Beginning in 2014, most people must have health insurance that meets minimum federal coverage standards or pay a tax penalty. Health benefit plans provided by your employer and most state or federal government health plans (Medicare, Medicaid, CHIP, TRICARE, and some veterans’ health programs) will usually satisfy the requirement.
If you don’t have access to employer or government-sponsored health coverage, you can buy an individual plan to cover yourself, and your family. Insurance companies can not deny you coverage or charge you more if you have a preexisting condition.
If you have to buy an individual health plan, you must buy it during an open-enrollment period.
This years under 65 open enrollment period will run from November 1, 2016 to January 31, 2017.
Rates and Premium Subsidies
Insurers may consider only three factors when setting your rates: your age, where you live, and whether you smoke or use tobacco products.
You might qualify for a subsidy to help pay for coverage. To get a subsidy, your income must be between 100 percent and 400 percent of the federal poverty level.
Subsidies are available only when you buy a health plan through the marketplace. You can not get a subsidy if you buy directly from an insurance company. Also, you are not eligible for a subsidy if you have access to affordable coverage thru your employer, spouses employer.
Health Plan Costs
With any type of health plan, you’ll have to pay some of the costs of your health care yourself. The following are some of the costs you might have to pay:
- Premiums.
- Deductibles.
- Copayments.
- Coinsurance.
Health Plan Benefits
Healthcare Reform (ACA) requreis plans sold to provide specific benefits for individual and small group plans. These are the ten essential health benefits.
The essential health benefits include coverage for health care services in the following categories:
- ambulatory patient services (outpatient care you get without being admitted to a hospital)
- emergency services (trips to the emergency room)
- hospitalization (including surgery)
- maternity and newborn care
- mental health and substance use disorder services, including behavioral health treatment (including counseling and psychotherapy)
- prescription drugs
- rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- laboratory services
- preventive and wellness services and chronic disease management
- pediatric services, including oral and vision care.
Specific health benefits can vary by state and insurance company.