If you’ve been unable to get insurance either because of a pre-existing illness or high costs, the Affordable Care Act opens up new options.
Here are seven things you need to know:
As of Oct. 1, you can now shop for a private health plan on new online marketplaces. Insurers can’t reject you or charge you higher rates because of your health status or just for being a woman. You have until Dec. 15 to enroll for coverage that starts Jan. 1, though open enrollment runs through March 31.
Prices for coverage will vary dramatically across the country and even within states — just as they do now. If your income is between about $11,600, which is the federal poverty level for an individual in 2013 and four times that amount, or $46,000, you will be eligible for government subsidies to lower the cost of your coverage. How cheap is coverage? About 56 percent of those currently uninsured will have the option of choosing a plan that costs less than $100 a month, according to the early estimates released by the federal Health and Human Services Department.
In some cases, depending on where you live, your age and how poor you are, premiums may cost nothing. Here are some other examples: A 27-year-old in Los Angeles with an annual income of $30,000 may pay as little as $97. A 27-year-old in Chicago with an income of $25,000 a year could pay $96 a month. A 27-year-old in Jackson, Miss. could pay as little as $8 a month.
The websites will also help determine if you are eligible for Medicaid, the state-federal health insurance program for people with low incomes. The health law expanded Medicaid to cover everyone with incomes under 138 percent of the poverty level, or about $15,800. But only half the states enacted the change when it was made optional by the Supreme Court last year. To find out if your state expanded, click here.
To find the online marketplace in your state, go to www.healthcare.gov. To determine your options, you’ll need to enter your zip code, age, and in some cases, whether you smoke. You’ll also have to estimate your household income for 2014 to determine how much, if any, subsidy for which you are eligible. If you are eligible for a subsidy, the amount will automatically be deducted from the premiums you have to pay the plan each month. If people under estimate their 2014 income — and get a higher subsidy than they are entitled — they would owe money back to the federal government in 2015.
The subsidy gets reconciled when people fill out their income taxes in 2015. Once you’ve entered the information, the web-site will give you a list of plans in your area and their monthly cost. All the plans will be required to cover 10 essential health benefits, including hospitalization, doctor visits, emergency services, prescription drugs, maternity care and rehabilative services such as physical therapy.
If you want to know whether your doctor or favorite hospital is in a plan, the exchange will direct you to the insurer’s website to find out. Word of caution: The cheapest plans will likely have the fewest choices of doctors and hospitals.
Shopping for health coverage will be easier than it has been but it won’t be as simple as buying a plane ticket on Expedia. If you have questions, you can call the federal consumer hotline at 1-800-318-2596. Or to talk to specially trained navigator in your area, find one here. Or you can contact an insurance agent trained in the law.
The exchange is mostly for the uninsured, but others may benefit as well. If you have employer-based coverage, you may have no need to go on the exchange. But if your share of the premium costs more than 9.5 percent of your annual gross income, you may qualify for a subsidy. If you currently have an individual policy that you bought for yourself, you may find a better deal on the exchange because it offers subsidies that could lower your costs.