By Nancy Boyd, Director of Billing/RCM Operations, ClearlyMD.
Do you have questions about the marketplace health insurance plans? Here are some facts:
- In 2014, most Americans are required to have health insurance or pay a per-month fee on their taxes for every month they went without insurance coverage
- Open enrollment begins November 15th of each year
- No one can be denied coverage for health-related issues
- Marketplace is open to all Americans but no one is required to use it. Plans may still be purchased from private health plans or through a broker
- If you get insurance through an employer, you may still be able to use the marketplace to see if you are eligible for tax credits
- Plans cost less than 8% of your family income while most insurance obtained through an employer can cost up to 9.5%
- Premiums are based on income, age, tobacco use, family size, geography, and type of plan you buy
- Individuals and families earning less than 400% of the federal poverty level annually get cost assistance
- Small businesses with fewer than 50 full-time equivalent employees can use the marketplace to purchase insurance coverage for their employees
- 4 ways to apply: in person, by phone, paper application, or online
- Healthcare.gov is a one-stop shop to apply for coverage, compare plans, and shop for the best plan without having to use a broker
- By October 1, 2013, each state was required by law to have a new online marketplace where residents could buy health insurance. Most states will offer 5 tiers of plans- Catastrophic, Bronze, Silver, Gold, and Platinum. (Most are expected to purchase Silver.)
- Tennessee’s participating plans:
BCBST- offers PPO plans in the Bronze- Platinum tiers
Cigna- offers PPO plans in the Bronze – Gold tiers
Community Health Alliance- offers Catastrophic plans – Gold tiers
Humana offers PPO plans in any tier
- Mississippi’s participating plans:
Humana- offers PPO plans in any tier
Ambetter from Magnolia- offers HMO plans Bronze-Gold
- Other States participating plans:
BCBS is currently the only payer offering Multi-State Plans. Multi-State
options are curretnly offered in thrity states.
Insurers are allowed to phase in coverage, with 60% of the states in year one, 70% in year two, 85% in year three, and 100% in year four and each subsequent year.