Finding your way through the Health Insurance Marketplace

Application phase for health plans runs Oct. 1 through March 31.

Americans have a new way to shop for health insurance with the Oct. 1 roll out of the Affordable Care Act’s Health Insurance Marketplace.

Each state’s Marketplace, sometimes called an “exchange,” can be found at HealthCare.gov. It essentially serves as a one-stop-shop where private insurers compete for your business, particularly if you currently don’t have insurance. You’ll be able to choose among health plans to find the one that best fits your needs and budget, from cheaper, high-deductible bronze plans to more expensive platinum plans.

Each plan, though, is required to cover so-called “essential” services, such as doctor and hospital visits, prescription drugs, and maternity and mental health care.

“It’s a new era in health care, the rise of the consumer,” said Scott Streator, vice president for CareSource’s Health Insurance Marketplace product line. “Employers have largely, though unintentionally, shielded the consumer from understanding the full cost of health care, and employees haven’t had the option of many choices in health plans. But now that’s changed with the advent of these health care exchanges.”

The nonprofit, CareSource, Ohio’s largest Medicaid managed care plan, is one of several health insurers offering health plans on Ohio’s federally run exchange.

How it works

The Marketplace primarily targets the uninsured and under-insured. If you already have health insurance and you’re happy with it, you don’t need to do anything, though you’re free to visit the website and examine your options.

Now through March, simply plug in your zip code at HealthCare.gov to arrive at your state’s marketplace and begin the online application. Most consumers will shop for a health plan under the individuals and families category.

You’ll click answers to a series of multiple-choice questions and provide information about your household size and income. You’ll learn about your eligibility for federal subsidies and tax credits, if you can lower costs on monthly premiums or qualify for lower out-of-pocket costs. You might learn you qualify for free or low-cost coverage available through Medicaid or the Childrens’ Health Insurance Program (CHIP).

The website allows you to select several plans and compare prices, benefits and premiums side by side before choosing and enrolling.

Information you need to apply

• Social Security numbers (or document numbers for legal immigrants)

• Birth dates of family members

• Pay stubs, W-2 forms or “Wage and Tax Statements”

• Policy numbers for any current health insurance

• Information about health insurance you or your family could get from your jobs

Small businesses

Click on “Small Business” to learn about the Small Business Health Options Program (SHOP). For 2014, the SHOP Marketplace is open to employers with 50 or fewer full-time employees. It will be open to employers with up to 100 full-time workers beginning in 2016. If you’re self-employed with no employees, you must use the individual marketplace, not SHOP.

For those using the small business program, you must offer coverage to all of your full-time employees — generally those working 30 or more hours per week on average.

According to the website, SHOP allows you to:

• Control the coverage you offer and how much you pay toward employee premiums.

• Compare health plans online on an apples-to-apples basis..

• See if you qualify for a small business health care tax credit worth up to 50 percent of your premium costs. You can still deduct from your taxes the rest of your premium costs not covered by the tax credit. Beginning 2014, the tax credit is available only for plans purchased through SHOP.

Estimated costs

A report released by the U.S. Department of Health and Human Services estimated Ohioans would have nearly 50 plans to choose from on the marketplace.

Four levels of plans will be offered — bronze, silver, gold and platinum — with the premium costs and the percent of medical expenses covered increasing as you go up. All plans cap annual out-of-pocket expenses at $6,350 for an individual, $12,700 for families.

Without tax credits, Ohio’s lowest-cost bronze plan averages $263 a month and the lowest-cost silver plan averages $304. The second lowest-cost silver plan — known as the benchmark plan — averages $321.

The report found that factoring in tax credits, a 27-year-old making $25,000 a year would see the premium for the benchmark silver plan drop to $145 in Ohio. For a family of four making $50,000, the tax credit would cut the monthly premium for the benchmark silver plan to $282.

But those rates will also vary by city. Rates for Southwest Ohio weren’t released by press time, but including tax credits the family plan will average $93 a month in Cleveland and $273 in Columbus.

