White Paper – Health Insurance Marketplace

A Guide

Step 1: Decide if the Marketplace is for you

  • The marketplace is designed for individuals, families and small businesses who are not otherwise covered.
  • If you are already covered through a job, Medicare or Medicaid, you do not need to apply.

Step 2: Apply for coverage
You can apply in one of four ways.

  • Online at HealthCare.gov
  • By phone at 1-800-318-2596
  • With in-person help from a trained assister, agent or broker
  • With a paper application

Step 3: Choose the best plan for your health care needs

  • The marketplace makes it easier than ever to compare plans.
  • The cheapest, and suggested, plans appear first in the list.
  • This comparison is based off your personal information, so ensure that it is accurate!

Step 4: Enroll in coverage

  • After selecting a plan, the company will contact you. You must pay your first month’s
  • premium to be considered enrolled.
  • Important deadlines are as follows:
    • Coverage starting January 1st: enroll by December 15th
    • Coverage starting February 1st: Enroll by January 15th
    • Coverage starting March 1st: Enroll by January 31st
Frequently Asked Questions

1. What is the Health Insurance Marketplace?
The Health Insurance Marketplace is not really a “place” at all. It is a tool designed to help individuals and small businesses compare and enroll in coverage at the best price for their specific health needs.

2. Who needs to enroll in coverage through the marketplace?
The Marketplace is designed for individuals, families and small businesses who are not otherwise covered. Individuals already covered through a job, Medicare or Medicaid do not need to apply.

3. How does the marketplace work?
The marketplace creates a central network where private insurers compete for the business of participants. The idea is to lower overall healthcare costs for participants by comparing all available offers, selecting a plan that suits their specific coverage needs, and how much they are willing to pay for it.

4. What if I am a Medicare beneficiary?
Medicare is not part of the Marketplace. Individuals with Medicare are considered covered. The Marketplace does not offer supplemental (Medigap) coverage or Part D drug plans. Medicare beneficiaries can compare coverage options at Medicare.gov.

5. When do I need to apply on the Marketplace?
Family insurance plans offer coverage to up to age 26. After age 26, coverage can be found through a job, school or Marketplace plan. Loss of coverage, such as leaving a job individuals for a special enrollment period up to 60 days after the event wherein they can apply for coverage outside of open enrollment period.

6. What do the levels of coverage mean?
There are 5 levels of coverage detailed in the table below. Generally premiums increase with increased insurance payment.

  • Catastrophic Plan: Insurance Payment, 0%; Beneficiary Payment, 100% until deductible met
  • Bronze Plan: Insurance Payment, 60%; Beneficiary Payment, 40%
  • Silver Plan: Insurance Payment, 70%; Beneficiary Payment, 30%
  • Gold Plan: Insurance Payment, 80%; Beneficiary Payment, 20%
  • Platinum Plan: Insurance Payment, 90%; Beneficiary Payment, 10%

7. What are the important deadlines during the open enrollment period?
Deadlines

  • November 1st: Open enrollment begins - 1st day 2016 plans are available
  • December 15th: Last day to enroll for coverage starting January 1st
  • January 15th: Last day to enroll for coverage starting February 1st
  • January 31st: Last day to enroll for coverage starting March 1st, end of open enrollment

8. What is the penalty for not enrolling in health insurance?
A fee will be charged for uninsured individuals when they file their federal tax returns. The fee will be equal to 2.5% of household income or $695, whichever is higher, per adult or $347.50 per child under age 18 in 2016.

9. What if I am already insured through the marketplace and miss the December 15th deadline?
If no action is taken during the open enrollment period, the participant will be reenrolled in their previous plan automatically most likely. This is often not the best choice because failing to update income and household changes may result in higher premiums or coverage without meeting requirements.

10 . Where can I go for more information?
All this information, and more, is available at www.HealthCare.gov.

Prepared by:
Tyler Page
PharmD Candidate 2016
UMKC School of Pharmacy