Affordable Care Act Health Insurance Marketplace Open Enrollment

Issues: Health Care

On October 1st the Affordable Care Act Health Insurance Marketplace will begin open enrollment. This is an important day for all Americans. The Marketplace (sometimes known as an insurance exchange) is a new way to find quality health coverage and will help if you don’t have coverage now or if you have it but want to look at other options. With a Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll.

The place to begin is the Health Insurance Marketplace (https://www.healthcare.gov), where you'll fill out an application and see all the health plans available in your area. The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP).

If you are without access to the Internet, you can also apply for Marketplace coverage by mail or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat are available 24/7 at 800-318-2596 to help you complete your application. Both downloadable and paper applications will be available October 1st.

Insurance plans in the Marketplace are offered by private companies, but no plan can turn you away or charge you more because you have a pre-existing illness or medical condition. Once you have insurance, the plan can't refuse to cover treatment for your pre-existing conditions. Plans can't charge women more than men for the same plan, and many preventive services are covered at no cost to you.

Plans will also include an out-of-pocket maximum, which is the total amount you'll have to pay if you get sick. For example, if your plan has a $3000 out-of-pocket maximum, once you pay $3000 in deductibles, coinsurance, and copayments the plan will pay for any covered care above that amount for the rest of the year. The Affordable Care Act also does not allow for yearly or lifetime limits on spending, meaning that insurance companies can't put dollar limits on how much they will spend each year or over your lifetime to cover essential health benefits. After you've reached your out-of-pocket maximum, your insurance company must pay for all of your covered medical care with no limit.

There is also good news in the Affordable Care Act for women. Women won’t be charged more for health insurance just because of gender. Women can’t be denied coverage or charged more due to pre-existing conditions like cancer or pregnancy. Women can choose from any primary care provider, OB-GYN, or pediatrician in their health plan’s network without a referral and women will get free preventive care, including mammograms, well-woman visits, and contraception services.

And remember, depending on your income, you may qualify for other health coverage options, including Medicaid, which provides coverage to millions of Americans with limited incomes or disabilities. The Children’s Health Insurance Program (CHIP). CHIP provides coverage for children, and in some states pregnant women, in families with incomes too high for Medicaid but too low to afford private insurance. You may also qualify for lower costs for monthly premiums and out-of-pocket costs on private insurance based on your household size and income. Some people with very low incomes may wind up paying very small premiums — or no premiums at all.

As soon as you can, go to http://www.healthcare.gov and begin the process of ensuring health benefits for you and your family.

Finally, my staff and I are happy to offer assistance to you in dealing with any federal agencies. For example, I offer my help with Social Security and Medicare issues, military health care and benefits, and tours of the Capitol in Washington, D.C. If you have a son or daughter that is interested in serving in a military academy, he or she should contact my office during their junior year of high school. Please do not hesitate to contact me if I can be of service to you or your family. Thank you.