Consumers flooded into the state health insurance exchanges that opened this week under the Affordable Care Act, temporarily tying up the system. Though the open-enrollment period runs until March 31, 2014, consumers may purchase plans now through Dec. 15 for coverage that will begin on Jan. 1, 2014.
Buying your own health insurance can be a confusing and time-consuming process. U.S. News & World Report's health insurance resource page offers information on plans available in each state, how to purchase one that best fits your family, and who to call or email if you need help. But there are still plenty of questions. Here is a list of the ones we hear most frequently, along with the answers you're looking for.
Q: What are the health insurance marketplaces?
A: Also known as the health insurance exchanges, the online health insurance marketplaces are where consumers can shop for and buy health insurance during open enrollment periods (the current one runs from Oct. 1 through March 31, 2014). The idea is to be able to compare health plan choices, determine if you are eligible for a tax credit (called a subsidy) to help pay for your plan, and find out if you qualify for Medicaid, the federal insurance program for the poor.
Q: What's a subsidy?
A: Subsidies are calculated on a sliding scale based upon annual income. If you are between 100 percent and 400 percent of the Federal Poverty Level (about $46,000 for individuals and $94,200 for families of four in 2013), you will be eligible for tax credits to help you pay for health insurance. This money is called a "subsidy" and it can be used to help you pay for monthly premiums. If you are at or below 250 percent of the poverty level, you will be eligible to receive help with out-of-pocket medical expenses. Beware, though, that if your income level goes up during the year, you may have to pay back some of this financial aid. For More Information: Some Families Could Be Forced to Repay ACA Subsidies.
Q: When can I sign up for health insurance?
A: For 2014, open enrollment began on Oct. 1 and ends on March 31, 2014. In 2014, open enrollment go from Oct. 1 through mid-December. To have coverage that will begin on Jan. 1, 2014, you must pay for your plan's first monthly premium no later than Dec. 15, according to Kaiser Health News.
Q: Do I have to buy health insurance?
A: If you are currently uninsured, then yes. Beginning on Jan. 1, 2014, all U.S. citizens will be required to have health insurance or pay a penalty. The penalty for 2014 is $95 per adult, $47.50 per child, $285 for families, or 1 percent of annual household income, whichever is greater. There are certain exceptions: religious affiliation, membership to an Indian tribe, citizens living abroad, and undocumented immigrants may not have to comply. And if you already have health insurance through your employer, you don't have to worry about buying health insurance now. For more information: Why Do I Need Health Insurance?
Q: Will I have to pay the penalty if I lose my job?
A: No. You may spend three months uninsured without a penalty if you lose your job.
Q: If I am buying my own insurance, do I have to buy an exchange plan?
A: No. You can purchase insurance on the exchange or in the private market. However, subsidies will not be available to those who purchase privates plans sold off the exchange.
Q: Does every state have an exchange?
A: Yes. Sixteen states and the District of Columbia are running their own exchanges, 27 states have federally operated exchanges, and 7 states have partnerships with the federal government to run the exchanges. To see what's available in your state, visit U.S. News & World Report's guide to health insurance.
Q: If I can get insurance through work, can I still buy an exchange plan?
A: Yes. However, you may not qualify for subsidies on the exchange unless your employer's health insurance plan costs more than 9.5 percent of your annual income, among other restrictions.
Q: I'm on Medicare. Do I need to buy health insurance before Jan. 1, 2014?