Health Insurance Marketplace

October 1st starts the beginning of the enrollment period for individuals to obtain health insurance through the newly launched Health Insurance Marketplaces, also known as Health Insurance Exchanges. The process of obtaining insurance through the Marketplace varies by state.  Since Missouri  opted out of setting up its own health insurance exchange, and Missouri will be using the federally facilitated Health Insurance Marketplace. How this will affect individual insurance options varies widely depending on how you currently obtain your health insurance.

Beginning in 2014, individuals are required to have health insurance through their employers or private insurance plans. Individuals who have been uninsured for more than three months in 2014 will be required to pay a fee for being uninsured. In 2014 the fee for being uninsured will be $95.00 per individual, or a percentage based on total income. This fee will slowly increase in 2015 and 2016. Individuals who obtain insurance through the Health Insurance Marketplace will not have to pay this fee as long as they sign-up for an insurance plan before the Marketplace closes on March 31st of 2014.

Obtaining insurance through the Marketplace is NOT required. Individuals insured through their employers or private insurance plans, obtained outside the marketplace, will meet the requirements for having health insurance as long as they were uninsured for less than three months in 2014. However, there are advantages to purchasing insurance through the Health Insurance Exchanges.

The Centers for Medicare and Medicaid Services estimates that 90% of currently uninsured individuals will qualify for discounted or free health insurance through the Marketplace. Individuals with incomes between 100% and 400% of the Federal Poverty Level (about $23,500-$94,200 for a family of four) will qualify for premium tax credits that help reduce the cost of monthly premiums. These tax credits can only be used if insurance is purchased through the Health Insurance Marketplace.  A variety of plans are available offering differing levels of coverage and monthly premiums.

When obtaining insurance through the Marketplace, individuals will first fill out a form discussing income and related information. This helps determine if an individual is eligible for premium tax credits or other assistance.  Once this is complete they will then browse the qualified health plans available in Missouri and select one that best fits their needs.

Sign-up will take place through the Health Insurance Marketplace website at HealthCare.gov, by phone 1-800-318-2596, or even by mail. Individuals requiring assistance in signing-up will have the option of using the phone and chat assistance available from healthcare.gov, or a variety of local organizations available for in-person assistance. Many local groups are currently undergoing the process of becoming Certified Application Counselors or Navigators who receive federal assistance to help enroll individuals in the marketplace. These groups will be available to assist individuals locally in signing-up for the Marketplace.

In the meantime, there are many resources available to find out more information about the Health Insurance Marketplace.

HealthCare.gov is the website for individuals to sign-up for insurance through the Health Insurance Marketplace. They currently have a large amount of information discussing how the Marketplace will work and who is eligible for insurance through the Marketplace.

Enroll Missouri was established by the Missouri Hospital Association and has information specific to individuals in Missouri who will be using the Health Insurance Marketplace.

Cover Missouri is a project by the Missouri Foundation for Health designed to keep individuals informed about the Marketplace. They post current news, resources and information about legislative issues associated with the Health Insurance Marketplace.

WebMD recently launched a guide and frequently-asked-questions section giving a general overview of how the Marketplace will operate.

The Institute of Medicine of the National Academies published a useful guide (opens as PDF) that attempts to explain the process in easy to understand language.