Shopping in the Affordable Care Act Health Insurance Marketplace

Health Care

The Health Insurance Marketplace open enrollment for 2014 lasted from October 1, 2013 through March 31, 2014, allowing uninsured Americans without minimum essential health coverage to purchase health insurance so that they could comply with the new health care law or face a penalty.

If you already had minimum essential health insurance through your employer, Medicaid, Medicare, or your parents, then you didn’t need to worry about the new health care reform law.

If you missed the deadline to purchase health insurance and don’t qualify for a special enrollment period or an exemption, you will be able to purchase health insurance for 2015 in the Health Insurance Marketplace during a new open enrollment period beginning November 15, 2014.

There are also some cases where you may be eligible for a special open enrollment period or an exemption from purchasing insurance and avoid a tax penalty on your 2014 taxes.

While it may have a different name in your state, the Health Insurance Marketplace is your one-stop shop for buying health coverage online. You may also be able to qualify for a discount on your health insurance when you purchase in the Marketplace.

It’s helpful to understand how health insurance works before getting started. A few terms you need to know before looking at plans:

  • Discount or Subsidy: The amount that the government contributes to help pay for your health insurance.  Under the Affordable Care Act, this discount, also known as a subsidy or the premium assistance tax credit, will help people who can’t afford it pay for health insurance.
  • Monthly premiums: This is a monthly fee you pay your insurance company for your plan, whether you use medical services or not.
  • Out-of-pocket costs: Any costs you pay before your insurance begins to pay its share. These include your deductible, copayments and coinsurance.
  • Benefits: All plans sold through the Marketplace provide the same essential health benefits, cover pre-existing conditions and offer free preventive services. But some plans offer additional benefits.
  • In-network/out-of-network:  Insurance providers will contract with specific “network” of doctors, hospitals and pharmacies. Different plan types have varying coverage for care you get inside and outside of this network.

Plans in the Health Insurance Marketplace are separated into five levels: Bronze, Silver, Gold, Platinum and Catastrophic as follows: 

Bronze

The bronze plan is the cheapest option with the highest deductible. Under the bronze level, your insurance will pay about 60 percent of your covered health expenses and you will owe 40 percent. The bronze plans also have the most basic coverage and a limited network of doctors and hospitals.

Silver

Silver plans have lower out of pocket costs than bronze but higher than both the gold and platinum. Under the silver plan, the health plan will pay about 70% and you will pay about 30% of your total average cost.

Gold

Gold plans split your costs 80/20. While gold plans cost a little more, you will have lower deductibles and out-of-pocket costs. The network of doctors and hospitals accepting these plans is much larger, and if you see a doctor outside of your plan’s network, you’ll most likely still have a portion of the services covered.

Platinum

Platinum plans have a much higher monthly premium, but it offers the richest coverage and the lowest out-of-pocket costs with a 90/10 split. Similar to the gold level, you have more options for doctors and hospitals in your network.

Catastrophic

Catastrophic plans pay less than 60% of your total average cost and are only available to those who are under 30 years old or have a hardship exemption.

TurboTax has you covered. Whether you qualified for special open enrollment or have more questions about the next open enrollment on November 15, TurboTax Health can help you understand how the new health care law impacts you and your taxes.

 

 

Comments (2) Leave your comment

  1. Well, TurboTaxBlogTeam, any ideas about internet security on these exchanges and what will the marketplace look like when most subsidies disappear ?

  2. Between the lack of security on the exchange websites and the likelihood that Halbig vs. Burwell will be decided in favor of what the law actually says (i.e., you can only get a subsidy if you are applying through an exchange set up by a State and not the Fed Gov’t), what does TurboTax think about health care insurance shopping with these realities in mind ?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s