The new health insurance marketplace and you

Healthcare reform under the Affordable Care Act (ACA) is moving full speed ahead in 2014. Some of the important highlights for individuals and families include:


Everyone must have health insurance. This “individual mandate” requires everyone (with few exceptions) to have health insurance or pay a penalty. If you do not have health insurance through an employer, you can buy your own policy or enroll in a free or low-cost health plan, depending on your income.


Guaranteed access to health insurance. You can get health coverage regardless of your health status or pre-existing conditions. Health insurance companies cannot turn you away or drop your policy due to a current or past illness, injury or other health condition.


Health insurance exchanges provide a new way to shop for and enroll in health plans. Each state has its own exchange open for enrollment with coverage that became effective in January 2014. Texas has opted for a partnership exchange with the federal government.


Health plans on the exchange offered by multiple insurance companies make it easy to shop and compare plans. Health plans are classified as bronze, silver, gold and platinum based on the percentage of costs covered (premiums are lowest in a bronze plan, highest in a platinum plan). Plans offer a basic package of benefits, including essential health benefits and preventive care, and they follow established limits for out-of-pocket costs (i.e., deductibles, co-pays and out-of-pocket maximums).


Premium subsidies may help make health insurance more affordable. Premium tax credits based on income offset the cost of premiums for those with income below 400 percent of federal poverty level (FPL). Those who qualify may get a tax credit that can be applied to a health plan sold on the exchange. Use this tool to walk through FPL as it relates to your income and family size: www.kff.org/interactive/subsidy-calculator.


Medicaid expansion (in participating states) expands Medicaid health coverage to more low- to moderate-income Americans. Individuals and families can go to the exchange to find out if they are eligible for Medicaid and/or the Children’s Health Insurance Program and enroll in these government programs.


Navigators and other in-person assistors trained and certified by the state and/or federal government are available to give one-on-one enrollment assistance.


To get started, visit www.healthcare.gov and select Texas.


We can help!


Baptist Hospitals of Southeast Texas is a Certified Application Counseling Hospital for the Affordable Care Act. We can help you apply online or by phone, and there is no charge for our services. To learn more, call (409) 212-6831 or visit www.bhset.net/obamacare.

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