The Health Insurance Marketplace will be the central hub of information for health insurance benefit plans, premiums, and financial assistance for individuals / families and small employers.
The Marketplace will open on October 1, 2013 and will offer coverage beginning January 1, 2014 with health insurance plans offered by private companies including BlueCross BlueShield, CoOportunity Health, Coventry, and Health Alliance. Delta Dental will offer dental plans. The health insurance plans offered “on” the Marketplace will also be available “off” the Marketplace. Other insurance companies will also be offering health and dental coverage “off” the Marketplace.
All health insurance plans (whether “on” or “off” the Marketplace) must comply with the Affordable Care Act. The benefits that are provided and the method of determining premium are mandated by the ACA.
Who Should Use the Marketplace?
Individuals who qualify for financial assistance must use the Marketplace to access the Premium Tax Credit or the Cost Sharing Reduction Subsidy. The Premium Tax Credit reduces your monthly premium. The amount you pay will be calculated as a percentage of your income. Any difference between the amount you pay and the actual premium is paid by the government. You may qualify for the Premium Tax Credit if your household income is less than 400% of the Federal Poverty Level. The 2013 FPL for a single person is $11,490 and for a family of four it is $23,550. The website of Families USA.org has a graph that provides more detail on the FPL. http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html.
You may also be eligible for the Cost Sharing Reduction Subsidy if your income is between 100% and 250% of the FPL. The Subsidy improves the benefits on your health insurance plan and reduces the out-of-pocket expenses that you will be responsible for. The Kaiser Family Foundation offers a Subsidy Calculator that estimates your eligibility for both financial assistance programs. http://kff.org/interactive/subsidy-calculator/
If your employer offers group benefits that are “affordable”, you may not be eligible for financial assistance. Affordable means that your share of the premium for employee only coverage is not more than 9.5% of your income.
Those who do not qualify for financial assistance may enroll in the plan of their choice either “on” or “off” the Marketplace.
Help!! What do I do now?
Policies owned by individuals and those offered through small employers will be modified to comply with the ACA when the policy renews in 2014. Insurance companies have begun sending information to policyholders about the changes that are coming for policies that renew on January 1, 2014. You need to know all of the options that are available to you.
Visit www.HealthCare.gov for an overview of the ACA and its impact on you. Contact your agent to find out what health insurance plans are available and to discuss your questions so that you can make the best decision for your health insurance coverage in 2014.
by Chris McPike, Vice President
ComPro