Research Guides: Understanding the Affordable Health Care Marketplace

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Are You Covered?
Health Insurance Marketplace Logo

The new Affordable Care Act requires you to have health insurance. If you do NOT have health insurance of your own or with your parents, you must sign up prior to January 1. (You can be covered under your parents' insurance plan until 26 years of age; check with their plan provider.)
 
Starting on October 1, there will be a marketplace to allow you to select a plan you can afford.  Go to http://www.healthcare.gov and complete the application. This one application will allow you to see available plans and their cost; as well as apply for the expanded Medicaid program. Failure to enroll by January 1 may result in a penalty, unless you qualify for an exemption

Continue reading the information on this guide to learn more about the Affordable Health Care Act and New Jersey's Health Insurance Marketplace.
Guide to the Health Insurance Marketplace

Here’s a quick rundown on the most important things to know about the Health Insurance Marketplace, sometimes known as the health insurance “exchange.” Follow the links for more information on each topic.

The new Health Insurance Marketplace helps uninsured people find health coverage.When you fill out the Marketplace application we’ll tell you if you qualify for:

No matter what state you live in, you can use the Marketplace. Some states operate their own Marketplace. In some states, the Marketplace is run by the Federal government.Find the Health Insurance Marketplace in your state.

Most people must have health coverage in 2014 or pay a fee. If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. Some people may qualify for anexemption to this fee.

You’re considered covered if you have MedicareMedicaidCHIP, any job-based plan, anyplan you bought yourselfCOBRAretiree coverageTRICARE, VA health coverage, or some other kinds of health coverage.

If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution your employer makes to your premiums.

If you have Medicare, you’re considered covered and don’t have to make any changes.You can’t use the Marketplace to buy a supplemental or dental plan.

Marketplace open enrollment ends March 31, 2014. If you enroll by December 15, 2013, coverage can begin as soon as January 1, 2014.

Questions? Call 24 hours a day, 7 days a week: 1-800-318-2596 (TTY: 1-855-889-4325)

Ready to apply? Get started.

(Above content from https://www.healthcare.gov/get-covered-a-1-page-guide-to-the-health-insurance-marketplace/, 10/1/2013)
 

How Do I Choose Marketplace Insurance?
There are 4 categories of 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.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.
Note: The Marketplace also offers "catastrophic" plans to people under 30 years old and to some people with very low incomes. Learn more about catastrophic plans.

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.
  • 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.
 
(Above content from https://www.healthcare.gov/how-do-i-choose-marketplace-insurance/)
Not sure what to do?
Answer the questions at the link below to find out what you need to do to find coverage for yourself, your family, or your business.

https://www.healthcare.gov/quick-answers/#step-1
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Get Started!
Go to http://www.healthcare.gov to fill out your application.

NJ Family Care


Beginning January 2014, NJ FamilyCare - New Jersey's publicly funded health insurance program - will include CHIP, Medicaid and Medicaid expansion populations. That means qualified NJ residents of any age may be eligible for free or low cost health insurance that covers doctor visits, prescriptions, vision, dental care, mental health and substance use services and even hospitalization.

Open enrollment for this new eligibility group begins October 1, 2013. Coverage begins January 1, 2014.

Who is eligible?


Beginning October 1, 2013, new federal rules change Medicaid eligibility. NJ FamilyCare will include:children, pregnant women, parents/caretaker relatives, single adults and childless couples. Financial eligibility will be determined by the latest federal tax return which, when filed, will be electronically verified.

Children 18 and under will continue to be eligible with higher incomes up to 350% FPL ($82,425 for a family of four). Parents still need to renew the coverage each year.

Parents/Caretaker Relatives with income up to 133% FPL ($31,322 for a family of four) must have tax dependent children in their household in order to be eligible under this category. This is a new Medicaid Expansion eligibility group. Dependent children in the household must be insured also.

Adults without dependent children with ages 19-64 and incomes up to 133% FPL ($15,282 single/ $20,629 couple) are considered to be another new Medicaid Eligibility Expansion Group.

Pregnant Women up to 200% FPL. There are no changes to pregnant women.

Aged, Blind or Disabled programs or Long Term Care, there are no changes in eligibility.