Individuals & Families

You may not have heard a lot about the “Marketplace,” but you will as we get closer to Oct. 1, 2013.

That’s when open enrollment (the time period during which you can apply for coverage) on the Health Insurance Marketplace begins. The Marketplace, sometimes called the Exchange, is an online forum where individuals can compare, shop and apply for health insurance. Tennessee, like all states, will have its own Marketplace. These Marketplaces are a requirement of the health care reform law passed in 2010.

In 2014, all individuals will be required to have insurance or pay a tax. People aren’t required to use the online Marketplace, but many will be eligible for federal subsidies and tax credits if they buy insurance through it.

Currently, an estimated 250,000 to 900,000 Tennesseans are uninsured. Health Insurance Marketplaces will give more people greater access to health insurance and wellness benefits.

By 2014 all states must have a Health Insurance Marketplace.

More People Are Eligible for Coverage

Health care reform provides greater access to health insurance in several ways.

  • If you are a young adult, you may remain on your parents’ health insurance plan up to age 26.
  • If your income is less than 138 percent of the federal poverty level – currently this is $15,856* for a household of one or $32,499* for a household of four – you may qualify for Medicaid coverage, which in Tennessee is known as TennCare.
  • Or, if you fall in that income level, purchasing an individual or family policy may become easier through the Health Insurance Marketplace. When you purchase insurance through the Marketplace, you may be eligible to receive tax credits and subsidies to lower the cost of the insurance premiums.
  • You are guaranteed coverage even if you have health issues or pre-existing conditions.
  • Employers and individuals will be required to purchase health insurance coverage or risk being fined.

*Figures based on 2013 Poverty Guidelines. 

Financial Aid for Lower-Income Individuals and Families

The Health Insurance Marketplace will offer financial assistance to low income individuals on a graduated scale.

  • People with incomes up to 250 percent of the federal poverty level – currently $28,725* for a household of one or $58,875* for a household of four – will be eligible for premium tax credits and help with out-of-pocket health care costs.
  • Those with incomes between 251 percent and 400 percent of the federal poverty level –currently $28,840* to $45,960* for a household of one – will be eligible for tax credits to make up for a portion of the premiums.
  • Tax credits are set at a fixed dollar amount. They won’t change based on the insurance plan or insurance company chosen.
  • During the purchase process, you can see your premium choices among all insurance carriers.

*Figures based on 2013 Poverty Guidelines. 

Marketplace Plan Options

Open enrollment (the time period during which you can apply for coverage) for the Marketplace is set to start Oct. 1, 2013. Individual Marketplace plans will be divided into four different levels – Bronze, Silver, Gold and Platinum.

All plans must cover essential health benefits. It is expected that a few plans will be offered by different insurance carriers at each level.

What can you do to prepare for open enrollment?

  1. Make a list of questions that will help you choose your health plan. For example, “Can I stay with my current doctor?” or “Will this plan cover my health costs when I’m traveling?”
  2. Make sure you understand how insurance works. Many people may have received insurance coverage through their employers, and others may not have been covered by insurance in the past. If you are unaware of how insurance works, you should seek information about insurance terms including deductibles, out-of-pocket maximums, copayments, etc. You’ll need to know these terms while you’re shopping around.
  3. Start gathering information about your household income. You’ll need income information to find out how if and for how much financial help you’re eligible. Your previous years’ income tax return is a good start.
  4. Set your budget. There will be numerous health coverage options, and breaking them down by cost can help narrow your choices.
  5. Find out from your employer whether they plan to continue to offer health insurance, especially if you work for a small business.
  6. Explore current options. You may be able to get help with insurance now, through existing programs or changes that are in effect already from the new health care law.

For example:

  • If you are a young adult, you can stay on your parents’ health insurance plan up to age 26.
  • You are guaranteed coverage even if you have health issues or pre-existing conditions.

Watch for More Information

We will continue to keep individuals informed of changes and updates to health care reform. Starting in October, you’ll have access to the online Marketplace. You’ll be able to enroll yourself, directly through the website, or call a toll-free phone hotline.

If you’re having trouble finding a plan that meets your needs and budget, BlueCross BlueShield of Tennessee will be available to give you personalized help with your choices.

Health Care Reform Taxes and Fees Impact You 

While health care reform will make health insurance more affordable for some, it is expected to increase premiums for others.

The Affordable Care Act’s fees and taxes are designed to fund the provisions of health care reform and help offset costs required to carry out the legislation. But, as a result, these taxes and fees are expected to drive up premiums for people covered under individual and employer plans.

To learn more about what’s driving the cost of health care, visit www.KnowTheCostTN.com. The website includes a section on Health Care Costs 101, how reform impacts costs and what BlueCross is doing to advocate for quality, affordable care.