RCT Online News

Affordable Care Act Basics and FAQs

By Chase Merrill

Outreach and Enrollment Specialist

Certified Application Counselor

Bear Lake Community Health Centers
 

(The Bear Lake Community Health Center provides a trained Navigator to help Rich County Residents sign up for the Health Insurance Exchange if they need help finding out about the different options available or need help with the online sign up.)

Under the Affordable Care Act, the Health Insurance Exchange or Marketplace was established. The Marketplace is a new way to shop for health insurance. There is greater transparency and increased competition, because all the insurance companies that are on the Marketplace are competing for business. All of the insurance plans offered on the Marketplace are provided by private, name brand insurance companies. Here in Cache County, there are four companies offering a total of 41 different plans on the Marketplace. The companies are Arches, Altius, Bridgespan (Regence), and Selecthealth. 
 

The insurance plans on the Marketplace are categorized into five different categories, called the Metallic Levels, which identify the amount of total cost-sharing between the insurance company and the consumer. The first category is the Bronze level. The amount of cost-sharing is 60% insurance company and 40% consumer. These plans have low monthly premium costs, but higher out of pocket costs on deductibles and copayments.

The second category is the Silver level. The amount of cost-sharing is 70% insurance company and 30% consumer. The next category is the Gold level. The amount of cost-sharing is 80% insurance company and 20% consumer.

The highest level is the Platinum level. The amount of cost-sharing is 90% insurance company and 10% consumer. These plans have the highest monthly premiums, but the lowest out of pocket costs.

The last category are the Catastrophic plans. Catastrophic plans have very low monthly premiums, but also have really high deductibles.
 

Some of the new basics that came about because of the Affordable Care Act are that insurance companies cannot deny anyone insurance because they have a pre-existing condition. All insurance plans provide free preventative care such as mammograms, needed vaccines, and colonoscopies. Men and women will be charged the same price for insurance. And all Marketplace insurance plans cover a set of Essential Health Benefits that include maternity and newborn care, hospitalization, ambulatory services, prescription drug coverage, rehabilitative and habilitative services and devices, emergency services, pediatric services including vision and dental, and laboratory services.
 

One of the biggest misconceptions about the new Health Insurance Marketplace is that anyone can get health insurance at any time. There are certain open enrollment periods that allow for enrollment on Marketplace insurance plans. The current open enrollment period goes until March 31^st, 2014. After March 31^st, 2014, there are only certain qualifying life events that allow for application and entrance into a Marketplace insurance plan. These qualifying life events include Loss of Employer coverage, Marriage, Divorce, Birth of a Child, Adoption, Gaining Lawful citizenship status, and Moving out of the State.
 

There are Premium Tax Credits available to help reduce the cost of monthly insurance premiums for those between 100% and 400% of Federal Poverty Level (FPL). The amount of Premium Tax Credits a family qualifies for is based on family size and gross annual household income, including the wages of working children. FPL for an individual is $11,490 to $45,960. FPL for a couple is $15,510 to $62,040, FPL for a family of four is $23,550 to $94,200, and FPL for a family of six is $31,590 to $126,360. Note: If you qualify for coverage through your employer, or have insurance coverage through your spouse’s employer, you will NOT qualify for premium tax credits. The only exception is if the annual amount you pay for your insurance is more than 9.5% of your gross household income, then you may qualify for premium tax credits.
 

If you have any additional questions, or would like to enroll in a Marketplace insurance plan, Chase Merrill is a Certified Application Counselor who works for Cache Valley Community Health Centers, is available to answer questions and to help you through the application process. Call 435-755-6061 or 435-363-5640 to set up an appointment.