Health Insurance Marketplace

As part of the Affordable Care Act, the Health Insurance Marketplace opened for enrollment on October 1. The marketplace will allow anyone to purchase coverage through a variety of different insurance companies, with reduced cost options available for low income families.

Open enrollment: October 1, 2013 – March 31, 2014
Coverage begins: January 1, 2014

Applying for Coverage

The first step to finding a plan is to set up an account and fill out an application. In North Carolina, the marketplace is being run by the federal government, so enrollment is through Healthcare.gov. Other states are running their own marketplace and have individual websites. The application will gather information about your family size, income, current health coverage, and more. After you complete the application, you will be able to see all the plans that you qualify for, including any free or reduced options. Once you compare the plans and choose the right option for your family, you can enroll and decide how you would like to pay your monthly premiums.

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How to Choose a Plan

If you decide to purchase insurance through the marketplace, it’s important to assess the healthcare needs of yourself and your family to make sure you pick the right plan. All plans are put into one of four levels based on the coverage offered: bronze, silver, gold, and platinum. Bronze and silver plans will have a lower premium (monthly cost), but your out-of-pocket expenses could end up being high if you need a lot of medical care or prescriptions throughout the year. Gold and platinum plans will have a higher premium, but the insurance company will cover more of the cost for services throughout the year. It’s hard to predict what your future healthcare needs will be, but those who are healthy and need little care are usually better off with a lower-premium plan, and those who need lots of medical care throughout the year are usually better off with a higher-premium plan.

Find out more about choosing the right insurance plan.

Also, consider the following questions when you are choosing a plan:

  • Do you need frequent checkups throughout the year?
  • Do you have an illness or condition that could require major procedures?
  • Do you take lots of prescriptions?
  • If you have lower coverage and a major medical issue comes up, will you be able to afford the out-of-pocket expenses?

How Much Will You Pay?

How much you will pay for health insurance depends on many factors, including income, family size, and the type of coverage that you need. Families or individuals below certain income levels will be able to pay lower rates for monthly premiums and out-of-pocket expenses. You or your child might also be eligible for free or reduced coverage through Medicaid or the Children’s Health Insurance Program. If you do not qualify for any free or reduced costs, you can still pay the standard price to get insurance coverage through the marketplace.

Special Notes

It’s important to remember a few key notes about the new health insurance marketplace:

  • Everyone is eligible to buy insurance on the exchange, regardless of pre-existing conditions.
  • All plans will cover essential health benefits.
  • Everyone who can afford it is required to have health insurance by 2014, whether it is through the marketplace, private insurance, Medicare, Medicaid, or other means. Those who do not have coverage by 2014 will have to pay a fee of $95 or 1% of their annual income, whichever is higher.

Need help? There are many sources of help right here in Johnston County. Click here and enter your zip code to find out where you can get in-person help or online and phone assistance to apply, choose a plan, and enroll.