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Health insurance marketplace – enroll now

By Mary W. Poole

Before Obamacare, healthcare premiums were too expensive for many families to afford. And even if you could afford it, insurance companies would deny coverage to anyone who had a pre-existing medical conditions, making it near impossible to get coverage if you weren’t 100-percent healthy. Obamacare, officially known as the “Affordable Care Act,” changed all of that. Now, by law, healthcare has become much more affordable and universally available. You don’t need a high income or perfect health to get insured. Obamacare can be very confusing – the law is over 1,000 pages long!

People have been overloaded with information, some of which has been inaccurate. Some government websites have also been limited in terms of ease of use and plans offered. All this has made it difficult for people to know their options, shop around, and enroll in the plan that is truly the best fit for their income and coverage needs. And delaying on getting coverage is not an option. A big part of the law states that if you do NOT have coverage, you will have to pay a fine, which has increased since last year. The fine is either

  1. a) 2.5-percent of your total income or
  2. b) fines for each member of your household ($695 /adult, $347.50/child) with no household limit. Who wants to pay hundreds and even thousands in dollars in penalties for not having insurance?

Things you can do to get ready to enroll

Explore the Marketplace. Visit HealthCare.gov to learn more about the Health Insurance Marketplace and programs you may qualify for. The Health Insurance Marketplace is a way to find health coverage that fits your budget and meets your needs. With one application, you can see all your options and enroll. You can apply for private insurance, Medicaid, or the Children’s Health Insurance Program (CHIP). Every health plan in the Marketplace offers the same set of essential health benefits, including doctor visits, preventative care, hospitalization, prescription, and more. You can compare plans based on price, benefit, quality, and other features important to you before you make a choice.

Ask your employer if it offers health insurance. Some employers will take advantage of the Small Business Health Options Programs (SHOP) to provide health coverage to employees. If not, you may need to get coverage through the Marketplace or other sources.

Make a list of questions you have before it is time to choose your health plan. For example, “Can I stay with my current doctor?” or “Will this plan cover my health costs when I am traveling?” This will help you as you compare different health plans. Insurance plans offered through the Marketplace are run by private companies. No matter where you live, you will be able to compare your health coverage options in the Marketplace and see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll.

Gather basic information about your household income. Most people using the Marketplace will qualify to save money. To find out how much you are eligible for, you will need income information like the kind you get on your W-2, pay stubs, or tax return.

Set your budget. There are different types of health plans to meet a variety of needs and budgets. You will need to figure out how much you are able to spend on premiums each month. Think about your health care needs. If you expect a lot of doctor visits, or need regular prescriptions, you might want a plan that has higher monthly premiums, but pays more of the costs when you need care so you pay lower out-of-pocket costs for each visit, prescription, or other medical service.

Do not delay, Open Enrollment for 2016 coverage began November 1, 2015 and ends January 31, 2016. Visit HealthCare.gov to get answers to your questions. You can also call the Health Insurance Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.

Mary W. Poole is Director Public Relations at Baptist Hospitals of Southeast Texas