Insurance Exchanges open for business

By Scott Theis, Managing Editor

On October 1, the health insurance marketplaces or exchanges opened to the public for the first time. Those unable to afford or qualify for quality health insurance plans previously now have a chance to buy insurance on these exchanges between October 1 and March 31 during the open enrollment period. Starting in 2014, everyone must have minimal health insurance or be fined by the federal government. Anyone under the age of 26 and who is currently a full time student still has the ability to get insurance through their parents. But for those who don’t qualify under those conditions or want supplemental coverage there are three ways to sign up for coverage: through the mail, online, or with the help of a certified enrollment Navigator.

The easiest way for our tech savvy generation to apply is to enroll online at http://www.healthcare.gov. It’s there you will be required to set up an account using an active email address to gain access to the exchanges. Then you will be able to enter all required information to find out what types of coverage you can receive and, more importantly, their cost. If you would like to get a general idea of what the cost will be without entering any private information, the website has a premium calculator tool. The premium calculator will not take detailed information to show you those prices and will not include any available price deductions through tax credits and other government help.

For those who prefer the help of an actual person through this process, you’ll need to find a certified enrollment Navigator. To find a Navigator in your area, visit http://www.localhelp.healthcare.gov. These Navigators will take you step-by-step through the enrollment process and will be able to answers all your questions.

Now, let’s go over what the plans cover. Every plan, other than what are called catastrophic plans, is required to cover the following according to the website: “ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment (which includes counseling and psychotherapy), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, pediatric services, including oral and vision care.” These services are covered for each of the four plans above catastrophic plans.

Now, there are five levels of insurance you can purchase on the exchanges: catastrophic, bronze, silver, gold, and platinum. The catastrophic plan is intended for young, healthy adults who do not need a lot of coverage. These plans are also referred to as high deductible plans because you will pay everything or nearly everything out-of-pocket until you reach your yearly deductible. Those deductibles start around $5,000 and can be upwards of $20,000. These plans are genuinely only so you can get in to see a doctor, get prescriptions for non-chronic or recurring illnesses, or so you’re covered in emergency situations. The other plans cover everything listed above and cover a certain percentage of your costs starting at 60 percent with the bronze plans, increasing by 10 percent with each level, up to 90 percent with the platinum plans. This means that you will pay the remaining 10-40 percent of your costs. And starting January 1, no insurance provider will be able to deny you coverage or charge you more for pre-existing conditions.

For anyone who is already covered by some type of insurance that meets minimal standards including Medicare, your parent’s plan, or insurance you get from an employer is not required to get any further coverage. The plans you purchase on the exchanges do not take effect until January 1 at the earliest.

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