The Marketplace: Understanding Our New Healthcare Plans
Do you have insurance? Have you considered signing up for the Affordable Care Act’s Market-Place insurance plans? Believe it or not, a lot of people are confused with health insurance today. A lot of people are also angry at the fact that they may have to pay a fine if they don’t have coverage by January 2014. As a result, I will explain some of the basic details in hopes of clarifying your concerns.
Health insurance has become a very controversial, stressful, and unpleasant discussion for many people, including mental health professionals. If you are uninsured by January 1, 2014, you may be fined $95 per adult and $47.50 per child. The fee could also be based on about 1% of your income, which increases yearly. Open enrollment will end March 2014 until the next annual enrollment period. If you owe any penalties, they will be assessed and applied to your 2014 taxes. If your income is so low that you do not have to pay taxes or you receive social security disability and do not pay taxes, you will not be affected by this penalty.
There are 5 categories that you should be aware of as a consumer:
- Silver plan: This plan has a lower out-of-pocket cost than the bronze, but a higher out of pocket-cost than both the Gold and platinum.
- Bronze plan: This plan has a lower premium, but higher out-of -pocket costs.
- Platinum plan: This plan has the highest premiums, but lower out of pocket cost. This plan will pay more of the costs if you need a lot of care.
- Gold plan: This plan has a higher premium, but lower out of pocket costs at the doctor’s office.
- Catastrophic: This plan is available to individuals under age 30 or those with very low income. This plan has a very high deductible that must be met before the plan covers expenses.
Things to consider when applying for coverage
It is important to keep in mind that the higher your premium or monthly payment, the lower the out-of-pocket costs or costs you have to pay upfront. The lower your monthly payment or premium, the higher your out-of-pocket costs. It is also important to consider two things:
- How much medical or therapuetic care you need
- How much medical or therapeutic care you don’t need
When you look at the 5 categories above, consider your (or your loved ones) health condition and needs. Do you use healthcare services less than others? Do you see the doctor or your therapist every couple of months? Do you have a stable health condition or mental health condition? If so, you may benefit from the Silver or Gold plan, a plan that offers you low monthly payments (but higher out of pocket costs when you do seek services). On the other hand, if you need frequent services, see your therapist or doctor often, and have a chronic condition, you may benefit more from the platinum plan.
Any time you make healthcare decisions, be sure to do your research and ask questions before making any decisions. This is your healthcare or the healthcare of your loved one, you deserve to have your questions answered and your concerns clarified.
Applying for coverage
There are several steps you have to take to apply for coverage in your state:
- Provide basic information: Set up an account online to apply or call your local Marketplace number and request an application.
- Complete an application: From the looks of it, the application is the simple part. No worries here. Just have basic income information, your SSN, names of the applicant, home address, and other basics.
- Compare you options: You’ll be able to see your options and choose.
- Enroll in your new plan: Once you provide basic information and choose your options, you can enroll.
*Remember that you can still purchase many prescription medications through your local pharmacy at generic drug prices ($4, $6, $8).
For more information on the Marketplace plans in your state, visit Marketplace in my state. Click here for information on how the Affordable Care Act can affect Autism Spectrum Disorders. To calculate costs, click here. If you have questions and would like to chat online, call, or email, visit healthcare.gov or call 1-800-318-2596, 24 hours a day, 7 days a week.
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Healthcare.gov. (2013). What are the different types of health insurance? Health Insurance Basics. Retrieved from, https://www.healthcare.gov/what-are-the-different-types-of-health-insurance/.
Hill, T. (2013). The Marketplace: Understanding Our New Healthcare Plans. Psych Central. Retrieved on August 3, 2015, from http://blogs.psychcentral.com/caregivers/2013/10/the-marketplace-understanding-our-new-healthcare-plans/