Transamerica Institute

Health Care Exchanges

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Health Care Coverage Information for Your State

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Exchanges are new health insurance marketplaces in each state.  Under the Affordable Care Act (ACA), every American must have insurance in 2014 and every year after that – purchased as an individual/family, through their employer, or through a government program – or pay a penalty when paying their federal income taxes.

If I do not have health insurance, where can I get coverage?

As of October 1, 2013 each state has a one-stop shop for health insurance, called the Exchange, where you can compare the different plan options and costs in one place. Depending on your state, you may use the Healthcare.gov website or a state-run website. If you do not have insurance through your job, individual coverage, or a government program, you can buy it in your State Exchange or seek other options in the traditional health insurance market. Many states have hired Guides, Navigators, or Application Assisters to answer your questions and can walk you through the entire sign-up process for the Exchange. You can find out how to contact these people on Healthcare.gov. 

Most states will allow you to apply for coverage online, by phone, or in person.  You will need your social security number (or document number if you are a legal immigrant), and employer and income information (paystubs, W-2 forms, and wage and tax statements).

This assistance is free-you do not need to pay a fee to get help signing up for the Exchange.  If you are asked to pay, you are not speaking with a state-licensed Guide, Navigator, or Application Assister.

 

When do I sign up?

The Open Enrollment period for 2017 health care coverage is November 1, 2016 to January 31, 2017. If you haven’t enrolled in coverage by then, you generally can’t buy Marketplace health coverage for 2017 until the next Open Enrollment period for coverage during the Fall of the following year.

If you don’t have health coverage during 2017, you may have to pay a tax penalty.  The fee will be calculated in two different ways – as a percentage of your household income, and per person. The  will be higher in 2017 than it was in 2016. In 2016 the fee was 2.5% of your household income ($800 for $40k) or $695 per adult/$347.50 per child, whichever is more. Final 2017 amounts will be published when available.

If you’re enrolled in a 2016 Marketplace plan, your benefit year ends December 31, 2016. To continue health coverage in 2017, you can renew your current health plan or choose a new health plan through the Marketplace during the 2017 Open Enrollment period.

Renewing your plan doesn’t require you to go through the whole application process again - many people will automatically be re-enrolled - you should receive a notice from your insurance plan explaining what you need to do to stay enrolled.

What are the enrollment and coverage start dates?

During Open Enrollment, if you enroll:

  • Between the 1st and 15th days of the month, your coverage starts the first day of the next month.
  • Between the 16th and the last day of the month, your coverage starts the first day of the second following month. So if you enroll on January 16, your coverage starts on March 1.

 

How much will it cost? Can I get help paying for insurance?

Cost will be determined by several factors, such as age, household income and size, geography, tobacco use, and how much insurance coverage is purchased.  Financial assistance is available in the Exchange for those who qualify (based on income) through a new tax credit called the Advanced Premium Tax Credit.  Some applicants will even be eligible (based on income) to have all of their premiums paid through this financial assistance after applying.

How do I pick a plan?

All major medical plans sold through a State Exchange cover 10 essential health benefits. These benefits include hospitalizations, emergency services, maternity and newborn care, mental health, preventive care, children’s services and more.  Individual and small group plans sold outside of the Exchange are also required to cover these 10 essential health benefits.

The prices of the plans vary. You can pick the plan that is best for you depending on how much care you need and what you can afford.

There are four basic levels of coverage in the Exchange: Platinum, Gold, Silver and Bronze. This ranking system is intended to make it easy to compare different health plans. As the metal category increases in value, so does the percentage of medical expenses that a health plan will cover. The health plans that cover more of your medical expenses usually have a higher monthly payment (premium) but you will pay less whenever you receive medical care (out-of-pocket costs).  Not all states offer four levels of plans, find information for your individual state using the drop down menu above.