Marketplace insurance: What you need to know

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Community

October 29, 2019 - 9:30 AM

The seventh open enrollment for the Marketplace Health Insurance Exchange opens Friday.

Until then, people can windowshop to preview plans and prices for 2020. For 2020, our area will continue to have Blue Cross Blue Shield of Kansas and Medica plans with the addition of Ambetter by Sunflower Health Plans to choose from.  

A few facts:

 

What 

• Open enrollment is the only time each year when people can sign up for Marketplace health insurance plans. 

The enrollment period lasts six weeks. Enrollment begins Friday and ends Jan. 1.

This week people can “windowshop” at healthcare.gov and review what type of plan is available under their circumstances and how much they would pay, if given discounts for their income and the number of people in their household.

 

Why 

• There are two main reasons people without employer insurance should consider buying plans on the exchange. 

One is that plans bought on the exchange are required to provide insurance for essential health benefits, including emergency coverage, mental health coverage and pre-existing conditions. The other is that nine out of 10 customers on the exchange qualify for a discount, and many of them qualify for such a high discount that their monthly premium is less than $100.

Those making between 100% and 400% of the federal poverty level may qualify for subsidies to assist paying for premiums and out-of-pocket healthcare costs if they do not have employer-based health insurance or employer- based family coverage. 

 

When 

• Open enrollment runs Friday through Dec. 15.

• Some people who have gone through a life-changing event, like losing employer health insurance, can get a “special enrollment period” allowing them to enroll outside the open enrollment window.

 

How 

• Start with the federal ACA sign-up website, healthcare.gov.

• Beware of some of the websites that come up on an internet search for “Obamacare” or “ACA,” because they may dupe people into thinking they’re the real Obamacare or ACA website. If going outside healthcare.gov, it’s important to deal with an honest agent or certified assister counselor to get the best plan. 

Unscrupulous sites might promote alternative plans that get a higher commission for the website or insurance agent, but can be more expensive for the client or deliver less protection than they thought. It’s healthcare.gov where the government is calculating what you really pay — including the all-important discount most applicants get after federal help.

 

Who 

• Healthcare.gov has a phone number with helpers, 1-800-318-2596. For Spanish speakers, the website is cuidadodesalud.gov.

• For in-person assistance, Kansas has Certified Application Assisters who are trained and certified individuals to help you apply and enroll in a health plan who are required to provide you with fair, impartial, and accurate information. 

• Private insurance agents who are reputable and have experience in health insurance can also be a resource for these plans.

• To find an assister or insurance agent who can answer your questions and assist with application and enrollment, visit healthcare.gov and click “Find Local Help.” You can also visit coverks.org to find Certified Application Counselors.

I am a Certified Application Assister for the Marketplace and a Medicare Senior Health Insurance Counselor for Kansas (SHICK) assisting with questions, applications, plan comparisons, and enrollment during open enrollment period. Please call 620-223-3720 or e-mail [email protected] if you would like an in-person appointment at one of our offices in Fort Scott, Erie, Iola, and Yates Center.

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