An hour or less

The application process should take about 30 to 60 minutes. It’s designed to be easy to use, as “simple, clear and straight-forward a process as possible,” said Trey Daly, Ohio director for Enroll America, a nonprofit outreach group whose mission is to maximize the number of uninsured Americans who enroll in health coverage.

“We know that for a lot of folks this may be the first time they’ve gone through the process of selecting insurance for themselves and their families,” Daly said. “For others, they may have had these experiences (but without good outcomes.) The key message is the barriers between them and insurance in the past hopefully will be put aside.”

Having no insurance could cost you

If you don’t have health insurance starting in 2014, you could be fined. The fee in 2014 is 1 percent of your yearly income or $95 per person for the year, whichever is higher. The fee, to be paid when you file your taxes in 2015, increases every year. In 2016, it’s 2.5 percent of income or $695 per person, whichever is higher. The fee for uninsured children in 2014 is $47.50 per child. The most a family would have to pay in 2014 is $285.

Where to find more information and help?

Enroll America, Dayton-based CareSource, local social service agencies and others are canvassing Southwest Ohio, partnering with libraries, churches, community health centers, colleges and others to educate and enroll about the health care changes.

Here are some resources to find out more:

Consumer websites: HealthCare.gov and LocalHelp.HealthCare.gov; CuidadoDeSalud.gov; GetCoveredAmerica.org

National Marketplace Toll Free Call Center: 800-318-2596, open 24/7

The Ohio Association of Foodbanks: 800-648-1176 or send email to Navigator@ohiofoodbanks.org.

Butler County: Primary Health Solutions, 210 S. 2nd St., 2nd Floor, Hamilton; 513-454-1460

Clark County:

• Rocking Horse Community Health Center, 651 S. Limestone St., Springfield; 937-324-1111

• Health Partners of Western Ohio, 106 N. Main St., New Carlisle, 419-221-3072

Champaign County: Champaign County Department of Job and Family Services, 1512 S. U.S. 68, Suite N100, Urbana, 937-484-1500

Darke County: Family Health, 5735 Meeker Road, Greenville, 937-547-2326

Greene County: Greene County Department of Job and Family Services, 541 Ledbetter Road, Xenia, 937-562-6000

Warren County: Warren County Department of Job and Family Services, 416 S. East St.,

Lebanon, 513-695-1420

Miami County: Miami County Department of Job and Family Services, 2040 N. County Road 25-A, Troy, 937-440-3471

Preble County: Preble County Department of Job and Family Services, 1500 Park Ave., Eaton, 937-456-6205

Montgomery County:

• Community Health Centers of Greater Dayton, 937-586-9733

• Helping Hands Community Outreach Center, 4999 Northcutt Place, 937-268-6066

• CareSource, Community education representatives will be conducting sessions throughout Ohio to answer questions about the Marketplace, including Monday, Oct. 7, from 10 a.m. to noon at the Trotwood branch of the Dayton Metro Library, and again from 3 to 5 p.m. and 6 to 8 p.m. at the East (Dayton) Branch, 2008 Wyoming St.

Call 800-479-9502 or visit caresource.com for schedules and more information.

• Outreach and enrollment counselors from the Samaritan Homeless Clinic, in conjunction with Five Rivers Health Centers, will be at the following locations Oct. 1 to Dec. 20:

— Samaritan Homeless Clinic, 925 S. Edwin C. Moses Blvd., Dayton; 7:30 a.m. to 4:30 p.m. Monday and Thursday, 7:30 a.m. to 6:30 p.m. Tuesday and Wednesday, and 7:30 a.m. to 2:30 p.m. Friday.

— Center for Women’s Health, 1 Wyoming St., Dayton; 1 to 3 p.m. Mondays and 9 to 11 a.m. Thursdays.

— Family Health Center, 2345 Philadelphia Drive, Dayton; 9 to 11 a.m. Tuesdays, 1 and 3 p.m. Thursdays.

— Medical Surgical Health Center, 725 S. Ludlow St., Dayton; 9 to 11 a.m. Wednesdays, 1 and 2:30 p.m. Fridays.

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