The enrollment period for 2019 Marketplace insurance coverage is now underway. While many people view the process as complicated, there are places to turn for help. Pam Laye, supervisor of outreach and enrollment at Keystone Health, offers some answers to frequently asked questions.
Why is it important to have health insurance?
No one plans to get sick or hurt, but most people will need medical care at some point. Health insurance covers most costs, protecting you from unexpected, high medical bills and offers many other important benefits as well. You pay less for covered in-network health care, even before you meet your deductible. Without health insurance, you are faced with paying the bills yourself and those bills could amount to a lot of money and debt which could take you years to pay off.
A three-day hospital stay could cost you as much at $30,000 if you don’t have insurance; a broken leg from skiing, bicycling or playing sports could cost you $7,500 if you don’t have insurance. The American Diabetes Association estimates that the average cost of diabetes is $13,700 in medical expenses per person per year. To help address the affordability of health insurance, tax credits and cost-sharing subsidies are available from the government that may make premiums more manageable or may help lower out-of-pocket expenses such as co-payments at the doctor’s office or the pharmacy.
When is the open enrollment period?
The Marketplace opened November 1, and will remain open until December 15 for coverage to begin on January 1. After the Marketplace closes, you can enroll or change plans only if you qualify for a special enrollment period. Circumstances that may qualify you for special enrollment include: marriage, a birth, adoption or fostering of a child and a change in your current insurance, income or citizenship.
What are the main options when it comes to plans?
In Franklin County the only two options are Capital Blue Cross and Highmark. Capital plans which are offered are Preferred Provider Organization (PPO) plans. This means if you go to a provider who accepts Capital Blue Cross insurance, you will pay a lower cost for care. If you go out of network (to a provider who does not accept your insurance plan) the cost will be higher than in network, but still lower than full cost. Highmark is offering only Exclusive Provider Organization (EPO) plans. This means if you go out of network, insurance is not going to cover your service and you will have to pay full price.
The deductible and out of pocket cost are about the same for both options which could be as high as $15,800 and as low as $2,000 depending on your plan.
When will my coverage begin?
If you enroll or change plans by December 15, 2018, your coverage will begin January 1, 2019.
Do I need to do anything if I enrolled last year?
If you do not update your application by December 15, 2018, you will probably be re-enrolled automatically. However, it is best to review your options every year. Prices and plans change annually and there may be a new plan that is more affordable for you. If the plan you selected last year is no longer available, you will likely be enrolled in a similar plan. It is important to make sure your healthcare provider accepts the plan you are using.
If I choose to be uninsured, will I have to pay a penalty?
Yes. If you were uninsured in 2017, you had to pay whichever amount was greater: 2.5% of your total adjusted gross household income, or $695 per adult and $347.50 per child, up to $2,085 per family. The fees have typically risen each year with inflation, but the final 2018 fees have not yet been announced. Starting in the 2019 calendar year, there will not be a penalty for remaining uninsured. (This will take effect with 2019 taxes, which are filed in early 2020.)
How do I enroll?
There are several ways you can enroll. Most people choose to enroll online at www.healthcare.gov but you can also enroll by phone, with a paper application or with a trained helper or certified Marketplace counselor. The department I oversee, Keystone Health’s outreach and enrollment department, is one community resource that provides this service for free. Our certified enrollment navigators can meet with you and walk you through the process, and can also help you complete charity applications. You can call (717) 709-7969 for further information or to schedule a free appointment to meet with a Keystone Certified Assistance Counselor.
Marketplace agents can also help complete applications, but there is typically a fee for the use of this type of assistance. There is no cost or charge if you use a Keystone Certified Application Counselor.
