October 1st is just around the corner, and there are still many questions that people feel have been left unanswered with regard to the Affordable Care Act. As of this coming Tuesday, Americans across the nation will be able to begin signing up for healthcare through the Health Insurance Marketplace. Although this is a federally-implemented system, some states are controlling the Marketplace for their residents, while others are being run by the federal government, so it’s important to find out which Marketplace is serving your area. You can click here to see who’s in charge of the Marketplace in your state.
The first thing you’ll need to do to enroll in the Marketplace is set up an account on the official website. After registering, you’ll fill out the online application, which requires you to submit personal information such as your income and household size, etc. Through the application process, you’ll have access to all of the options for which you qualify, so that you can do a comparison. Your results will display both private insurance plans and free/low-cost coverage through Medicaid and the Children’s Health Insurance Program.
The Marketplace website will let you know if you qualify for lower costs on your monthly premiums, or if you qualify for lower out-of-pocket costs on your insurance deductible, copayments and/or coinsurance. Your savings options depend on your income. If you’re an individual, you’re going to be entitled to a break if you make up to $28,725 annually. A family of 2 qualifies for lower out-of-pocket costs if they make up to $38,775.
Families of 3: $48,825
Families of 4: $58, 875
Families of 5: $68,925
Families of 6: $78,975
Families of 7: $89,025
Families of 8: $99,075
These lowered out-of-pocket costs only apply to Silver-tier plans (of the four categories in the Marketplace: Bronze, Silver, Gold and Platinum). The separate tiers differentiate in terms of the amount you have to pay versus how much your plan pays to cover your medical expenses. For a rough estimate of what you could expect to be paying for coverage through the Marketplace before October 1st, you can use the Kaiser Family Foundation calculator, but bear in mind that this calculator does not account for where you live, which will affect the cost of your coverage substantially.
There are several things you can do to prepare yourself for next Tuesday. You can start by collecting basic information about your household income, by collecting the W-2 forms, current pay stubs, or tax returns for everyone in your household. You can also set a budget for your health care coverage expenses, to determine how much you’re able to spend on your premiums each month. You can do some research to learn more about how your insurance deductible, out-of-pocket maximums, copayments, and coinsurance options work, so that you’re prepared when making your choices next week. HealthCare.gov also has a source to educate you on the different types of health coverage, so checking that out would be helpful as well. You should also ask your employer if it plans to offer health insurance in 2014, because if they’re not you may be at risk of being fined if you’re not insured by January 1st. There are existing programs that will provide coverage that starts prior to January 1st, 2014, which you can learn more about here.
There are local agents trained across the nation who are certified to help individuals understand the new health care coverage. Although they’re called by several names—navigators, application assisters, certified application counselors, etc—all of these brokers and agents are able to provide the same kind of assistance with your application process and information about your individual choices. LocalHelp.HealthCare.gov can help you find an agent in your area who can help.