,000. Their total premium would be $13,126, but, thanks to the tax subsidy, they would only have to pay $2,074 per year, or $173 per month for family coverage.
You will have a choice of plans that offer more coverage (Gold plans) at a higher cost, and plans that offer lower coverage (Bronze plans) at lower cost. If you are eligible for subsidies, you can use them to help pay for any plan purchased in the Marketplace.
Most health insurance plans offered in the Marketplace have networks of hospitals, doctors, specialists, pharmacies, and other health care providers. Networks include health care providers that the plan contracts with to take care of the plan’s members. Depending on the type of policy you buy, care may be covered only when you get it from a network provider.
When comparing plans in the Marketplace, you can find a list of providers in each plan’s network. If staying with your current doctors is important to you, check to make sure they are included before choosing a plan.
Tobacco users will pay a 50% surcharge for insurance, and there are no subsidies to offset this extra premium for tobacco use.
Visit www.healthcare.gov/marketplace to learn more about the different types of coverage, ask questions, and sign up to receive important updates and reminders.