Obamacare’s health insurance exchanges are open for business.
Open enrollment begins today and continues through March 31 for the new Health Insurance Marketplace created through the Affordable Care Act, the federal health-care reform law commonly called Obamacare.
Under the law, most Americans are required to get health insurance or face a potential financial penalty when they file their taxes for 2014.
The marketplace, also known as an exchange, is a computerized system that will allow consumers and small businesses to compare plans and determine whether they qualify for financial help getting coverage.
Opponents, however, have continued to wage a political battle to try to get the next major stage of implementation killed or at least delayed.
Any potential government shutdown will not stop today’s launch of the Health Insurance Marketplace, said Gary Cohen, Centers for Medicare and Medicaid Services’ deputy administrator.
Political battles aside, Americans can start comparing their options today and decide what’s best for themselves and their families.
Here are a few details about what’s required and how the Health Insurance Marketplace is supposed to work for Ohio consumers:
Q: Under the Affordable Care Act, who needs to get health insurance?
A: Nearly all Americans who don’t have health insurance they purchase on their own, obtain through their employer or get from the government (Medicare and Medicaid) will face a financial penalty if they don’t enroll in coverage by Jan. 1.
People with religious objections, members of Indian tribes and people who are incarcerated aren’t required to get insurance coverage, according to the Internal Revenue Service. Those who would have to pay more than 8 percent of their household income toward insurance premiums or low-wage earners who aren’t required to file a tax return also are exempt from the requirement.
Q: Aren’t businesses required to offer their workers health insurance?
A: A requirement under the law that employers offer coverage to full-time workers — those averaging 30 hours or more a week — or face penalties has been delayed until 2015.
However, the Small Health Options Program, or SHOP marketplace, will be available through a government website — www.healthcare.gov — to let businesses with 50 or fewer workers shop for health insurance and potentially earn a small-business, health-care tax credit worth as much as 50 percent of the premium costs.
Q: What’s the penalty if I don’t get health coverage?
A: Penalties beginning in 2014 will be $95 per adult and $47.50 per child, up to $285 per family or 1 percent of annual income, whichever is greater, according to the Kaiser Family Foundation. Those penalties increase to $695 per adult and $347.50 per child, up to $2,085 per family or 2.5 percent of family income, in 2016.
Q: How does the new Health Insurance Marketplace work?
A: Ohio has opted not to run its own insurance exchange, so consumers and small businesses that want to shop for the new coverage options will need to use the federally run Health Insurance Marketplace online at www.healthcare.gov or by phone at 800-318-2596.
The federal government is approving in-person assisters, certified application counselors and “navigators” to help people find out information about their insurance coverage options and financial assistance for 2014.
Insurance brokers also can be approved to enroll people in plans.
Q: What kind of coverage will be available?
A: Plans in the marketplace are divided into four categories, based on the estimated percentage of the cost for the required benefits they cover. Bronze plans will cover an estimated 60 percent; silver, 70 percent; gold, 80 percent; and platinum, 90 percent.
Starting Jan. 1, all insurance plans in the marketplace must cover these “essential health benefits”: outpatient (ambulatory) care, emergency services, hospitalizations, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitation services, laboratory services and pediatric care, including dental and vision services for children.
The requirement also applies to plans that weren’t in existence before the federal law was enacted.
The list of approved insurers within the marketplace and details about plans available in each region aren’t expected to be available until the system goes live today, according to the U.S. Department of Health and Human Services.
Q: I can’t afford health insurance. Is there help available?
A: Tax credits might be available on a sliding scale to help purchase insurance through the exchanges for people with incomes up to 400 percent of the federal poverty level, or $45,960 for an individual and $94,200 for a family of four. Those earning 250 percent or less of poverty could also get help paying the out-of-pocket costs for care.
Workers who would pay more than 9.5 percent of their wages for coverage could qualify for subsidies to get coverage through the exchange, according to the Northeast Ohio Association of Health Underwriters. Those with available coverage that costs less are not eligible for subsidies through the exchanges.
Q: How much will these insurance plans cost?
A: Costs will vary, depending on the type of coverage selected. Typically, plans with lower out-of-pocket costs for consumers will have higher premiums.
Under federal law, plans won’t be able to deny coverage or charge people a higher premium because they’re sick or have a history of health problems. (Other nongroup plans sold outside the marketplace must follow the rules, too, unless they are considered “grandfathered,” according to the Ohio Department of Insurance.)
Insurers only will be able to consider family size, age, location and tobacco use when setting rates in the exchange.
A 27-year-old Ohio resident earning $25,000 annually will pay an average $110 per month for the lowest-cost bronze plan, including subsidies, according to a report released last week by the U.S. Department of Health and Human Services.
For an Ohio family of four earning $50,000 per year, the lowest bronze plan with subsidies would cost an average $156 per month.
Q: I already have health coverage through my job or from Medicare or Medicaid. Does the Health Insurance Marketplace affect me?
A: Under the federal law, government-run insurance programs, including Medicare and Medicaid, count as insurance coverage. There is no need to shop for coverage through the marketplace.
In most cases, health insurance offered by employers also counts as health coverage. However, people who pay more than 9.5 percent of their wages for coverage offered through an employee might want to check the marketplace to see whether it offers more affordable coverage options.
Q: What information do I need to apply for coverage and subsidies?
A: The federal government recommends having the following information available when getting ready to apply for coverage or potential subsidies through the marketplace:
• Social Security numbers (or document numbers for legal immigrants).
• Pay stubs or W-2 forms for everyone in the household who needs coverage.
• Policy numbers for current health insurance plans.
• A completed “Employer Coverage Tool” sheet, available online at www.healthcare.gov, to document information about any health plan offered by an employer, even if the employee doesn’t take the coverage.
Q: Where can I go for help?
A: Here are a few other places to get more information about the Affordable Care Act’s requirements for individuals and the new marketplace plans that are available with potential federal subsidies:
• The federal government is offering information, online enrollment and help applying for subsidies at www.healthcare.gov. People can also call 800-318-2596 to access the Health Insurance Marketplace.
• The federal government also is approving in-person assisters, certified application counselors and “navigators” to help with enrollment. A list of local resources is being updated regularly at https://local?help.healthcare.gov.
• The nonprofit Kaiser Family Foundation has a comprehensive website about health-care reform at http://kff.org/health-reform.
• A coalition of community groups led by the Ohio Association of Foodbanks is receiving a nearly $2 million navigator grant from the federal government to help statewide with the marketplace open enrollment. Call the Ohio Benefit Bank Hotline at 800-648-1176.
• AxessPointe Community Health Center has received a federal grant to help people find insurance coverage and apply for federal subsidies. The agency plans to offer community enrollment events starting later this month. Call 888-975-9188 for more information.
• Summit County Public Health plans to offer residents help enrolling in health insurance plans through the marketplace. Call 330-923-4891 and ask for help with insurance options through the marketplace..
• The Ohio Association of Health Underwriters has a website offering information about health-care reform for consumers and businesses at www.healthbenefitsohio.com.
• The Internal Revenue Service provides information about the requirement to get health insurance in 2014 on its website, www.irs.gov. Select the “Affordable Care Act Tax Provisions” link.
Cheryl Powell can be reached at 330-996-3902 or firstname.lastname@example.org. Follow Powell on Twitter at twitter.com/abjcherylpowell.