The Health Insurance Marketplace: A Primer
What is it? Created by the Affordable Care Act, the marketplace is a website — HealthCare.gov — where people can shop for health coverage offered by private insurance companies. On it, consumers can learn whether they qualify for federal tax credits or government insurance.
Who can shop on it? The short answer: Anyone. However, the marketplace is mostly aimed at people who don't get insurance through their employers — think students or the self-employed. Individuals who get insurance through their employer may shop for marketplace plans but they won't qualify for special tax credits if their employer-based coverage is considered "affordable" by the federal government.
So what's considered "affordable" coverage? A worker's share of the premium for employer-provided coverage can't cost him more than 9.5 percent of his annual household income.
What insurance companies are offering plans through the marketplace? Nine companies are offering marketplace plans in Georgia, up from just five insurers last year. They are: Blue Cross and Blue Shield of Georgia, Alliant Health Plans, Kaiser Permanente of Georgia, Peach State Health Plan, Humana, Assurant Health, Cigna, Coventry and UnitedHealthcare.
When can you start shopping? Right now. The open enrollment to buy 2015 coverage through HealthCare.gov started Nov. 15 and runs through Feb. 15. Some people may be able to sign up outside of that time period if they've experienced certain life events, such as a death in the family, a divorce or a birth.
Source: Staff research
***
I need help!
Don’t know the difference between a deductible and a co-pay? Never even heard the term “co-insurance”? Don’t worry, you aren’t alone. Here are a few places — although in no way is it a comprehensive list — where you can go to get your questions about health insurance and the marketplace answered.
Online: HealthCare.gov provides answers to a host of questions about open enrollment. Consumers can also shop insurance plan benefits and prices for 2015 without having to fill out an application. The nonprofit Kaiser Family Foundation also has a wealth of resources for consumers, including health insurance basics, at its site kff.org. eHealthInsurance.com provides a host of basic insurance information, as well as helps connect people with plans inide and outside of the marketplace.
Over the phone: If you can't find what you need online or just find a human voice more reassuring, you can get help over the phone from the HealthCare.gov folks 24 hours-a-day by calling 1-800-318-2596.
In person: Local health insurance brokers and agents remain a key resoure for individuals and businesses trying to make sense of dozens of health plan options and figure out which fits their particular needs. A new group of helpers called "health insurance navigators" were also created under the health care law to work one-on-one over the phone or in person with consumers who need help. Contact information for the two main groups offering navigator help in Georgia are Seedco at 1-855-899-6092 and Community Health Works at 1-866-988-8246.
Source: Staff research
***
BY THE NUMBERS
The Marketplace in Georgia
316,000 Approximate number of Georgians who signed up for 2014 marketplace coverage
87 Percentage who qualified for financial assistance
71 Percentage who chose silver plans
57 Percentage who are women
31 Percentage aged 18 to 34
Source: U.S. Department of Health & Human Services
***
Qualifying for financial help
A majority of Americans who bought marketplace plans for 2014 qualified for federal tax credits to help shrink monthly premiums. The credits are available for individuals who aren’t offered “affordable” employer-based insurance and who have incomes from 100 to 400 percent of the federal poverty level. Here’s a look by family size and income ranges of who may qualify for 2015.
Family of one, $11,670-$46,680
Family of two, $15,730-$62,920
Family of three, $19,790-$79,160
Family of four, $23,850-$95,400
Family of five, $27,910-$111,640
Family of six, $31,970-$127,880
Family of seven, $36,030-$144,120
Family of eight, $40,090-$160,360
Source: Families USA
***
Get insured or pay the price
The Affordable Care Act requires most Americans — including probably you — to have health insurance. Those who don’t and aren’t exempt, such as the very poor, will have to pay a penalty come tax time. And the penalty is getting bigger.
2014: $95 or 1 percent of a person's applicable income*
2015: $325 or 2 percent of applicable income
2016: $695 or 2.5 percent of applicable income
For each year beyond, the penalty will be adjusted for inflation.
* Applicable income is the amount of income that surpasses the tax filing threshold used to calculate the penalty.
Source: U.S. Department of Health & Human Services
***
Individual mandate exemptions
You may not face a penalty if you:
- Were uninsured for less than three months of the year
- Had a lowest-priced coverage option that would cost more than 8 percent of your household income
- Didn't have to file a tax return because your income is too low
- Are a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
- Are a member of a recognized health care sharing ministry
- Are a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
- Are incarcerated (either detained or jailed); does not include people being held pending disposition of charges
- Aren't lawfully present in the U.S.
- Qualify for a "hardship exemption," such as being homeless, filing for bankruptcy in the last six months or don't qualify for Medicaid because your state didn't expand the program. (Georgia didn't.) A full list of exemption reasons is at HealthCare.gov.
Source: U.S. Department of Health & Human Services
***
Key open enrollment dates
Nov. 15: Open enrollment for 2015 marketplace coverage begins
Dec. 15: The last day to enroll for coverage that starts Jan. 1
Dec. 31: All 2014 marketplace coverage ends, no matter when you enrolled
Jan. 1: 2015 marketplace coverage starts if you applied by Dec. 15, or if you accept automatic enrollment in your 2014 plan or a similar plan
Feb. 15: The last day to enroll in 2015 marketplace coverage. After that, you can't sign up for a health plan inside or outside the marketplace for the rest of 2015 unless you qualify for a "special enrollment period." *
* Enrollment in Medicaid or PeachCare is open year-round.
Source: U.S. Department of Health & Human Services
About the Author
