Why Get Health Insurance in the State Marketplaces?

Pros and cons to buying health insurance on the new state marketplaces.

Health Insurance, Health Costs, Insurance Claim
By SHARE

The Affordable Care Act calls for everyone to be insured in 2014, and sets a financial penalty if you don't get insured. Some healthy people may weigh buying insurance (with a monthly premium) versus taking this penalty. A range of options is available in your state's official marketplace. Each state's marketplace offers plans that come with different amounts of coverage and benefits. Also, if your income falls below a certain amount, you can qualify for a subsidy on monthly premiums, which can help you afford a more expensive plan.

Go to U.S. News' state insurance guide for specific buying advice.

Consider these factors about whether signing up for health insurance via your state marketplace is right for you.

If you buy health insurance:

  • Any plan, even the cheapest on the market, is guaranteed to protect you to some degree against 10 kinds of medical costs, including hospitalizations, preventive care (like annual physicals and some vaccinations), emergency services, and prescription drugs.
  • The amount you pay for health insurance each month will no longer be based on your health status, or history of past medical claims.
  • You cannot be denied insurance for having a preexisting medical condition.
  • Plans cannot have a lifetime limit on coverage. Before the ACA, some insurers would stop covering you after paying for a certain amount of care.
  •  Even the least-expensive plan will cap your out of pocket maximum at $6,350 per year for an individual, or $12,700 for a family.
  •  Financial aid in the form of tax credits or subsidies may be available, depending on your income, and some consumers may qualify for coverage through Medicaid.
  •  Plans cannot cancel your coverage once you get sick, unless you commit fraud when you apply for coverage in the first place.

If you choose not to buy health insurance:

  • Delaying medical care can lead to health problems or hospitalizations that could have been prevented.
  • The federal government will penalize you for not being insured by 2014; this is the controversial individual mandate of the ACA. For 2014, the penalties are $95 per adult and $47.50 per child, up to $285 or 1 percent of family income, whichever is greater. The penalties rise each year. For more information about the penalties, click here.
  • You are not protected against the cost of medical bills if you get sick. A three-day hospital stay can cost $30,000 or more if you are uninsured.
  • Medical bills can significantly impact your budget. About half of uninsured people have trouble paying their medical bills.
  • You may have trouble buying medicines. About a quarter of all uninsured people couldn't pay for prescription drugs, compared to 14 percent of people on Medicaid and 5 percent of people who were insured through their employer, according to research from the Kaiser Family Foundation

About 30 percent of uninsured people delayed getting medical care in the last year due to the cost, compared to about 12 percent who were on Medicaid. The ACA addresses cost concerns by offering tax credits to offset the cost of monthly premiums, and subsidies to help pay out-of-pocket expenses. To see if you qualify, use our subsidy tool "What Plan Type is Right For Me?" on your state's guide.

More Information about Health Insurance:

TAGS:
health insurance
health care
health care reform
Affordable Care Act
Health Insurance Guide

Search the U.S. News guide to health insurance and Marketplaces in all 50 States.