Insurance Marketplaces Offer Options For Consumers Without Job-Based Coverage

But those who fail to enroll in insurance can face penalties and the loss of subsidies to help pay premiums. KHN’s Mary Agnes Carey and Julie Appleby discuss:

MARY AGNES CAREY: Welcome to Enrollment Encore: what you need to know before open enrollment in the health law’s marketplaces begins again on Nov. 15. I’m Mary Agnes Carey. Kaiser Health News senior correspondent Julie Appleby joins us now to talk about what consumers need to know about enrolling in the health law’s online marketplaces, or exchanges. Julie, we’ve heard so much about the individual mandate. What is that?

JULIE APPLEBY: Basically a penalty. If you don’t have insurance through your job and you don’t buy your own coverage, you get hit with a penalty. So this year, 2014, it was $95 or 1 percent of your income, whichever was greater. It’s going up in 2015, to 2 percent of your income or $325, whichever is more.

MARY AGNES CAREY: And there are these things called the health insurance exchanges, the online marketplaces. Who enrolls in those?

JULIE APPLEBY: Basically people who don’t get their coverage through their jobs can go on there and buy a plan. These are people who are self-employed, or they’re students or for some other reason don’t have health insurance through their jobs.

MARY AGNES CAREY: And if I can’t afford health insurance when I look at the exchanges, is there any help available to me?

JULIE APPLEBY: There is. There’s some subsidies available under the health law for people who earn between 100 and 400 percent of the federal poverty level. In dollars that’s about $11,670 for 100 percent up to $46,000 approximately for people who are at the higher end. Now remember, these folks still also pay a percentage of that premium. They pay a percentage of their income towards it but these subsidies help them with that premium.

MARY AGNES CAREY: For folks who enrolled last year on the exchanges, they’re being urged to go back on the exchanges and take a second look. Why?

JULIE APPLEBY: Policy folks say that’s because some plans are going to be more expensive this year. Some plans may be cheaper, so it’s worth it to check to see where the plan that this consumer’s purchased for this year, what it’s going to cost for next year. Will it be cheaper or is there something better that they could get? So they should shop around.

MARY AGNES CAREY: So they’ll have to look at things like their premium cost, their out-of-pocket costs, whose taking the plan and those sorts of things?

JULIE APPLEBY: All those things could change. So your deductible could change. The premium could change. The amount of subsidy you get could change. So all of those things have to be taken into account when shopping for a plan this year.

MARY AGNES CAREY: Thank you, Julie Appleby with Kaiser Health News.

JULIE APPLEBY: Thank you.

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