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Health Care Reform:

Health Insurance & Affordable Care Act

Your Guide to the New Insurance Marketplaces

continued...

Who cannot buy coverage there?

Immigrants who are in the country illegally will be barred from buying insurance on the exchanges. Legal immigrants are permitted to use the marketplaces and may qualify for subsidies if their income is no more than 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four.)

If my employer offers me insurance, can I shop on the exchange to get a better deal?

Even if your employer offers coverage, you can opt to buy a plan on the exchange. However, you may not be eligible for a subsidy unless you make less than 400 percent of the federal poverty level and your employer's plan covered less than 60 percent of allowed medical expenses or cost more than 9.5 percent of your household income.

If I am buying coverage on my own, do I have to buy it on the exchange?

Consumers can shop for coverage on or off the exchange. However, subsidies are generally available only for plans sold on the exchange. Also, adults up to the age of 26 have another choice: They often can get coverage through their parents' health plans.

How will the process work?

For someone with a computer, it's relatively straightforward. You can go online to Healthcare.gov or to your state-run exchange, if there is one, and create an account. Then you would fill out an application and provide information such as household size, location, income and citizenship status.

Then the exchange takes over. It first determines whether the person is eligible for Medicaid; if so, it will refer you there. If not, it will tell you how much of a subsidy you can receive. (These subsidies will be sent directly by the government to the insurer to pay a portion of the premium.)

After that, the exchange will offer a list of health plans and their premiums and out-of-pocket costs, including deductibles and co-payments. If a consumer decides to buy one of those plans, in most cases, you will be directed to the insurer's Web site to make the payment. In some jurisdictions, consumers will make their first premium payment to the exchange and then further monthly payments to the insurer.

Mon, Sep 16 2013

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