UPDATE: Open enrollment time is here again! Whether you've already got coverage through the Health Insurance Marketplace or are thinking about getting some, here are a few things to think about—and do—for 2015.
We’ve told you some reasons why the Affordable Care Act (ACA for short, a.k.a. Obamacare) is awesome for people who have insurance—but what about people who don’t? Things are looking rosier for them, too. If you haven’t been able to get health insurance because of the cost, here are three things we think you should know.
1. Insurance may be more affordable than you think.
The Health Insurance Marketplace (a.k.a. exchanges) is designed to make health insurance more affordable for more people. It allows you to fill out one application to see all the health insurance plans being offered in your area. That means you can compare and contrast plans to find one that best meets your needs. (Comparison shopping FTW!) And there’s more.
Subsidies: Many people will qualify for tax-credit subsidies to make the plans they find in the Marketplace more affordable. Anyone earning up to 400% of the federal poverty line ($46,000 for an individual or $94,000 for a family of four) will qualify for subsidies, though the less you earn (or the more dependents you have), the bigger the discount. Only folks who aren’t eligible for coverage through their employer, Medicaid, or Medicare will qualify for subsidies. Starting October 1, 2013, you’ll be able to see whether you qualify by visiting the Marketplace directly, but in the meantime you can get an estimate using the Kaiser Family Foundation’s handy “subsidy calculator.”
Medicaid expansion: About half of the states are taking advantage of the provision of the ACA that allows them to expand Medicaid to cover more people who weren’t eligible before—specifically it will cover anyone making up to 133% of the federal poverty level (a little over $15,000 for an individual). The Marketplace will allow you to find out whether you qualify depending on the current lay of the land in your state. Even if your state isn’t expanding Medicaid overall, 31 states have expanded Medicaid eligibility just for birth control coverage, so you could still qualify for that.
Catastrophic plans: Anyone under 30 years old will be able to buy a catastrophic plan through the Marketplace. It’s mostly what it sounds like—coverage kicks in if you have a health catastrophe, only after you’ve paid a deductible of a few thousand dollars. The upside is that monthly premiums are lower, so this could be a good option for folks who are young and healthy and just want worst-case-scenario coverage.
Plus, these plans will have a big bonus thanks to the ACA’s emphasis on prevention: Preventive care (including birth control!) will be covered just the way it is in other types of plans. That means if you buy a plan with a high deductible, your plan will cover birth control and other preventive services without requiring you to meet your deductible or pay out-of-pocket.
2. You can get the ball rolling today.
You can sign up for a Marketplace account now so you’ll be ready to go on October 1, 2013, when enrollment opens. You can also sign up for alerts about your state to stay informed as the enrollment period approaches.
If you’re planning to buy insurance through the Marketplace, now would also be a good time to look at this handy checklist of everything you’ll need in order to apply and make sure you’re ready with all the items on the list. The enrollment period lasts from October 1, 2013, until March 31, 2014, and plans purchased through the Marketplace may provide coverage as soon as January 1, 2014.
3. You don’t have to go it alone.
The Health Insurance Marketplace itself provides loads of useful information to help you through the process of getting health insurance. They offer a 24/7 hotline at 1-800-318-2596 (TTY: 1-855-889-4325) and a live chat option on their website, also staffed 24/7. All of their resources are also available in Spanish and they offer some resources (including their free hotline) in other languages as well.
The U.S. Department of Health and Human Services (HHS) has awarded grants to organizations to help people navigate the new Marketplace. You can also go to your local public library to get information about how to buy insurance through the Marketplace.
National groups like Enroll America and the Young Invincibles are great sources of information as well. Even pharmacy chains like Walgreens and CVS are doing their part to make sure their customers know about the opportunity to get insured through the Marketplace.
What’s this about a penalty if I don’t sign up?
There is a penalty for folks who choose not to get insurance, unless they can show that they can’t afford coverage. According to healthcare.gov, the fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. It’ll increase every year so that by 2016, the fee will be $695 per person or 2.5% of yearly income.
The choice between paying a fee and not having coverage when you need it versus paying for health insurance that covers birth control and lots more seems pretty clear. (And if money's an issue, birth control coverage alone may be reason enough to spring for insurance since pregnancy is expensive.) But we know making the decision to get covered is just the first step. So if you’re planning to get insured through the Marketplace, let us know how it goes! We want to hear your stories and help make the process easier if we can.