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Things you should know about obamacare open enrollment


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The Obamacare open enrollment program has already started. This article gives an overall view on this program

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Things you should know about obamacare open enrollment

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  2. 2. Things You Should Know about Obamacare Open Enrollment The Affordable Care Act (ACA) insists most legal residents in the United States should obtain health insurance or pay a fine starting 2014. The Obamacare open enrollment program started October 1, 2013 and provides a great opportunity for uninsured Americans (around 48 million in 2012 according to a recent Census Bureau report) to enroll in a private health care insurance plan through Health Insurance Marketplace or Exchanges. The health care exchanges will not hold much significance for Americans who have job-based coverage and or are covered under Medicaid or CHIP (Children's Health Insurance Program). But for the rest, enrolling in a plan through an exchange will mean that they can get affordable care. One of the main benefits of enrolling in a private insurance plan from this state or federally run marketplace than outside is that the enrollee can get tax subsidies (for people with an income up to four times the federal poverty level, this year’s subsidy is $45,960 for an individual and $94,200 for a family of four) from the government for insurance premiums. The Marketplace can also help people find out whether they are eligible for free coverage available through Medicaid or the Children's Health Insurance Program (CHIP). With Obamacare, no health care insurance plan can deny coverage or charge extra fees on the basis of pre-existing health conditions. Earlier, insurance companies denied coverage and treatments or charged higher premiums from people who already have medical problems as it would cost more to cover them. The higher the risk of covering a person, the more reluctant was the insurer to offer coverage. From January 1, healthcare law will prevent insurers from refusing to cover people in poor health. For children under the age of 19, this protection began September 23, 2010. Obamacare has proved to be one of the most controversial legislations in recent time. The crux of the policy is that when health people purchase insurance, the money that insurers save on their coverage can be used to cover the costs of covering those who are older and ill, who will also be in the system. If you are among those who plan to purchase health insurance through a state or federally run exchange, here are some important things you should know: The Deadline for Enrollment The open enrollment period is between October 1, 2013 and March 31, 2014 and the plans bought within this period will not start until January 1, 2014. If you want your plan to start on January 1, the cut-off date for enrollment is December 14. Coverage for people who sign up in January or February will begin the following month. However, it is better not rush to enroll into an insurance plan. Take your own time and get expert advice to compare plans and find one which will meet your requirements and budget. Different Types of Plans There are mainly three types of plans – basic plan (bronze level), midrange (silver level) and higher-end (gold and platinum level). In addition to that, there is a catastrophic option which covers three doctor visits each year at no cost and preventive care including screenings and vaccines.
  3. 3. Regardless of the plan you buy from the marketplace, it would offer the same kind of benefits as well as free preventive care. There is no gender-based penalization for any plan. However, smokers may be penalized and some older people may have to pay more. Cost varies by plan based on where you live. Whatever be the cost, you would need to pay an amount as the monthly premium. You may also have a co-payment or be asked to pay a deductible when you see your doctor. Some plans like the catastrophic option will carry a higher deductible or some may have higher co-pays. However, almost all plans cap out-of-pocket costs to $6,350 and $12,700 per family. Tax subsidies and Medicaid eligibility can further reduce the monthly premium cost for an insurance plan. How Can You Enroll in an Insurance Plan through the Exchange If you have internet connection, go to the website, and click on the ‘Get Insurance’ tab. You will get a page as shown below from where you can go to the exchange in your state.
  4. 4. When you select your state from the dropdown list on this page, you are provided with information about the procedures to apply for coverage, compare plans and enroll. You can also check for Medicaid eligibility. If you do not have an internet connection, you can also enroll by mail. You can get assistance from call centers set up by government for open enrollment. Call the number 1-800-318-2596 (TTY: 1-855-889-4325) which is staffed aroundthe-clock and you can get required details in more than 150 languages. There are also specially trained advisers in communities, commonly known as ‘navigators’, to help you in person to enroll in a plan. Go to and enter your ZIP code. You can find the closest location from which you can access the navigators’ help. Moreover, you can view their address, phone number, e-mail address, website address, office hours, and details on which all ways they can help you. You can also make use of federally authorized marketplace-designated organizations based in community health centers, drug stores, churches and at the mall. Unlike traditional agents or insurance agents who can help you based on the state law, navigators and marketplace-designated organizations can give you general information about a plan as well as educate you on different plans. Their advice is absolutely free. If someone charges you a fee, then it is a scam. Exemptions from the Insurance Mandate Some American citizens are exempted from ACA’s insurance mandate as per Congress Congressional Budget Office. Unauthorized immigrants who have no right to receive Medicaid benefits and subsidies through insurance exchanges are exempted from this mandate. Others for who the mandate does not apply: • Those with a low income that does not require them to file tax returns • Members of federally recognized American Indian tribe who can receive services through an American Indian health care provider • Those for whom the cost of the insurance premium would be higher than a specified share of the income. People having certain hardships and religious beliefs that would conflict with the acceptance of insurance benefits are also exempted from the penalty. People in states where Medicaid is not expanded are also exempt. If you do not fall under these exempt categories, make sure you purchase a health plan by 2014. In 2014, the penalty tax will be 1% of you income, and will rise to 2% and 2.5% in 2015 and 2016 respectively. If you enroll in a health insurance plan through the health insurance exchange by March 31, 2014, you would not need to make the penalty for any month in 2014 before your coverage began. Open enrollment is also very significant for physicians. According to a recent news report, physicians across the country are getting ready to deal with newly insured
  5. 5. patients. This will mean increased financial pressures as well as greater stress with medical billing and coding tasks. About Outsource Strategies International Outsource Strategies International (OSI) is a leading medical billing and coding company offers quality medical billing and coding services that meet the unique needs of your healthcare practice. For more information on our services or an experiment with a no obligation Free Trial Analysis and follow up, call 1-800-6702809. To evaluate our quality, ask for our Free Trial offer.