Triage Health Insurance: New Options in 6 days!

Health Insurance Marketplace stacked logo

In just a few short days, there will be a new way to purchase health insurance in this country thanks to the Patient Protection and Affordable Care Act (ACA), through State Health Insurance Marketplaces.  These “Marketplaces,” sometimes referred to as “Exchanges,” will vary state by state but in every state there will be four main categories of insurance plans available to individuals, families, and small businesses (under 50 full time employee equivalents).  These four levels of insurance plans are named Platinum, Gold, Silver, and Bronze.  The main difference between these categories lies in how much the insurance company will pay, and how much the individual will pay for their medical expenses (otherwise known as a “cost-share”).

With the Platinum plan, you would pay 10% of your medical costs and the insurance company would pay for 90%.  With the Gold plan, you would pay 20% of your medical costs and the plan would pay 80%.  With the Silver plan, you would pay 30% of your medical costs and the plan would pay 70%, and finally, in the Bronze plan, you would be responsible for 40% of your medical costs and the plan would pay the remaining 60%.  In most states, you will have several different plans offered by from different insurance companies within each of these categories to choose from.

There is also a fifth category of plan called the catastrophic plan. These very limited plans will only be available to individuals under 30 years old and those who qualify for the financial hardship exemption from the individual mandate.

One of the benefits to purchasing a plan in the Marketplace, is that for all levels of plans there is a maximum annual deductible of $2,000 for an individual and $4,000 for a family plan.  It is likely that the Platinum plans will have lower deductibles, whereas Bronze plans will have higher deductibles.

Additionally, the ACA puts a limit on how much consumers are required to pay out-of-pocket for medical expenses (other than their premiums) when they purchase health insurance plans in the Marketplaces.  In 2014, the cap on these expenses is $6,350 and for a family the cap is $12,700.  After these maximums are reached, insurance will cover 100% of the medical expenses. These caps will help keep out-of-pocket costs to a certain amount and stem the tide of people having to declare bankruptcy because of their medical bills.

People who buy plans in the Marketplaces may also qualify for financial assistance to help them pay for their health insurance.  This financial assistance is based on income and family size.  For example, individuals who have incomes between 138% of the Federal Poverty Level (FPL) and 400% of the FPL premium (in 2013, $15,856 and $45,960) may be eligible for a premium tax credit.  This tax credit would reduce the amount you pay monthly for your premium.  In addition, individuals who have incomes between 138% of the Federal Poverty Level (FPL) and 250% FPL (in 2013, $15,856 and $28,725) will also be eligible for cost-sharing subsidies.  These subsidies will reduce the cost of health care expenses an individual or family has to pay when they receive medical care (e.g., lowering the co-payment you make when you visit the doctor’s office).  When you apply for a health insurance plan in the Marketplace, you will be asked to include some of your financial information – this is so the Marketplace can determine if you are eligible for any of these financial assistance options.

The Marketplaces will be open for business starting October 1, 2013, however, the earliest coverage will begin is January 1, 2014.  In order to have coverage start on January 1, 2014, you must purchase a plan by December 15, 2013.  For this first year, open enrollment in the Marketplaces will extend from October 1, 2013, through March 31, 2014.

For more information about what is happening in your state or to begin completing an application for health insurance, visit www.HealthCare.gov.

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