Getting started: Health Insurance Marketplace opens Oct. 1
Elizabeth Misson, newsnet5.com
10:23 AM, Sep 23, 2013
2:53 PM, Sep 23, 2013
CLEVELAND - Even though the Health Insurance Marketplace does not open until Tuesday, October 1, there are steps that you can take to prepare yourself to shop for your health insurance.
If you want to get a jump on planning for your health care costs for 2014, an online calculator from the Kaiser Family Foundation can help provide you with an estimate for how much your health insurance could cost you in 2014.
*Note: The calculator provides only an estimate. Your final premiums and costs may differ from the estimates depending on where you live and the coverage you select.
Once the Health Insurance Marketplace opens on October 1, you will be able to learn the actual amounts for different health insurance plans.
The Health Insurance Marketplace will offer 4 different levels of coverage:
- Bronze: Your plan pays 60 percent. You pay 40 percent.
- Silver: Your plan pays 70 percent. You pay 30 percent.
- Gold: Your plan pays 80 percent. You pay 20 percent.
- Platinum: Your plan pays 90 percent. You pay 10 percent.
All Marketplace insurance plan categories offer the same set of benefits. The categories reflect how much of you pay based on premium costs and out-of-pocket costs.
An important rule to remember when selecting your health insurance - 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.
For example, if you have no medical conditions and rarely go to the doctor a plan with a lower premium and higher out-of-pocket cost may work for you (Bronze or Silver plans). If you are in need of more frequent care, a higher premium and lower out-of-pocket plan may work best for you (Gold or Platinum plans).
*Note: Your premium is the amount that is paid for your health insurance plan. Depending on the plan, it can be a monthly, quarterly or yearly fee. Out-of-pocket expenses refer to costs for doctor visits, copayments, deductibles, etc., essentially anything that you pay ‘out-of-pocket' that is not reimbursed by your insurance. Some individuals can qualify for lower out-of-pocket costs, but this is only available on the Silver plan.
The Health Insurance Marketplace plans are required to include at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Once the exchanges open on October 1, individuals, families and small businesses may apply online (
healthcare.gov), over the phone (1-800-318-2596), in person, or by mail.
You can apply for health coverage, compare all your options, and enroll in a plan through one application through the Health Insurance Marketplace.
Insurance agents and brokers can also help you with your application and choices. To find information on where you can get help in your city, visit
The U.S. Department of Health and Human Services has established a hotline: 1-800-318-2596. The hotline is available 24 hours a day, 7 days a week to answer your questions.