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Health insurance questions explained

  • Written by Briana Gerdeman, News Writer

October 1 was the first day to sign up for health insurance in Washington’s marketplace.

Health insurance marketplaces or exchanges are required as part of the Affordable Care Act, often called Obamacare, which requires almost everyone to have health insurance starting in 2014 or pay a penalty.

Here’s how to figure out whether you need to buy insurance and how to use Washington Healthplanfinder, the marketplace for Washington state.

The site, which is run by a public-private partnership, helps individuals and employers compare health insurance plans and find out if they’re eligible for tax credits or subsidies to make insurance cheaper.

Chrissy Yamada, senior vice president and chief financial officer for EvergreenHealth; Beth  Albrecht, vice president of the healthcare consulting group Aon Hewitt; and Bethany Frey, senior communications specialist for the Washington Health Benefit Exchange provided information.

How do I know if I need to buy insurance?

If you already have health insurance through your job or through Medicare or Medicaid, you don’t need to sign up for insurance through Washington Healthplanfinder. You already meet the ACA’s requirements for minimum coverage.

If you don’t already have insurance, you will have to buy insurance or pay a penalty.

What happens if I don’t purchase insurance?

Most people will have to pay a penalty fee if they aren’t covered by insurance. In 2014, the fee will be $95 per adult and $47.50 per child, up to a total of $285, or 1 percent of your household income  —  whichever is greater. The fee will increase every year until 2016, when it will equal $695 or 2.5 percent of your income.

Some people may be exempt from the penalty fee based on their income level or religious reasons, or if they are nonresident aliens or members of an American Indian tribe.

When can I sign up for insurance?

The enrollment period for 2014 began on Oct. 1, 2013 and lasts until Mar. 31, 2014. But even if you buy insurance now, coverage won’t begin until Jan. 1, 2014.

You might be eligible for a special mid-year enrollment period if your income, family size or job status changes mid-year. However, if you decide not to buy insurance and get sick or injured midway through the year, that’s not considered a "qualifying life event" that will allow you to buy insurance.

Beginning in 2015, the enrollment period will be Oct. 15 through Dec. 7 of the previous year.

How do I choose the plan that’s best for me?

"Really, it’s a decision of, do you want to pay now or pay later?" Albrecht said. "It’s just like buying car insurance. You’re determining how risk averse you are."

To estimate how much insurance coverage you’ll need for the upcoming year, you can check your past year’s expenses with your current insurance company. You should also take into account long-term conditions and one-time events like having a baby or having surgery.

All new insurance plans must cover 10 essential benefits, including emergency services, hospitalization, maternity and newborn care, mental health care, prescription drugs, preventive care and pediatric services. Beyond those benefits, policies might offer different coverage for different types of care.

The plans differ mainly in the amount of health care costs they cover. Platinum plans cover about 90 percent, gold plans cover about 80 percent, silver plans cover about 70 percent, and bronze plans cover about 60 percent.

Policies that cover a higher percent of costs usually have a higher premium (the amount you pay per month) but a lower deductible (the amount you pay before insurance starts paying.)

How do I buy insurance?

On Washington Healthplanfinder, wahealthplanfinder.org, you can compare different insurance plans.

You can search by entering your zip code and county, but if you enter your birthdate, sex and income, you can get personalized suggestions. The site allows you to compare different plans side-by-side and offers definitions and examples for important terms.

"It’s supposed to be very user-friendly," Frey said.

After you find a plan you want, you can make an account to enroll in the insurance policy.

You can also buy insurance from other carriers who aren’t on the exchange, but you won’t be eligible for a subsidy that could make insurance cheaper. If you have insurance through your job, you can also buy a different insurance plan through Washington Healthplanfinder, but you also can’t get a subsidy.

How can I get cheaper insurance?

If your income is less than 138 percent of the federal poverty level, you can be covered under Medicaid. That means a family of four with a household income of less than $32,499, or an individual with an income of less than $15,856 will qualify for Medicaid. You can find out if you qualify for Medicaid by applying for insurance on Washington Healthplanfinder.

If you earn less than 400 percent of the poverty level ($94,200 for a family of four or $45,960 for an individual), you can get tax credits to lower the cost of your monthly insurance premium. If you earn less than 250 percent of the poverty level ($58,875 for a family of four or $28,725 for an individual), you can get subsidies that will lower your out-of-pocket costs. But these benefits are only available if you sign up for insurance through Washington Healthplanfinder.

If I’m a business owner, how does the Affordable Care Act affect me?

Businesses aren’t required to insure employees, but starting in 2015, businesses with more than 50 employees that don’t offer "meaningful and affordable" insurance will have to pay a fee. Owners of small businesses (with fewer than 50 employees) who do offer insurance may be eligible for a 35 percent tax rebate, which will increase to 50 percent in 2014.

Even if business owners want their employees to have insurance, they could choose not to offer insurance, which might make employees eligible for subsidies on the exchange. The employer could increase employees’ compensation so they can purchase their own insurance.

"It might be that their employees get a better benefit from the individual market," Frey explained.

How can I find more information about health insurance?

Visit wahealthplanfinder.org to compare and buy health insurance, or call 1-855-WA-FINDER or 360-688-7700 to find out more. Through the Washington Healthplanfinder, you can look up "navigators," such as hospitals and nonprofit organizations, who are trained to explain insurance options. For more about the Affordable Care Act, you can visit healthcare.gov or kff.org.

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