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.
By Lauren Birchfield Kennedy of the National Partnership for Women & Families.
Have you heard? As of today, there’s a new way to buy more affordable health insurance, because the new online insurance marketplaces are officially open! If you haven’t heard about these marketplaces—or if you have questions about what they are and how they work—keep reading.
Beginning in January of 2014, you will likely be required by law to have health insurance. For people who don’t already have health insurance, or who are looking for a new plan, state-based marketplaces will be the place to go to shop for quality, affordable coverage that meets their health needs—including guaranteed access to affordable birth control. And it’s easier than you might think to sign up.
So what is the marketplace?
The marketplaces are similar to an online store—like Amazon—where you can compare different products and choose the one that fits your budget and your needs. When it comes to a marketplace, the product it offers is health insurance. Each state will offer a marketplace, which will let you look at different health plans, compare them to each other, and see how much they cost. The website HealthCare.gov can direct you to your state’s marketplace, so don’t worry about finding it on your own.
Tell me more about the health plans I’ll find in my state’s marketplace.
The marketplace offers different levels of coverage to fit your needs and your budget. Plans are classified as Platinum, Gold, Silver, and Bronze based on how much the plan will pay for your health care and what services are covered, but every single plan covers essential health care services, including no-cost birth control.
The plans are guaranteed to meet certain standards.
Plans sold in state health insurance marketplaces are called Qualified Health Plans and they are guaranteed to offer quality coverage. In fact, they’re required to! To meet quality requirements and be allowed in the marketplaces, Qualified Health Plans must cover the essential health care services you need to stay healthy, at an affordable cost.
Qualified Health Plans are required to cover essential health care services, including:
Family planning visits
STI and HIV screenings
Cervical cancer screenings
Interpersonal violence screenings
In fact, some of these important services must be covered at no additional cost to you! If you buy a Qualified Health Plan, you won’t have a co-pay for your birth control and you won’t be forced to spend any extra money to see your primary care doctor or your gynecologist. And Qualified Health Plans won’t charge you more because you’re a woman, or exclude you from coverage because you have a pre-existing condition.
The plans are designed to fit your budget.
If your income is below a certain level, you may qualify for financial assistance to help cover the cost of your health insurance. That’s right—the government will help you pay for your coverage! There are two ways the government makes the plans in the marketplace more affordable for eligible people: (1) premium tax credits (a.k.a. subsidies) and (2) cost-sharing reductions. Premium tax credits decrease the amount you pay for your health plan each month. Cost-sharing reductions decrease the amount you have to pay out-of-pocket when you visit the doctor, go to the hospital, or fill your prescription. In short: financial help is finally here. The marketplace will help you find the plan that fits your budget and gives you the coverage you need.
The plans aren't "one size fits all."
When shopping in your marketplace, you’ll have lots of choices when it comes to picking the plan that is right for you. Knowing that when it comes to health coverage, there’s no "one size fits all," the marketplace offers Qualified Health Plans of different shapes and sizes. Every marketplace will offer several levels of health plans: Platinum, Gold, Silver, and Bronze.
The plan with the lowest monthly premium that still meets marketplace quality requirements is a Bronze plan. If you choose a Bronze plan, your monthly payment will be less, but you may pay more out-of-pocket when you visit the doctor or go to the hospital. If you choose a Gold or Platinum plan, your monthly payment will be more, but you’ll pay less out-of-pocket in co-pays or deductibles for every health care service.
Interested in signing up?
To enroll in a marketplace health plan, your first stop should be HealthCare.gov. HealthCare.gov will help you determine if you’re eligible to sign up for insurance in a state marketplace and direct you to where you need to shop. HealthCare.gov will also help you find out if you’re eligible for financial assistance to help pay for your insurance. Just by entering some basic income information, you can find out if you qualify for premium and cost-sharing assistance. You can count on this website to have the information you need to investigate health plan options and decide which one is right for you.
Well, that covers the basics. Now that you have a better understanding of how the marketplaces work, visit HealthCare.gov to learn more about the health plans that are available to you. You’ll be taking an important first step toward a full, healthy life. And remember—make sure you have health insurance by January 1, 2014!
Lauren Birchfield Kennedy is the senior health policy counsel at the National Partnership for Women & Families. Kennedy advises the National Partnership’s health policy agenda and oversees advocacy strategy for key policy priorities, including Affordable Care Act implementation and insurance market reform. She has an extensive background in women’s health policy and expertise in health programs serving lower income women, including Medicaid and the Title X family-planning program. Kennedy holds a law degree from Harvard Law School and a B.A. from UCLA. She splits time between D.C. and Massachusetts, all the while dreaming of her native California.