“The Affordable Care Act and Your City"

Purchasing Insurance through the Healthcare Marketplace: What You Need to Know

 

(Note:  Reprinted from the National League of Cities.)

The Affordable Care Act (ACA) is bringing changes to the way health insurance will be provided to many Americans. As October 1, 2013 (the date open enrollment begins) draws closer, people are likely asking their local elected officials how they can obtain health insurance through the ACA.

The answer is not as complicated as one may think.

To answer this question, local officials will need to know if the person is employed full-time, and if their employer provides them with health insurance.

If the answer to both questions is yes, then there is nothing more they need to do.  They have insurance, and for them nothing will change, other than possible improvements in the quality of their insurance.

If they are not employed or are employed but don’t have insurance, direct them to HealthCare.gov, the official government website for the ACA.

In case they want more detailed information, there are a few things local officials should know. Here are the steps for obtaining insurance through the Healthcare Marketplace:

1. Create an account.

The first step is to create an account. Individuals will need to provide some basic information, including name, address, age, number of family members, and then choose a user name and password, and provide answers to a series of security questions.

2. Apply for insurance.

Starting October 1, 2013, every individual or household that does not have insurance and has created an account will be asked to provide information that will enable the Healthcare Marketplace to determine which coverage is most appropriate, and how much it will cost.

Those who want insurance will have to provide information about income, information on their children and other dependents, information about their employer, and proof that they are an American citizen or in the United States legally.  

Income is perhaps the most important information, because it will determine how large or small of a federal insurance subsidy that an individual or their household will receive, and therefore, how much the insurance coverage will actually cost.  The ACA has very clear guidelines about the percentage of income individuals will be required to pay for insurance, and anything above that amount is likely to be paid through a federal subsidy.

3. Review the options and pick a plan.

The third step in this process will be for residents to review their available insurance options, compare benefits and cost, including co-pays and drug benefit plans, and select the plan this is most appropriate for them or their households.  The Healthcare Marketplace will allow everyone who uses its services to do side-by-side comparisons of health care plans.

4. Sign up

The last step will be to actually sign up for the insurance plan of choice.  Once this is done, individuals and households will have insurance.  Everyone who signs up for insurance between October 1, and December 31, 2013, will be insured as of January 1, 2014.  Those who enroll between January 1, and March 31, 2014 will have insurance starting in the month after which they signed up.

For now, a few more facts:

  • Consumers can begin enrolling in new health plans on October 1, 2013. This enrollment period will extend through March 31, 2014, and applies to employer provided health insurance as well as individually purchased health coverage. Coverage for plans enrolled in before December 31, 2013 should begin on January 1, 2014. For those enrolling in January or February of 2014, expectations are that coverage will begin the month following enrollment.
  • In 2014, and subsequent years, open enrollment will begin on October 15 and end December 7.  Coverage for enrollments during this time will begin on January 1st of the following calendar year.
  • Actual enrollment in a qualified health plan can be performed at the Healthcare Marketplace, through an insurance company, or through an insurance broker, depending on state and federal law.
  • Not all states have elected to set up their own Healthcare Marketplaces.  As of August 6, 2013, 16 states and the District of Columbia have decided to establish state-based Healthcare Marketplaces.  The remaining states will still have Healthcare Marketplaces, but they will be operated by the federal government.  (Note:  The Texas marketplace will be operated by the federal government.)  Individuals who enter their state’s Healthcare Marketplace through the HealthCare.gov portal or directly through their state’s website will not be able to tell if their state has its own Healthcare Marketplaces or is relying on the federal Marketplace.

For more information, you can see the National League of Cities toolkit by clicking here, or on their website at:

http://www.nlc.org/media-center/news-search/the-affordable-care-act-and-your-city-%E2%80%93-toolkit-and-webinar-for-elected-officials.

 

TML member cities may use the material herein for any purpose. No other person or entity may reproduce, duplicate, or distribute any part of this document without the written authorization of the Texas Municipal League.

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