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Health Care Reform:

Health Insurance & Affordable Care Act

Your Guide to the New Insurance Marketplaces

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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.

You can also fill out paper applications or apply over the phone. The federal and state exchange sites have toll-free numbers where consumers can find information about getting help in person.

Are exchanges the only place where I can get subsidized coverage?

Not exactly. Under a little-known rule proposed by the administration in June, consumers will be able to buy an exchange-approved plan - and receive a health law subsidy - from the insurance company itself rather than from the exchange.

I am on Medicare. Do I need to use the exchange?

No. Medicare is not part of the health insurance exchanges.   As a Medicare beneficiary, you can enroll in the program’s traditional drug coverage or in a Medicare Advantage plan, where Medicare enrollees get coverage through private health insurance plans, on Medicare.gov during the Medicare open season, which begins Oct. 15.

What about federal workers?

Most federal workers will continue to get their health coverage through the Federal Employees Health Benefits Program (FEHBP) and not be required to purchase coverage through the health law’s marketplaces. Members of Congress and their personal staffs, however, will be required to buy health insurance through the exchanges. 

A proposed rule from the Office of Personnel Management said the government would continue its practice of paying up to 75 percent of the premium, as it does for federal workers enrolled in FEHBP.  Members of Congress and their personal staffs will not be eligible for the health law’s subsidies and will purchase on the exchange in the state where they live, the agency said.

Mon, Sep 16 2013

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