By Megan Kirk
In recent times, healthcare has been a major hot button topic for people across the country. With access and affordability at the forefront, the issue of healthcare proved to be a top concern for voters this election season. With the help of the Healthcare Marketplace, individuals are able to purchase health coverage for themselves, their employees and their families.
Also known as Obamacare, the Affordable Care Act was inaugurated in 2010 with the goal of making healthcare accessible for everyone with low-cost plans, expanding the Medicaid program and support programs that would lower the cost of healthcare overall. The Healthcare Marketplace was launched soon after and is a website where individuals can view and compare multiple health plans under the Affordable Care Act.
Operated by the federal government, the Healthcare Marketplace provides medical, dental and vision coverage with the top insurers across Michigan. While some states run their marketplaces independently on separate websites, Michiganders can enroll and shop plans using the federal site, https://www.healthcare.gov.
While many individuals depend on employers to provide healthcare options, many businesses have been forced to close their doors; some with no plans to reopen. As a result, people have been left unemployed and uninsured. Owners of small businesses can choose to ensure their employees using the Small Business Options Program, better known as SHOP, through the marketplace. For individuals applying, providing detailed income and household information can lead to tax credits and coverage for children under the Children’s Health Insurance Program, or CHIP.
Enrollment in a plan under the Healthcare Marketplace does have advantages for its members. All plan benefits include free women’s wellness visits as well as preventive care visits. Also, some plans offer reduced pricing on prescription drug coverage for generics. Pregnancy is another covered benefit under plans in the marketplace.
In addition to those services, the marketplace also covers mental and behavioral health services and substance abuse coverage. For pre-existing conditions, under the Affordable Care Act, coverage is authorized. Some plans also provide coverage for lab tests, hospital stays and emergency care.
Plans in the marketplace fall under four “metal” categories: bronze, silver, gold and platinum. Each plan determines a level the insurance company pays and what the enrollee is responsible for paying. Under the bronze plan, insurance pays 60 percent, while the enrollee is responsible for the remaining 40 percent cost of coverage. With the bronze plan, enrollees have the lowest monthly premium, but high deductible costs.
The platinum plan features the highest monthly premium; however, it features the lowest cost when seeking care. With the platinum plan, the insurance company covers 90 percent, and the enrollee covers the remainder. The silver and gold packages are moderately placed in the middle. The silver package offers both a moderate premium and cost of coverage when care is needed. The gold plan features a higher monthly premium with lower deductibles.
Although there are several benefits to enrolling in a plan using the marketplace, there are potential disadvantages for new and current enrollees. Some enrollees may have to pay higher premiums. This is largely due to the rising market cost of healthcare and depends on the overall health of the applicant. Those who are typically healthy pay lower premium costs. Also, shopping for plans can be overwhelming as there are several plans to choose from. Assistance is available online or on the phone for questions or help enrolling. There can also be a tax penalty imposed for being uninsured during the year.
If choosing to enroll in a plan, it is helpful to have access to tax information, information on employer and income, and information about the household including spousal employment and anyone claimed as a dependent on income tax forms.
Open enrollment for the healthcare marketplace plans ends December 15. For coverage during 2021, applicants must enroll in a plan on or before the deadline. All plans purchased before the deadline will become active January 1, 2021. Only applicants who experience a life-changing event qualify for a special enrollment period. Those events can include adopting or having a child, getting married and losing healthcare coverage due to job loss. In these circumstances, applicants will have 60 days before or 60 days after the event to enroll in a coverage plan, dependent on the reason for special enrollment. Missing the enrollment period will result in having to wait until the next enrollment period to apply.