Things you should know about obamacare open enrollment
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.
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
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, Healthcare.gov 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
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 Localhelp.healthcare.gov
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
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
patients. This will mean increased financial pressures as well as greater stress with
medical billing and coding tasks.
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