Health Insurance Marketplace: What You Need to Know

Health Care

Affordable Care Act, also known as Obamacare, created the online Health Insurance Marketplace so uninsured Americans can purchase health insurance and avoid a tax penalty mandated by the Affordable Care Act.

While the open enrollment season for 2014 closed on March 31, you may still purchase a plan if you qualify for a special enrollment period.

If you are uninsured and never bought a health insurance plan on your own, now is a good time to learn some basics about health care plans so come the new open enrollment period in November, you will be well equipped to make an educated decision.

While each state may have its own Marketplace, Obamacare mandates that all health plans cover the same set of essential health benefits, including maternity care, mental health services and prescription drugs.

Insurance companies are also required to cover pre-existing conditions and offer free preventative services.

But with so many plans to choose from, how do you know which one is right for your situation?

There is really no silver bullet here. When you are comparing plans, you are essentially trying to find a balance between how much you will pay each month (monthly premiums) with how much care you and your family will need.

For example, if you expect you will require a lot of health care next year, paying a higher monthly premium(low out-of-pocket expenses) will help you save more money in the long run.

On the other hand, if you are healthy and visit the doctor mostly for checkups, a plan with a low monthly premium (but high out-of-pocket expenses) may be a good option to consider.

So, in addition to comparing your monthly premiums (which you pay each month, whether or not you go to the doctor or buy prescriptions), you need to evaluate the potential out-of-pocket costs outlined in a plan. These include:

  • Deductible – the amount you have to pay for covered services before your insurance starts to pay.
  •  Copayment (copay) – a fixed amount you pay for certain health care services (copay can vary based on the type of services).
  •  Coinsurance – your share of the health care costs as a fixed percentage of the total charge.
  •  Out-of-pocket maximum – the most you pay before your plan starts to pay 100 percent.

You may also be eligible for a subsidy to help you pay for your health insurance if you purchase health insurance in the Marketplace.

To also help you navigate the Marketplace, all plans are separated into five categories: Bronze, Silver, Gold, Platinum, and Catastrophic.

Now that you know the lingo and understand your options, all you need to do is to match a plan with your anticipated health care needs.

If you have more questions about the Affordable Care Act, TurboTax has you covered. TurboTax Health is here to help you understand how the new health care reform law impacts you and your taxes.

 

 

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