By Alice Ronconi
Waymark Online Insurance Services
October 1, 2013 is the “opening” date of the state health insurance marketplaces required by the Affordable Care Act, commonly known as Obamacare. Fortunately for you, the Kansas Association of REALTORS® (KAR) has partnered with Waymark
Online Insurance Services to offer you a “one-stop” online marketplace to shop for health insurance plans which will include the options offered on the state health insurance marketplaces, and, if you qualify, obtain the subsidy from the federal government. Remember, if you do not have that qualified health plan (QHP) coverage by January 1, 2014, you could pay a federal penalty (in 2014 will be $95 per adult or 1 percent of adjusted family income, whichever is higher, and will increase to $695 or 2.5 percent of income in 2016).
Here are a few things to keep in mind as you work with your agent in determining what plan to buy.
There are 4 categories of QHP Marketplace insurance plans: Bronze, Silver, Gold, and Platinum. The categories help you choose a plan that’s right for you.
4 categories of Marketplace insurance plans
When you compare Marketplace insurance plans, they’re put into 4 categories based on how you and the plan can expect to share the costs of care:
• Bronze
• Silver
• Gold
• Platinum
All Marketplace insurance plan categories offer the same set of essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services by 2014.
The categories do not reflect the quality or amount of care the plans provide. The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your total out-of-pocket costs —the total amount you’ll spend for the year if you need lots of care.
Sources: www.healthcare.gov
Note: The Marketplace also offers “catastrophic” plans to people under 30 years old and to some people with very low incomes.
Balancing monthly premiums with out-of-pocket costs
As with all health plans, you’ll have to pay a monthly premium. But it’s also important to know how much you have to pay out-of-pocket for services when you get care.
• Premiums are usually higher for plans that pay more of your out-of-pocket
medical costs when you get care. For example, if you have a Gold plan, you’ll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
• With a Bronze plan, you’ll likely pay a lower premium, but you’ll pay a higher share of costs when you get care.
• Platinum plans will likely have the highest monthly premiums and lowest out-of-pocket costs. The plan will pay more of the costs if you need a lot of medical care.
• Some carriers in some states are severely limiting their provider networks in order to keep premiums down. This may end up with, e.g. one carrier’s gold plan being cheaper than a competing carrier’s bronze plan.
• In general, when choosing your health plan, keep this in mind: the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.
What to consider when choosing your plan
Think about the health care needs of your household when considering which Marketplace insurance plan to buy.
Do you expect a lot of doctor visits or need regular prescriptions?
• If you do, you may want a Gold or Platinum plan.
• If you don’t, you may prefer a Bronze or Silver plan. But keep in mind that if you get in a serious accident or have an unexpected health problem, Bronze and Silver plans will require you to pay more of the costs.
One other aspect that you should be aware of: the difference between a “private exchange” that offers health insurance plans and the “state and federal exchanges.” A perfect example is the program offered by the National Association of REALTORS®. This is an example of a private exchange, and its offerings are not eligible for federal subsidy, should you qualify. The program being offered through the partnership with Waymark Online Insurance Services will be eligible for federal subsidy, should you qualify, because it will be offering the health plans available through the federal and state exchanges.
Again, KAR has made this process easy for you by providing you a single, online location to obtain your mandated health insurance AND ensure that you will receive the federal subsidy, if you qualify. Visit www.insureksrealtors.com today or call 855-716-1114.
Sources: www.healthcare.gov
Your Kansas Association of REALTORS® has partnered with Waymark Online Insurance Services to help our Kansas members with your insurance needs, find out more here!
