Congress passed the Affordable Care Act (ACA) in March 2010. The ACA, also referred to as Obamacare, paved the way for uninsured Americans to purchase health insurance without the worry that they’d be denied or have to pay exorbitant costs because of pre-existing conditions. In some states, the state government set up a state-run exchange. In other states, like Arkansas, the state partners with the federally managed Healthcare.gov.
The Healthcare.gov marketplace went live in the fall of 2013. Since then, millions of Americans have applied for and purchased health insurance. In addition, many of them have received financial aid in the form of subsidies and tax credits to help offset the cost of health insurance. If you live in Arkansas and are interested in purchasing your own health insurance, be sure to study your options and apply during the open enrollment period. That’s the best way to find out what you’re eligible for and make sure you’re getting the best plan at the best price to you.
In 2015, five companies offered insurance plans through the exchange. These include:
- Ambetter of Arkansas (Celtic)
- Arkansas Blue Cross Blue Shield
- National Blue Cross Blue Shield Multi-State Plan (MSP)
- QCA Health Plan, Inc.
- QualChoice of Arkansas
In addition to individual plans, small business owners can purchase health insurance for their employees through the exchange. In 2015, only one insurance company offered plans for small business owners. That company is Arkansas Blue Cross Blue Shield.
Any plan offered in a state or federally run marketplace must offer 10 essential services. These services include:
- chronic disease care
- doctors’ visits and check-ups
- mental health services, including substance abuse recovery treatment
- emergency room care
- in-patient hospital stays and services
- outpatient treatments or tests
- laboratory services, as well as diagnostic imaging
- maternity care, including delivery and care for the mother and newborn
- pediatric care, including vision and dental insurance
- clinical rehabilitative services, including physical, speech, or occupational therapy
Prescription drug coverage is also mandatory with these plans. Children’s health insurance plans cover vision and dental insurance, but adult plans do not. If you would like either of these types of insurance, you can purchase them separately via the marketplace.
Five types of health insurance plans are offered through the marketplace. These plan types include:
- Bronze: A bronze plan pays 60 percent of your expenses. You’re responsible for the remaining 40 percent.
- Silver: A silver plan pays 70 percent of your expenses. You’re responsible for the remaining 30 percent.
- Gold: A gold plan pays 80 percent of your expenses. You’re responsible for the remaining 20 percent.
- Platinum: A platinum plan pays 90 percent of your expenses. You’re responsible for the remaining 10 percent.
- Catastrophic: People 30 and younger are the only individuals who can purchase a catastrophic plan. These plans are designed to be used only in the event of a medical emergency and pay less than 60 percent of your expenses.
Lower percentage plans, such as the bronze plan, have lower premiums, which means you will have higher out-of-pocket costs when you receive medical care.
Three factors are used to determine your health insurance premiums:
- Age: Older individuals will likely pay more for their insurance than younger people.
- Location: Even within states, regional differences determine how much a person pays for health insurance. Someone living two counties over may pay significantly more for their insurance than you pay for yours.
- Tobacco use: People who smoke or use tobacco products can expect to pay more for their health insurance than people who do not use tobacco.
If you’re curious about your estimated costs for purchasing a health insurance plan, the Kaiser Family Foundation has a Health Insurance Marketplace Calculator. Using basic information you provide the calculator, it can estimate how much you might pay in monthly premiums. It cannot tell you how much financial assistance you will qualify for, but based on your income information, it can indicate whether it thinks you may qualify for aid or not.
According to the calculator, a single 40-year-old nonsmoker from Arkansas who makes $45,000 a year can expect to pay $281 per month for a silver plan. According to the calculator, this person is not eligible for any subsidies or tax credits.
However, despite what the calculator suggests, the only way to know for sure if you qualify for any type of aid is to apply through the exchange.
You may be asking yourself, “Do I qualify for a health insurance subsidy?” You’re not alone. Many people who apply for health insurance want to know if they’re eligible for any assistance in paying for their health insurance plan.
Here is a breakdown for how financial aide is determined in the marketplace:
- Household income: Income is the largest factor. The marketplace uses the Federal Poverty Level (FPL) to determine your financial capabilities for paying for your insurance.
- Household size: The size of your family will impact how much you pay for your insurance. It will also impact how much financial aid you may be eligible for.
You may be eligible for one of these forms of financial assistance:
- Medicaid: Your income and household size may qualify you for a low-income health insurance plan.
- Lower monthly premiums: You may qualify for help paying your monthly premiums. This price will be deducted off your premium, and you will only pay the lower amount.
- Lower out-of-pocket costs: Your deductible, co-pays, and out-of-pocket maximum can be reduced if you meet certain financial criteria.
- Tax credits: Some folks may receive a tax credit each year to help offset the cost of their health insurance.
To enroll or to learn more about enrolling visit Healthcare.gov or call 1-800-318-2596. Doing so will help you find the answer to many questions you may have. You can also seek out a trained navigator who can help you apply and answer your questions as you go.
Most people see the cost of monthly premiums as a deterrent, but by buying insurance, you will avoid penalty fees and the financial distress that comes with being uninsured in the event of a medical emergency. No matter how healthy and fit you think you are now, being prepared with adequate medical insurance for the future is just a smart idea.