Each week over the new few months, TMA will answer the most frequently-asked questions. This week, TMA’s “Hey, Doc” education campaign explains the marketplace, why Texas patients who need insurance should care, and how they can get ready to sign up for marketplace insurance.
You can find each week’s Q&A and more information at Heydoc.texmed.org.
Q: What Exactly Is This Marketplace and Why Should I Care?
A: The ACA says most individuals must have health insurance as of 2014. So the law required that health insurance exchanges — or “marketplaces” — be established in every state as a way for individuals to buy 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 an insurance company. Or maybe you have a certain health problem 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.
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 inside or even outside the exchange must cover these services, and the insurance company 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, 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 also can find out right then and there if you can get a tax break on your private insurance premiums or if you qualify for state programs like Medicaid or the Children’s Health Insurance Program.
The time to sign up for plans offered in the marketplace is approaching fast: Open enrollment begins Nov. 15 for coverage beginning Jan. 1, 2015. Unless you qualify for an exemption under the federal law, you must get insurance or you could have to pay a fine.
Q: How Can I Get Ready to Sign Up?
A: You will have some decisions to make and important information to gather to sign up for health insurance coverage when the marketplace opens again on Nov. 15. But there are a few things you can do now to get ready:
- Learn about different types of health coverage so you know what kind of plan fits you or your family.
- If you already have a marketplace plan from 2014, you can keep your current one or shop around to change plans.
- Make a list of questions you may have before it’s time to choose a plan, such as whether you can keep your current doctor.
- Make sure you understand how coverage works, including things like premiums, deductibles, and copayments. This will help you determine what you have to pay and when. HealthCare.gov and BeCoveredTexas.org can help you understand these and other insurance terms.
- Gather information about your household income, for example, pay stubs, W-2 forms, or tax returns. You will need this information to determine what kind of plan you may want, and whether you qualify for tax credits or subsidies. When you enroll, you also will have to provide information on any insurance you currently have, such as policy numbers and employer coverage.
- Set your budget.
- Ask your employer if it plans to offer health insurance coverage in 2015. If not, you may have to find insurance through the marketplace or other sources.
Stay tuned for more answers to frequently asked questions about the Marketplace.