6 Things I Know About the Healthcare Marketplace

6 Things About the New Healthcare Market Place

Two major things happened today.  The government shut down and the new healthcare Marketplace opened.  Two pivotal events on the same day in America, that’s nothing new to us westerners.  We learn to go with the flow and just complain about it on social media.  So this morning when I read on Facebook that the shutdown had happened I got up (yes I check my FB in bed…no judging) got ready for my day and left.  When I got to work we were being inundated with phone calls about the market place and how the shutdown would affect us (I work at a non-profit that gets federal funds), we got so many calls that I had to do a lot of research in a short amount of time.  Here are some of my findings.

The below three dates

A. October 1, 2013 (TODAY or yesterday, or last month) - The marketplace opens

B. January 1, 2014 – Health Insurance coverage can begin

C. March 31, 2014- Open enrollment ends

Don’t Rush to Apply

If you currently are currently insured either through your employer, Medicaid, Medicare or have Veteran Benefits you need not concern yourself with enrolling.  You can still go to the website, create an account and poke around to see if there are better deals out there. 

Sidenote: you can also see if you are eligible for Medicaid through the website. 

Ok, rush to apply

You can be charged a fee if you fail to obtain health insurance.  You can also receive help from the government through two different ways.  They can either pay you through a tax credit or they can pay the insurance company directly. They will not pay it all, but they will pay an ok portion.  Check out this calculator to find out how much in a subsidy you would be eligible for.

What Services are Mandated to be Covered?     

Preventative Care

Wellness Services

Mental/Behavioral Health

Laboratory Services

Chronic Disease Management

Pediatric Services including Oral Health and Vision

Substance Abuse Disorder Services

Maternity health & New Born Care

Hospitalization

Emergency Services

Ambulatory Services (inpatient & outpatient)

Laymen Terms Benefit Explanation

The days where insurance providers sent you a 500 page booklet with 9 point font explaining your benefits are GONE.  Under “Obamacare” providers MUST explain their benefits package in simple terms that can be understood easily.  They also must include a glossary of terms.  Looks like all that fine print is getting the heave ho. 

What Will Out of Pocket Costs Look Like

This will be different for everybody.  Your best bet is to get an estimate of costs by either making an account on the website or going to the Keiser Foundation’s page to calculate costs.  Important costs are your deductible, your co-insurance, (which is the portion you're responsible for after the deductible is covered) and your out-of-pocket maximum, (which is the maximum amount you pay each year before insurance kicks in and covers everything afterward).

There you have it, those were the six things that stuck out to me the most.  I hope this helps some in the crazy days ahead.