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Shop the Market Place for Better Health

April 18, 2013

BETTER  HEALTH  IS  NEAR!

This article, written for the April 2013 issue of AARP Monthly Bulletin by investigative journalist, Marsha Mercer, is a synopsis on upcoming Insurance Exchanges. She uses the term “Marketplace”  rather than “Insurance Exchange.”

“Millions of Americans will shop for health insurance in a new way starting October 1, 2013 when online Insurance Exchanges, or Marketplaces, open for business in every state.

While most workers will still get insurance through their jobs, and people 65 and older will still be covered by Medicare, these new virtual shops will offer insurance plans to small employers and people who buy their own insurance, including those who previously could not afford insurance or were denied coverage because of pre-existing health conditions. The exchanges could be a lifeline for many older Americans. ‘People 50-64 have had the most trouble of any age group finding coverage, especially if they have pre-existing conditions,’ says Sarah Dash of the Georgetown University Health Policy Institute.

Consumers now will be able to compare private insurance plans and purchase coverage that begins January 1, 2014.

People also will be able to (discover) online if they are eligible for Medicaid or a tax credit subsidy to help pay their premiums. The Exchanges are not open to Medicare enrollees. Every state, plus the District of Columbia, must have an Exchange – although these Marketplaces have been a hot political issue for states – which has several options: (1) Operate the Exchange out right, (2) Run it in partnership with the federal government or (3) Let the federal Department of Health and Human Services (HHS) run the show.

At press time, half of the states (25) had decided on federal Exchanges. 18 announced state run exchanges, and eight plan to work in partnership with HHS.”

Her article continues, “States, many with leaders who oppose the health care law, preferred having the federal government deal with this huge new undertaking. Oklahoma was placed in this category by the governor.

‘For consumers using an Exchange, however, it really shouldn’t matter whether yours is run by the state, the feds or a partnership

,’ says Jenna Stento, a manager in the health reform practice at Avalere Health, a healthcare policy consulting firm.

Health plans will vary by state, but in each state four levels of coverage will be offered; bronze, silver, gold and platinum. All plans will offer a core package of 10 essential health benefits, including hospitalization, prescription drugs, mental health, rehab care and preventive services. Each state will set essential benefits equal to what’s covered in a typical employer plan in that state.

The health law limits how much a person pays in premiums as a percentage of income. Singles with income up to $45,960 and couples with combined incomes of up to $62,040 in 2013 may be eligible for tax credits. The income limit for 2014 has not been set yet. The Exchanges are expected to enroll about 7 million people in 2014 and 24 million by 2016, according to the Congressional Budget Office.

‘The intent is to simplify the process of selecting a plan,’ 

says Linda J Blumberg, an economist at the Urban Institute’s Health Policy Center.

‘The Exchanges and reforms in the law carry a lot of advantages for older adults; flexibility, financial assistance, more options than they have ever had before,’

she says. ‘And,’ she adds, ‘they can make the decision whether to be self-employed, retire early or change jobs without worrying about access to health insurance.’

 

Toll-free phone numbers and humans will be available to help you navigate the system, and the government has a checklist for help at  healthcare.gov/marketplace.

Someone who chooses not to buy health insurance will pay a tax of $95 or up to 1% of income, whichever is greater, in 2014. The tax rises to $695 or 2.5% of income in 2016.”

Common sense declares, “Shop the Marketplace for better health!”

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