Obamacare 101: Countdown To The Texas Insurance Marketplace | KERA News

Obamacare 101: Countdown To The Texas Insurance Marketplace

Sep 23, 2013

A week from today, Oct. 1, is a make-or-break moment for the Affordable Care Act. On that day, the health insurance “marketplace” opens for business. Because Texas refused to set up its own marketplace, the federal government will run the show here. And there are still a lot of questions — including how much insurance will cost. 

We won’t get an answer to that one until next Tuesday — so says Marjorie Petty, federal Health and Human Services director for Texas. But she did agree to answer several pressing questions.

Who’s eligible?

Petty points out that the marketplace will serve uninsured people whose incomes range from the poverty level to four times that much. For a family of four, that’s between $24,000 and $94,000 a year.

How does the marketplace work?

“A person can go online and look at a grid that lists all the Texas insurance companies and they can be assured that everyone is offering the same ten essential health benefits, ” Petty explains. “They can compare the premium choices that they have. They can also look and say I would rather pay a higher deductible and have lower premiums, or just the opposite, depending on what their individual healthcare situation is. There will be information on how much that premium would be depending on one of the four levels that the consumer might pick.”

[MORE: Obamacare 101: How The Texas Health Insurance Marketplace Will Work]

How are the prices determined?

“The price to the consumer will be influenced by the amount of their income. So, as you go into the marketplace on the computer and you enter your income and work through the questions on the application, it will be able to tell you how much of a subsidy you’re eligible for.  The lower your income, the higher the subsidy that will be available to help purchase insurance,” Petty says. “For those people that fall below that 100% level of poverty, they would not be required to have insurance.  They can get a waiver because of affordability.”

What’s the biggest challenge in getting the word out about these marketplaces?

“The biggest challenge really is the 18 to 34 year old,” Petty answers. ” And the reality of it is, it’s that group that actually has the highest incidence of accidental injury and death.  So, it is very important for young people to recognize how they can unexpectedly be affected by the need for health insurance and healthcare coverage.”

Take a look at sample premiums and subsidies on the Kaiser Family Foundation calculator.

What if I already have insurance?

If you have a health plan that meets minimum coverage requirements through your employer, or you are on Medicaid or Medicare, you comply with the Affordable Care Act and don’t need the marketplace.

What if I don’t want to buy health insurance as required under the Affordable Care Act in 2014?

Each uninsured person without an exemption from the law will pay a flat fee or a percentage of income each year, whichever is greater. In 2014, the penalty is $95 or 1 percent of taxable family income. It goes up to $325 or 2 percent in 2015; $695 or 2.5 percent in 2016.  After that, the flat fee will be adjusted for cost of living, but the share of family income will remain at 2.5 percent.

How do I apply for coverage on the marketplace?

Complete an online or application through a toll-free call center. You need pay stubs or W-2 forms; social security numbers for you and all members of household. And policy numbers if any members of household have health insurance.

Where can I get help?

The federal government has invested millions of dollars in grants to train people who can walk you through your health insurance options.  They cannot recommend plans, only explain.  They’ll work out of local health clinics, libraries, churches and other community organizations.  To find a “navigator”, go to healthcare.gov, click on the how do I get help button, and enter your zip code.

What’s the deadline for signing up?

Enrollment begins Oct. 1 and ends March 31, 2014.