Monday, September 16, 2013

Hey, Doc: What’s an Insurance Marketplace?

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next several years. Texas physicians and the Texas Medical Association have carefully studied the law to help you understand what the changes mean to your health care.

As the Affordable Care Act (ACA) continues to roll out, Me&My Doctor’s “Hey Doc” series will answer your frequently-asked questions, as well as some you might not have thought to ask.

Q. What exactly is this Marketplace and why should I care? 

A. The Patient Protection and Affordable Care Act (ACA) requires most individuals to have health insurance in 2014. So the law required that so-called health insurance exchanges—now referred to as marketplaces—be established in every state as another avenue for individuals to purchase private health insurance on their own. Most people get insurance through their jobs. But if you don’t have that option, you can shop in the marketplace instead of buying directly from insurance companies. Or maybe you have a certain condition that in the past prevented you from getting health insurance because it was too expensive or simply hard to get. Now you will have options in the marketplace.

Changes under the ACA also require that as of 2014, all individual and small group health plans must provide a minimum package of “essential health benefits,” which include a basic set of services like physician visits, hospital and emergency care, preventive services like vaccines and screenings, and prescription drugs. So any health plan you purchase in or even outside the exchange must cover these services, and they cannot deny you coverage because of a pre-existing condition.

Instead of having to search out health plans on your own, the marketplace is designed to be a one-stop-shop where you can go online to check out your coverage options in one place, get easy-to-understand information, and compare plans before you make a decision. Kind of like Orbitz or Travelocity, but for health insurance instead of travel. You can also find out right then and there if you qualify for a tax break on your private insurance premiums—another feature of the health reform law—or for state programs like Medicaid or the Children’s Health Insurance Program (CHIP).

The time to sign up for plans offered in the marketplace is approaching fast: Open enrollment is slated to begin Oct. 1 for coverage beginning Jan. 1, 2014. Unless you qualify for an exemption under the federal law, you must get insurance starting Jan. 1 or you could have to pay a fine.


Anonymous said...

If I live in Texas where can I go online to see the plans in the marketplace?

Martha said...

The government has not released the names of the insurers or the number of health plans that will be available on the federal exchange for Texas. Watch for information.

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