To make sure you are up-to-date with the latest information on the pending marketplaces, I have assembled everything we know about the enrollment process, plan types, tax subsidies and cost sharing opportunities thus far.
Things are going to start to look and feel very different in the coming months, so it’s important to know what changes are coming and how they will affect you.
Open Enrollment
I have already touched upon the potential impact and consequences of open enrollment, however it’s so important I feel it needs stated again.
All individual and family health insurance plans in Ohio, will operate on an open enrollment schedule. That means you will have a specific time in which you are able to purchase, add to or change your coverage.
This system is vastly different from what we have now, currently you can buy an individual health insurance plan anytime you want and cancel it anytime you want.
When is Open Enrollment?
The federal and state run health insurance marketplace enrollment will begin on October 1, 2013.
If your application is finalized between October 1 and December 15, 2013 you will have an effective date of January 1, 2014. Your effective date is when your policy starts or takes effect.
If your application is finalized between December 16, 2013 and March 31, 2013 you will have one of two effective dates.
If your application is finalized between the first and fifteenth day of any month after December 15, 2013 your effective date will be the first day of the following month.
Example: If you applied for health insurance on February 12, 2014 your effective date would be March 1, 2014.
If your application is finalized between the sixteenth and the last day of any month after December 15, 2013 and before April 1, 2014 your effective date will be the first day of the second month after.
Example: If your application was finalized on March 23, 2014 your effective date would be May 1, 2014.
Plan Types and Medal Levels
There will be five different plan levels available to purchase through State and Federal Marketplaces, formally know as exchanges.
Platinum - Pays 90 percent of your health care expenses.
Gold - Pays 80 percent of your health care expenses.
Silver - Pays 70 percent of your health care expenses.
Bronze - Pays 60 percent of your health care expense.
Catastrophic plan - A lower cost health plan with limited benefits available to people under the age of 30 and to people with financial hardships.
Silver plans are the only plans, in addition to premium subsidies, that will also be eligible for cost sharing subsidies. More on that later.
It’s important to note, it’s possible for a company to offer more than one plan for each medal. Right now it sounds like insurance companies will slap the appropriate medal next to whatever plans qualify. That means, Anthem Blue Cross and Blue Shield could have two platinum, three gold, four silver and zero bronze plans. Medical Mutual of Ohio could offer three platinum, five gold, two silver and six bronze plans.
Premium Subsidy
While the medals are designed to streamline your available options, premium subsidies were created to make your health insurance more affordable.
To qualify for a premium subsidy you must have a household income somewhere between 100-400 percent of the federal poverty line.
Income Breakdown:
- Individual with annual income of $10,830 to $43,336
- Family of 2 with annual income of $14,470 to $58,280
- Family of 3 with annual income of $18,310 to $73,240
- Family of 4 with annual income of $22,050 to $88,200
Cost Sharing Subsidy
If your income is between 100 and 250 percent of the federal poverty line, you will qualify for subsidies to help pay your out-of-pocket costs. Simply put, the subsidy (only available on Silver plans, which cover 70% of benefits) will provide you with lower deductibles and copays.
Here’s a breakdown of the adjusted percentages after the cost sharing subsidies.
| FPL | Coverage |
|---|---|
| 100-150% | 94% |
| 150-200% | 87% |
| 200-250% | 73% |
It’s also important to note that, as part of the law, only a certain percentage of your income is allowed to make up your total cost for health insurance.
Here is a breakdown of how much of your income should go towards health insurance in relation to your position on the FPL.
- Up to 133% FPL - 2% of income
- 133-150% FPL - 3-4% of income
- 150-200% FPL - 4-6.3% of income
- 200-250% FPL - 6.3-8.05% of income
- 250-300% FPL - 8.05-9.5% of income
- 300- 400% FPL - 9.5% of income
If you want to calculate your exact tax subsidy eligibility you can do so here.
The Bottom Line
There are a lot of dates, percentages, and labels to keep track of as we move closer to health care reforms main event in 2014. You are going to want to make sure you know exactly when you can apply, what your options are and if you qualify for a subsidy.
If not, you run the risk of paying substantially more for your health insurance, or worse yet not being able to buy it period. If you want to check out what todays version of a health insurance marketplace looks like, you can do so here.
